Be aware of when things have gone wrong in your particular area.

Have back up plans in place in case things go awry. 

Admit when you need to seek help from those more experienced/qualified than you.

Have the courage to challenge and question the knowledge or expertise of your colleagues, especially if you do not know them well.

Acknowledge that errors occur due to false assumptions.

• Possible to achieve continual improvement through small incremental changes 
• Continuous improvement is most effective when it becomes embedded in our everyday way of working 

1. Wash with soap and water when:
   • Hands are visibly dirty or soiled with blood or other body fluids.
   • In case of contact with spore-forming pathogens such asClostridium difficile.
2. Use of alcohol-based hand rubs is preferred for all other clinical situations.

1. System changes; it is very important to make sure that hand rubs are available inside and outside all patient rooms. Surveying health care workers regarding their acceptance of the alcohol hand rub products is essential to compliance with using those products.
2. Training and education; Hospitals should invest in educating trainers, observers, and health care workers. 
3. Evaluation and feedback; Hand hygiene compliance should be measured regularly and feedback must be given in a timely manner. Compliance can be measured by observation or by measuring soap and hand rub consumption. Some hospitals provide real-time feedback when hand hygiene is not performed. This can be a very effective tool to identify offenders and educate them quickly.
4. Reminders in the workplace; Posters should be used widely in the health care setting emphasising the indications for hand hygiene, such as the five moments, and the appropriate way to use hand rubs and soap.
5. Institutional safety climate; The medical board should make hand hygiene an institutional priority and provide the needed resources. Senior clinicians and administrators should provide visible support for hand hygiene as a role model. Policies and procedures should be implemented to hold health care workers accountable for hand hygiene compliance.