infection control and hospital epidemiology may 2007, vol. 28, no. 5 concise communication figure. Characteristics of hand hygiene events observed during the study period. Quality of Hand Hygiene in a Pediatric Hospital in Rio de Janeiro, Brazil C. B. Hofer, MD, PhD; T. F. Abreu, MD, PhD; E. G. Silva, RN; C. A. Sepu ´lveda, MD; F. A. Gibara, MD; N. R. L. Lopes, MD; A. F. Mota, MD; S. A. Barreiro, MD; L. M. Santos, MD; E. N. Souza, MD; A. C. C. Frota, MD, MSc We assessed the quality of hand hygiene among healthcare workers at a pediatrics hospital in Rio de Janeiro, Brazil. Hand hygiene was performed in 491 (34%) of 1,455 opportunities. Of these hand hy- giene events, correct performance was observed in only 173 (35%). Multivariate analysis revealed that correct performance of hand hy- giene was associated with the use of an alcohol-based product and a lack of jewelry (for all events) and employment in an infirmary with a comparatively higher ratio of nurses to patients (for events involving nurses). Infect Control Hosp Epidemiol 2007; 28:622-624 Although hand disinfection has been considered the most important measure to reduce the incidence of nosocomial infection, the percentage of hand hygiene events that are per- formed correctly remains low among healthcare workers (HCWs). 1-3 In 2002, the Centers for Diseases Control and Pre- vention (CDC) issued a guideline for hand hygiene in health- care settings to guarantee the quality of hand hygiene, 4 but widespread adoption of the guideline has yet to occur. 5,6 The aim of this study was to describe the quality of hand hygiene among HCWs at a pediatrics hospital (Instituto de Puericultura e Pediatria Martaga ˜o Gesteira [IPPMG]) in Rio de Janeiro, Brazil. methods Setting. IPPMG is a tertiary care pediatrics university hos- pital with 60 beds in 6 infirmaries, at least 2 sinks per infir- mary, and 1 dispenser of alcohol-based hand hygiene solution per bed. The beds are separated by glass panels to provide staff with a complete view of the room. IPPMG is a reference center for patients requiring treatment by specialists and ad- mits patients aged 0-13 years. Because there is no intensive care unit in this institution, patients in critical condition are admitted to the infirmaries. Study design. The data for this cross-sectional study were collected during an educational intervention. 7 Seven pediatric infectious diseases fellows were trained for 3 weeks, using information from the CDC guideline, 4 to observe hand hy- giene opportunities (ie, events that required prior and/or sub- sequent hand washing with soap and water or rubbing with alcohol) in the wards while supervised by a member of the infection control team. This activity is part of the training process in the infection control rotation of the IPPMG pe- diatric infectious diseases fellowship program. Each observer chose a specific corner in the infirmaries where they could visualize the entire room, especially the sinks. During the peak of the weekday workload (ie, mornings), HCWs were observed without their knowledge for hand hygiene oppor- tunities. Observations were conducted during 20-minute pe- riods at least twice per week each week during the study period, and data were reported on a structured questionnaire. Each month, the observers rotated to another infirmary, with continuous supervision to ensure the quality of the data. Any mistakes regarding the observations or completion of the questionnaires were discussed during periodical meetings with the entire group. All HCWs (ie, physicians, nurses, nurse assistants, respi- ratory therapists, psychologists, dieticians, social workers, oc- cupational therapists, clerks, students, and volunteers) were included in the observations. Noncompliance with hand hy- giene by a HCW was considered to be the failure to disinfect their hands before and/or after involvement in any oppor- tunity that mandates hand hygiene, such as contact with pa- tients, preparation of medication, manipulation of inanimate objects, donning of gloves, performance of invasive proce- dures, and possible contact with organic fluids. Correct per- formance of hand hygiene was determined on the basis of the CDC guideline. 4 Performance of hand hygiene was con- sidered to be incorrect whenever HCWs did not use soap