In this hospital-wide intervention study, different interventions to improve hand hygiene compliance were implemented over three years. The interventions were conducted in 5 categories: (1) leadership/accountability, (2) measurement/feedback, (3) hand disinfectant availability, (4) education/training, and (5) marketing/communication. Monthly changes in observed hygiene compliance and rates of nosocomial infections per 1000 inpatient days were measured. Hygiene compliance increased significantly from 41% to 87% during the initiative and improved further to 91% in the following year. Nurses achieved higher hand hygiene compliance (93 %) than physicians (78 %). This trend was accompanied by a significant and sustained decrease in the rate of nosocomial infections from 4.8 to 3.3 per 1000 hospital days.

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