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Just Clean Your Hands - Resources and references

Home Hospitals: Education and training Tools for implementation Order materials	Long-term care homes and retirement homes: Education and training Tools for implementation Order materials
More Information: Ask the experts News Training videos Frequently asked questions	4 moments for hand hygiene Hand hygiene success stories Program background Resources and references

• PIDAC infection prevention and control
• PIDAC hand hygiene fact sheet
• Ontario Hospital Association (OHA) - hand hygiene reporting
• Ontario Hospital Association (OHA) - patient hand hygiene
• Canada's Hand Hygiene Campaign

Reference list

• General
• Alcohol-based hand rub
• Alcohol-based hand rub as a fire hazard
• Alcohol-based hand rub and blood alcohol level
• Alcohol-based hand rub and cultural/religious objections
• Compliance
• Economic cost of infections
• Fingernails/rings
• Infection and quality of life
• Gloves
• Guidelines/best practices
• Role models
• Social marketing & behaviour change

General

References follow table:

Association between improved adherence with hand hygiene practice and health care-associated infection rates

ICU = intensive care unit; NICU = neonatal ICU; MICU = medical ICU
HAI = health care-acquired infection; N.S. = not stated
MRSA = methicillin-resistant Staphylococcus aureus; VRE = vancomycin-resistant enterococci

Reproduced with permission from “WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft, April 2006)” (5)
[Table 1.19.1]

General references

• Backman C, Zoutman DE, Marck PB. An integrative review of the current evidence on the relationship between hand hygiene interventions and the incidence of health care-associated infections. Am J Infect Control. 2008;36(5):333-48. (Abstract only)
  
  
• Larmer PJ, Tillson TM, Scown FM, Grant PM, Exton J. Evidence-based recommendations for hand hygiene for health care workers in New Zealand. N Z Med J. 2008;121(1272):69-81. (Full text available)
  
  
• Bloomfield SF, Aiello AE, Cookson B, OBoyle C, Larson EL. The effectiveness of hand hygiene procedures in reducing the risks of infections in home and community settings including handwashing and alcohol-based hand sanitizers. Am J Infect Control.2007 35(10 Suppl 1):S27-S64.
  (Full text available)
  
  
• Larson EL. A causal link between handwashing and risk of infection? Examination of the evidence. Infect Control. 1988;9(1):28-36. (Abstract only)
  
  
• McGeer A. “Hand hygiene by habit”: Infection prevention: practical tips for physicians to improve hand hygiene. Ont Med Rev. 2007;74(10):31.
  
  
• Pittet D, Allegranzi B, Sax H, Dharan S, Pessoa-Silva CL, Donaldson L, Boyce JM; WHO Global Patient Safety Challenge, World Alliance for Patient Safety. Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis. 2006;6(10):641-52. (Full text available)
  
  
• Pittet D, Boyce JM. Hand hygiene and patient care: pursuing the Semmelweis legacy. Lancet Infect Dis. 2001;April:9-20.
  
  
• Pittet D, Mourouga P, Perneger TV. Compliance with handwashing in a teaching hospital. Infection Control Program. Ann Intern Med. 1999;130(2):126-30. (Full text available)
  
  
• Pittet D. Clean hands reduce the burden of disease. Lancet. 2005;366:185-7. (Full text available)

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Alcohol-based hand rub

• Grayson ML, Melvani S, Druce J, Barr IG, Ballard SA, Johnson PD, Mastorakos T, Birch C. Efficacy of soap and water and alcohol-based hand-rub preparations against live H1N1 influenza virus on the hands of human volunteers. Clin Infect Dis. 2009 Feb 1;48(3):285-91. (Abstract only)
  
  
• Mody L, Saint S, Kaufman SR, Kowalski C, Krein SL. Adoption of alcohol-based handrub by United States hospitals: a national survey. Infect Control Hosp Epidemiol. 2008 Dec;29(12):1177-80. (Full text available)
  
  
• Girard R, Aho LS, Aupée M, Berthelot P, Dumartin C, Erb M, Goetz ML, Lashéras A, Zaro-Goni D. Alcohol-based rubs for hand antisepsis. Lancet Infect Dis. 2008 Oct;8(10):584-5. (Abstract only)
  
  
• Rupp ME, Fitzgerald T, Puumala S, Anderson JR, Craig R, Iwen PC, Jourdan D, Keuchel J, Marion N, Peterson D, Sholtz L, Smith V. Prospective, controlled, cross-over trial of alcohol-based hand gel in critical care units. Infect Control Hosp Epidemiol. 2008;29(1):8-15. (Abstract only)
  
  
• Kampf G, Löffler H. Prevention of irritant contact dermatitis among health care workers by using evidence-based hand hygiene practices: a review. Ind Health. 2007;45(5):645-52. (Full text available)
  
  
• Bush K, Mah MW, Meyers G, Armstrong P, Stoesz J, Strople S. Going Dotty: a practical guide for installing new hand hygiene products. Am J Infect Control. 2007;35(10):690-3. (Abstract only)
  
  
• Kampf G, Löffler H. Dermatological aspects of a successful introduction and continuation of alcohol-based hand rubs for hygienic hand disinfection. J Hosp Infect. 2003;55(1):1-7. (Abstract only)
  
  
• Girou E, Loyeau S, Legrand P, Oppein F, Brun-Buisson C. Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial. BMJ. 2002;325:362-5. (Full text available)
  
  
• Boyce JM, Kelliher Vallande N. Skin irritation and dryness associated with two hand-hygiene regimens: soap and water hand washing versus hand antisepsis with an alcoholic hand gel. Infect Control Hosp Epidemiol. 2000;21:442-448. (Abstract only)
  
  
• See also: References listed under “Guidelines” below.

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Alcohol-based hand rub as a fire hazard

• American Society for Healthcare Engineering. Alcohol Based Hand Rubs (ABHR). [Web page]. Chicago, IL: The American Society for Healthcare Engineering of the American Hospital Association; 2008.
  
  
• Kramer A, Kampf G. Hand rub-associated fire incidents during 25,038 hospital-years in Germany. Infect Control Hosp Epidemiol. 2007;28(6):745-6. (Abstract only)
  
  
• Prasad R.  Quezado Z.  St Andre A.  O'Grady NP. Fires in the operating room and intensive care unit: awareness is the key to prevention.  Anesth  Analg. 2006;102(1):172-4. (Full text available)
  
  
• Hazard report: fire risk from alcohol-based hand sanitizers worsens in oxygen-enriched environments. Health Devices. 2006;35(10):390. (No abstract available)
  
  
• Wagner WM. Double-edged sword. Managing the potential fire hazards posed by alcohol-based hand cleaning products. Health Facilities Management. 2003;16(6):47-50. (No abstract available)
  
  
• Boyce JM, Pearson ML. Low frequency of fires from alcohol-based hand rub dispensers in healthcare facilities. Infect Control Hosp Epidemiol. 2003;24(8):618-9. (Abstract only)
  
  
• Bryant KA.  Pearce J.  Stover B. Flash fire associated with the use of alcohol-based antiseptic agent. Am J Infect Control.2002;30(4):256-7. (No abstract available)
  
  
• Ontario Office of the Fire Marshall. Safe Practices for the Use of Alcohol-Based Hand Rinse in Care and Treatment Occupancies.

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Hand rubs and blood alcohol level

• Kramer A, Below H, Bieber N, et al. Quantity of ethanol absorption after excessive hand disinfection using three commercially available hand rubs is minimal and below toxic levels for humans. BMC Infect Dis. 2007;7:117. (Full text available)
  
  
• Brown TL, Gamon S, Tester P et al. Can alcohol-based hand-rub solutions cause you to lose your driver's license? Comparative cutaneous absorption of various alcohols. Antimicrob Agents Chemother. 2007;51(3):1107-8. (Full text available)
  
  
• Miller MA, Rosin A, Crystal CS. Alcohol-based hand sanitizer: can frequent use cause an elevated blood alcohol level? Am J Infect Control. 2006;34(3):150-1. (Abstract only)
  
  
• Miller MA, Rosin A, Levsky ME, Patel MM, Gregory TJ, Crystal CS. Does the clinical use of ethanol-based hand sanitizer elevate blood alcohol levels? A prospective study. Am J Emerg Med. 2006;24(7):815-7. (Abstract only)

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Alcohol-based hand rub and cultural/religious objections

• Allegranzi B, Memish ZA, Donaldson L, Pittet D; World Health Organization Global Patient Safety Challenge Task Force on Religious and Cultural Aspects of Hand Hygiene; World Alliance for Patient Safety. Religion and culture: potential undercurrents influencing hand hygiene promotion in health care. Am J Infect Control. 2009 Feb;37(1):28-34. (Abstract only)
  
  
• Ahmed QA, Memish ZA, Allegranzi B, Pittet D; WHO Global Patient Safety Challenge. Muslim health-care workers and alcohol-based handrubs. Lancet. 2006;367(9515):1025-7. (Abstract only)

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Compliance

• Gould DJ, Chudleigh JH, Moralejo D, Drey N. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev. 2007;(2):CD005186. (Full text available)

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Economic cost of infections

• Chen YY, Wang FD, Liu CY, Chou P. Incidence rate and variable cost of nosocomial infections in different types of intensive care units. Infect Control Hosp Epidemiol. 2009 Jan;30(1):39-46. (Abstract only)
  
  
• Maragakis LL, Perencevich EN, Cosgrove SE. Clinical and economic burden of antimicrobial resistance. Expert Rev Anti Infect Ther. 2008 Oct;6(5):751-63. (Abstract only)
  
  
• Vonberg RP, Reichardt C, Behnke M, Schwab F, Zindler S, Gastmeier P. Costs of nosocomial Clostridium difficile-associated diarrhoea. J Hosp Infect. 2008 Sep;70(1):15-20. (Abstract only)
  
  
• Mauldin PD, Salgado CD, Durkalski VL, Bosso JA. Nosocomial infections due to methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus: relationships with antibiotic use and cost drivers. Ann Pharmacother. 2008 Mar;42(3):317-26. (Abstract only)
  
  
• Stone PW, Larson E, Kawar LN. A systematic audit of economic evidence linking nosocomial infections and infection control interventions: 1990-2000. Am J Infect Control. 2002;30(3):145-52. (Abstract only)
  
  
• Kim T, Oh PI, Simor AE. The economic impact of methicillin-resistant Staphylococcus aureus in Canadian hospitals. Infect Control Hosp Epidemiol. 2001;22(2):99-104. (Abstract only)
  
  
• Rubin RJ, Harrington CA, Poon A, Dietrich K, Greene JA, Moiduddin A. The economic impact of Staphylococcus aureus infection in New York City hospitals. Emerg Infect Dis. 1999 Jan-Feb;5(1):9-17. (Full text available)
  
  
• Zoutman D, McDonald S, Vethanayagan D. Total and attributable costs of surgical-wound infections at a Canadian tertiary-care center. Infect Control Hosp Epidemiol. 1998;19:254–9. (Abstract only)

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Fingernails/rings

• Fagernes M, Lingaas E. Impact of finger rings on transmission of bacteria during hand contact. Infect Control Hosp Epidemiol. 2009;30(5):427-32. (Abstract only)
  
  
• Yildirim I, Ceyhan M, Cengiz AB, Bagdat A, Barin C, Kutluk T, Gur D. A prospective comparative study of the relationship between different types of ring and microbial hand colonization among pediatric intensive care unit nurses. Int J Nurs Stud. 2008;45(11):1572-6. (Abstract only)
  
  
• Wongworawat MD, Jones SG. Influence of rings on the efficacy of hand sanitization and residual bacterial contamination. Infect Control Hosp Epidemiol. 2007 ;28(3):351-3. (Abstract only)
  
  
• Rupp ME, Fitzgerald T, Puumala S, Anderson JR, Craig R, Iwen PC, et al. Prospective, controlled, cross-over trial of alcohol-based hand gel in critical care units. Infect Control Hosp Epidemiol. 2008;29(1):8-15. (Abstract only)
  
  
• Gordin FM, Schultz ME, Huber R, Zubairi S, Stock F, Kariyil J. A cluster of hemodialysis-related bacteremia linked to artificial fingernails. Infect Control Hosp Epidemiol. 2007;28(6):743-4. (Abstract only)
  
  
• Fagernes M, Lingaas E, Bjark P. Impact of a single plain finger ring on the bacterial load on the hands of healthcare workers. Infect Control Hosp Epidemiol. 2007;28(10):1191-5. (Abstract only)
  
  
• Waterman TR, Smeak DD, Kowalski J, Hade EM. Comparison of bacterial counts in glove juice of surgeons wearing smooth band rings versus those without rings. Am J Infect Control. 2006;34(7):421-5. (Abstract only)
  
  
• Gupta A, Della-Latta P, Todd B, San Gabriel P, Haas J, Wu F, et al. Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit linked to artificial nails. Infect Control Hosp Epidemiol. 2004;25(3):210-5. (Abstract only)
  
  
• Trick WE, Vernon MO, Hayes RA, Nathan C, Rice TW, Peterson BJ, Segreti J, Welbel SF, Solomon SL, Weinstein RA. Impact of ring wearing on hand contamination and comparison of hand hygiene agents in a hospital. Clin Infect Dis. 2003;36(11):1383-90. (Full text available)
  
  
• Toles A. Artificial nails: are they putting patients at risk? A review of the research. J Pediatr Oncol Nurs. 2002;19(5):164-71. (Abstract only)
  
  
• Arrowsmith VA, Maunder JA, Sargent RJ, Taylor R. Removal of nail polish and finger rings to prevent surgical infection. Cochrane Database Syst Rev. 2001;(4):CD003325. (Abstract only)
  
  
• Parry MF, Grant B, Yukna M, Adler-Klein D, McLeod GX, Taddonio R, Rosenstein C. Candida osteomyelitis and diskitis after spinal surgery: an outbreak that implicates artificial nail use. Clin Infect Dis. 2001;32(3):352-7. (Full text available)
  
  
• McNeil SA, Foster CL, Hedderwick SA, Kauffman CA. Effect of hand cleansing with antimicrobial soap or alcohol-based gel on microbial colonization of artificial fingernails worn by health care workers. Clin Infect Dis. 2001;32(3):367-72. (Full text available)
  
  
• Foca M, Jakob K, Whittier S, Della Latta P, Factor S, Rubenstein D, Saiman L. Endemic Pseudomonas aeruginosa infection in a neonatal intensive care unit. N Engl J Med. 2000;343(10):695-700. (Full text available)
  
  
• Hedderwick SA, McNeil SA, Lyons MJ, Kauffman CA. Pathogenic organisms associated with artificial fingernails worn by healthcare workers. Infect Control Hosp Epidemiol. 2000;21(8):505-9. (Abstract only)
  
  
• Moolenaar RL, Crutcher JM, San Joaquin VH, Sewell LV, Hutwagner LC, Carson LA, et al. A prolonged outbreak of Pseudomonas aeruginosa in a neonatal intensive care unit: did staff fingernails play a role in disease transmission?Infect Control Hosp Epidemiol 2000;21(2):80-5. (Abstract only)
  
  
• Passaro DJ, Waring L, Armstrong R, Bolding F, Bouvier B, Rosenberg J, et al. Postoperative Serratia marcescens wound infections traced to an out-of-hospital source.J Infect Dis. 1997;175(4):992-5. (Abstract only)
  
  
• Wynd CA, Samstag DE, Lapp AM. Bacterial carriage on the fingernails of OR nurses. AORN J. 1994; 60(5):796,9-805. (Abstract only)
  
  
• Baumgardner CA, Maragos CS, Walz J, Larson E. Effects of nail polish on microbial growth of fingernails. Dispelling sacred cows. AORN J. 1993;58(1):84-8. (Abstract only)
  
  
• Pottinger J, Burns S, Manske C. Bacterial carriage by artificial versus natural nails. Am J Infect Control. 1989;17(6):340-4. (Abstract only)
  
  
• Hoffman PN, Cooke EM, McCarville MR, Emmerson AM.Micro-organisms isolated from skin under wedding rings worn by hospital staff. Br Med J (Clin Res Ed). 1985;290(6463):206-7. (Full text available)

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Infection and quality of life

• Groeneveld AB. Risk factors for increased mortality from hospital-acquired versus community-acquired infections in febrile medical patients.  Am J Infect Control. 2009; 37(1):35-42.(Abstract only)
  
  
• Thompson J. Jefferson J. Mermel LA.  Potential economic impact of hospital-acquired infections in uninsured patients: a preliminary investigation. Infect Control Hosp Epidemiol. 2008;29(8):764-6. (Abstract only)
  
  
• Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ. 2004;170(11):1678-86. (Full text available)
  
  
• Stelfox HT, Bates DW, Redelmeier DA. Safety of patients isolated for infection control. JAMA. 2003;290(14):1899-905. (Full text available)
  
  
• Cosgrove SE, Sakoulas G, Perencevich EN, Schwaber MJ, Karchmer AW, Carmeli Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis. 2003;36(1):53-59. (Full text available)
  
  
• Engemann JJ, Carmeli Y, Cosgrove SE, Fowler VG, Bronstein MZ, Trivette SL, et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis. 2003;36(5):592-598. (Full text available)
  
  
• Klevens RM, Edwards JR, Richards CL, Horan TC, Gaynes RP, Pollock DA, Cardo DM. Estimating health-care associated infections and deaths in U.S. hospitals, 2002. Public Health Rep. 2007;122:160-166. (Full text available)
  
  
• Gammon J. Analysis of the stressful effects of hospitalisation and source isolation on coping and psychological constructs. Int J Nurs Pract. 1998;4(2):84-96. (Abstract only)
  
  
• Jarvis WR. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol. 1996;17(8):552-7. (Abstract only)

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Gloves

• Diaz MH, Silkaitis C, Malczynski M, Noskin GA, Wareen JR, Zembower T. Contamination of Examination Gloves in Patient Rooms and Implications for Transmission of Antimicrobial-Resistant Microorganisms. Infect Control Hosp Epidemiol. 2008 Jan;29(1):63-5. (Abstract only)

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Guidelines/best practices

• Pittet D. Allegranzi B. Boyce J. World Health Organization World Alliance for Patient Safety First Global Patient Safety Challenge Core Group of Experts.  The World Health Organization Guidelines on Hand Hygiene in Health Care and their consensus recommendations. Infect Control Hosp Epidemiol. 2009;30(7):611-22. (Abstract only)
  
  
• Cookson B. Mathai E. Allegranzi B. Pessoa-Silva CL. Bagheri Nejad S. Schneider A. Tschopp C. Wendt C. Pittet D. Comparison of national and subnational guidelines for hand hygiene. J Hosp Infect. 2009; 72(3):202-10. (Abstract only)
  
  
• WHO, World Alliance for Patient Safety. WHO guidelines on hand hygiene in health care. Geneva: World Health Organization; 2009. (Full text available)
  
  
• Provincial Infectious Diseases Advisory Committee. Hand Hygiene Best Practice Document. Toronto, ON: Queen’s Printer for Ontario; 2009. (Full text available)
  
  
• CHICA-Canada Standards and Guidelines Core Committee. Hand hygiene. Can J Infect Control. 2008 Summer;23(2):114, 116-7. (Full text available)
  
  
• Haas JP. Larson EL. Compliance with hand hygiene guidelines: where are we in 2008? Am J  Nursing. 2008;108(8):40-4; quiz 45. (Full text available)
  
  
• Braun BI. Kusek L. Larson E. Title Measuring adherence to hand hygiene guidelines: a field survey for examples of effective practices. Am J Infect Control. 2008; 37(4):282-8. (Abstract only)
  
  
• Allegranzi B. Storr J. Dziekan G. Leotsakos A. Donaldson L. Pittet D. The First Global Patient Safety Challenge "Clean Care is Safer Care": from launch to current progress and achievements. J Hosp Infect. 2007; 65( Suppl 2):115-23. (Abstract only)
  
  
• Larson EL. Quiros D. Lin SX. Dissemination of the CDC's Hand Hygiene Guideline and impact on infection rates.  Am J Infect Control. 2007;35(10):666-75. (Abstract only)
  
  
• World Alliance for Patient Safety. WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft). Geneva, Switzerland: World Health Organization; 2006. (Full text available)
  
  
• Centers for Disease Control and Prevention; Association for Professionals in Infection Control and Epidemiology; Society for Healthcare Epidemiology of America. How-to guide: Improving hand hygiene. A guide for improving practices among health care workers. Cambridge, MA: Institute for Health care Improvement; 2006. (Full text available)
  
  
• Boyce JM, Pittet D. Healthcare Infection Control Practices Advisory Committee; HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. Morb Mortal Wkly Rep Recomm Rep. 2002;51(RR16):1-44. (Full text available)
  
  
• Health Canada, Laboratory Centre for Disease Control, Division of Nosocomial and Occupational Infections. Routine practices and additional precautions for preventing the transmission of infection in health care. Can Commun Dis Rep. 1999;25 Suppl 4:1-142. (Full text available)

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Role models

• Schneider J, Moromisato D, Zemetra B et al. Hand hygiene adherence is influenced by the behavior of role models. Pediatr Crit Care Med. 2009;10(3):360-3. (Full text available)
  
  
• Erasmus V, Brouwer W, van Beeck EF et al. A qualitative exploration of reasons for poor hand hygiene among hospital workers: lack of positive role models and of convincing evidence that hand hygiene prevents cross-infection. Infect Control Hosp Epidemiol. 2009;30(5):415-9. (Abstract only)
  
  
• Lankford MG, Zembower T R, Trick WE, et al. Influence of role models and hospital design on hand hygiene of health care workers. Emerg Infect Dis. 2003;9(2):217-223. (Full text available)

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Social marketing & behaviour change

• Morris ZS. Clarkson PJ. Does social marketing provide a framework for changing healthcare practice?. Health Policy. 2009;91(2):135-41. (Abstract only)
  
  
• Edgar T. Boyd SD. Palame MJ. Sustainability for behaviour change in the fight against antibiotic resistance: a social marketing framework. J  Antimicrob Chemotherapy. 2009;63(2):230-7. (Full text available)
  
  
• Mah MW, Tam YC, Deshpande S. Social marketing analysis of 20 [corrected] years of hand hygiene promotion. Infect Control Hosp Epidemiol. 2008 Mar;29(3):262-70.  Review. Erratum in: Infect Control Hosp Epidemiol. 2008 Apr;29(4):383. (Abstract only)
  
  
• Sax H. Allegranzi B. Uckay I. Larson E. Boyce J. Pittet D. 'My five moments for hand hygiene': a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect. 2007;67(1):9-21.  (Abstract only)
  
  
• Jenner EA. Jones F. Fletcher BC. Miller L. Scott GM. Hand hygiene posters: selling the message. J Hosp Infect. 2005; 59(2):77-82. (Abstract only)
  
  
• Whitby M. Pessoa-Silva CL. McLaws ML. Allegranzi B. Sax H. Larson E. Seto WH. Donaldson L. Pittet D. Behavioural considerations for hand hygiene practices: the basic building blocks. J Hosp Infect. 2007; 65(1):1-8. (Abstract only)
  
  
• Mah MW, Deshpande S, Rothschild ML. Social marketing: a behavior change technology for infection control. Am J Infect Control. 2006;34(7):452-7. (Abstract only)
  
  
• Pittet D. Improving adherence to hand hygiene practice: a multidisciplinary approach. Emerg Infect Dis. 2001;7(2):234-40. (Full text available)
  
  
• Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S, Perneger TV. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet. 2000;356(9238):1307-12. (Abstract only)
  
  
• Larson EL, Early E, Cloonan P, Sugrue S, Parides M. An organizational climate intervention associated with increased handwashing and decreased nosocomial infections. Behav Med. 2000;26(1):14-22. (Abstract only)
  
  
• Kretzer EK, Larson EL. Behavioral interventions to improve infection control practices. Am J Infect Control. 1998;26(3):245-53. (Abstract only)

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