Despite convincing evidence since the 1840s that improved hand hygiene reduces infection rates, studies show that healthcare worker compliance with hand hygiene is consistently suboptimal in many healthcare settings. Optimal hand hygiene is a critical component in any process focused on achieving and sustaining zero incidents of healthcare-associated infections (HAIs). Pennsylvania hospitals and nursing homes have reported a slow but steady decline in HAIs through the National Healthcare Safety Network and the Pennsylvania Patient Safety Reporting System. Reliance on current methods to detect hand hygiene compliance--such as direct observation, hand hygiene product use measurement, and electronic monitoring--has been problematic. Implementation of a credible hand hygiene program can be enhanced by integration of systems supporting hand hygiene activities with an understanding of workflow and human behavior. Healthcare facilities may improve hand hygiene practice by applying a multimodal framework of system and behavioral strategies to investigate, understand, and mitigate gaps in infrastructure and behavioral components of hand hygiene.
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