Didier Pittet MD, MS, CBE, Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland John M. Boyce MD, Hospital Epidemiology and Infection Control, Yale-New Haven Hospital, and Yale University School of Medicine, New Haven, CT, USA Benedetta Allegranzi MD, Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization, and Faculty of Medicine, University of Geneva, Geneva, Switzerland

"In their new textbook, Hand Hygiene: A Handbook for Medical Professionals, Didier Pittet, John Boyce, and Benedetta Allegranzi turn to leading experts on patient safety and infection control to produce an impressive book with 45 chapters focusing on every aspect of hand hygiene. But, as Pittet asks in the preface, “Does hand hygiene deserve a textbook?” It is refreshing for a textbook writer to ask this question about his own book, and the answer, as the foreword suggests, is a resounding “yes.”While hand hygiene is essential, compliance is complicated. Additionally, actual rates of compliance are difficult to measure as are the number of HAIs that can be prevented with high hand hygiene compliance rates. With these issues in mind, Pittet and colleagues present this new work with a noble objective, “to save many more millions of lives every year worldwide.”The edition includes many important, but often overlooked, areas in chapters covering topics such as handhygiene promotion strategies, human factors, barriers to compliance, and skin reaction to hand hygiene. Ofparticular importance, the book includes chapters on the safety climate as well as personal accountability. Of note, a chapter on religion and cultural practices sheds light on interesting issues that are often marginalised. The book is organised logically, beginning with a review of the data on HAI......We have a real problem with hand hygiene among medical professionals, and now is the time to embrace change. This handbook takes an important step in that direction. Pittet believes that a renewed commitment by providers will “drive excellence in hand hygiene practices, research, and attitudes for many years to come.” The editors and authors should be commended for this laudable goal and outstanding handbook" (The Lancet Vol 17 August 17)"This well-written book, coupled with its excellent editing, is easy to read. It succeeds in appealing to a diverse population of healthcare professionals. All healthcare facility leaders in patient safety and infection prevention would be well served by this guide and reference to improving hand hygiene" Doodys, Sept 2017

• Contributors xiPreface xvForeword xvii1. The Burden of Healthcare-Associated Infection 1Benedetta Allegranzi, Sepideh Bagheri Nejad, and Didier Pittet2. Historical Perspectives 8Andrew J. Stewardson and Didier Pittet3. Flora and Physiology of Normal Skin 12Gürkan Kaya and Didier Pittet4. Dynamics of Hand Transmission 18Andrew J. Stewardson, Benedetta Allegranzi, and Didier Pittet5. Mathematical Models of Handborne Transmission of Nosocomial Pathogens 28Ben S. Cooper and Nantasit Luangasanatip6. Methodological Issues in Hand Hygiene Science 36Matthew Samore and Stephan Harbarth7. Statistical Issues: How to Overcome the Complexity of Data Analysis in Hand Hygiene Research? 42Angèle Gayet-Ageron and Eli Perencevich8. Hand Hygiene Agents 51Pascal Bonnabry and Andreas Voss9. Methods to Evaluate the Antimicrobial Efficacy of HandHygiene Agents 58Manfred L. Rotter, Syed A. Sattar, and Miranda Suchomel10. Hand Hygiene Technique 70Marie-Noëlle Chraïti and Andreas F. Widmer11. Compliance with Hand Hygiene Best Practices 76Benedetta Allegranzi, Andrew J. Stewardson, and Didier Pittet12. Barriers to Compliance 85John M. Boyce, Benedetta Allegranzi, and Didier Pittet13. Physicians and Hand Hygiene 89Benedetta Allegranzi, Andrew J. Stewardson, and Didier Pittet14. Surgical Hand Preparation 94Andreas F. Widmer and Joseph Solomkin15. Skin Reaction to Hand Hygiene 101Elaine Larson16. Alcohol-Based Handrub Safety 105John M. Boyce and M. Lindsay Grayson17. Rinse, Gel, Foam, Soap … Selecting an Agent 109Andreas Voss18. Behavior and Hand Hygiene 115Mary-Louise McLaws and Hugo Sax19. Hand Hygiene Promotion Strategies 123Benedetta Allegranzi and Didier Pittet20. My Five Moments for Hand Hygiene 134Hugo Sax, Benedetta Allegranzi, and Didier Pittet21. System Change 144Benedetta Allegranzi, Andreas Voss, and Didier Pittet22. Education of Healthcare Professionals 152Elaine Larson, Marie-Noëlle Chraïti, and Wing-Hong Seto23. Glove Use and Hand Hygiene 156Marie-Noëlle Chraïti, Benedetta Allegranzi, and Elaine Larson24. Monitoring Hand Hygiene Performance 162Hugo Sax and John M. Boyce25. Performance Feedback 172Andrew J. Stewardson and Hugo Sax26. Marketing Hand Hygiene 180Julie Storr and Hugo Sax27. Human Factors Design 185Lauren Clack and Hugo Sax28. Institutional Safety Climate 193Enrique Castro-Sánchez, Alison Holmes, and Didier Pittet29. Personal Accountability for Hand Hygiene 201Robert M. Wachter and Peter Pronovost30. Patient Participation and Empowerment 206Yves Longtin, Susan E. Sheridan, and Maryanne McGuckin31. Religion and Hand Hygiene 216Jaffar A. Al-Tawfiq and Ziad A. Memish32. Hand Hygiene Promotion from the US Perspective: PuttingWHO and CDC Guidelines into Practice 221Katherine Ellingson33. WHO Multimodal Promotion Strategy 230Benedetta Allegranzi and Didier Pittet34. Monitoring Your Institution (Hand Hygiene Self-Assessment Framework) 244Benedetta Allegranzi, Andrew J. Stewardson, and Didier Pittet35. National Hand Hygiene Campaigns 249Claire Kilpatrick and Julie Storr36. Hand Hygiene Campaigning: From One Hospital to the Entire Country 256Philip L. Russo and M. Lindsay Grayson37. Improving Hand Hygiene through Joint Commission Accreditation and the Joint Commission Center for Transforming Healthcare 263Mark R. Chassin, Barbara I. Braun, and Anne Marie Benedicto38. A Worldwide WHO Hand Hygiene in Healthcare Campaign 275Claire Kilpatrick, Julie Storr, and Benedetta Allegranzi39. The Economic Impact of Improved Hand Hygiene 285Nicholas Graves40. Hand Hygiene: Key Principles for the Manager 294Eleanor Murray, Alison Holmes, and Didier Pittet41. Effect of Hand Hygiene on Infection Rates 299Benedetta Allegranzi, Stephan Harbarth, and Didier Pittet42A.Hand Hygiene in Specific Patient Populations and Situations: Critically Ill Patients 317Caroline Landelle, Jean-Christophe Lucet, and Didier Pittet42B. Hand Hygiene in Specific Patient Populations and Situations: Neonates and Pediatrics 324Walter Zingg and Hanan H. Balkhy42C. Hand Hygiene in Long-Term Care Facilities and Home Care 329Maria Luisa Moro, Marie-Noëlle Chraïti, and Benedetta Allegranzi42D.Hand Hygiene in Ambulatory Care 337Marie-Noëlle Chraïti, Sepideh Bagheri Nejad, and Benedetta Allegranzi42E. Hand Hygiene in Hemodialysis 344Marie-Noëlle Chraïti, Sepideh Bagheri Nejad, and Benedetta Allegranzi42F. Hand Hygiene in Specific Patient Populations and Situations: Anesthesiology 350François Stéphan43. Hand Hygiene in Resource-Poor Settings 357Nizam Damani, Shaheen Mehtar, and Benedetta Allegranzi44A. Role of Hand Hygiene in MRSA Control 367Stephan Harbarth44B. Role of Hand Hygiene in Clostridium difficile Control 373John M. Boyce and Walter Zingg44C. Role of Hand Hygiene in Respiratory Diseases Including Influenza 378Wing Hong Seto and Benjamin J. Cowling44D. Handborne Spread of Noroviruses and its Interruption 385Syed A. Sattar and Yves Longtin45. Conducting a Literature Review on Hand Hygiene 391Daniela Pires, Fernando Bellissimo-Rodrigues, and Didier PittetAppendix 400Index 409

Didier Pittet MD, MS, CBE, Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland John M. Boyce MD, Hospital Epidemiology and Infection Control, Yale-New Haven Hospital, and Yale University School of Medicine, New Haven, CT, USA Benedetta Allegranzi MD, Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization, and Faculty of Medicine, University of Geneva, Geneva, Switzerland

"In their new textbook, Hand Hygiene: A Handbook for Medical Professionals, Didier Pittet, John Boyce, and Benedetta Allegranzi turn to leading experts on patient safety and infection control to produce an impressive book with 45 chapters focusing on every aspect of hand hygiene. But, as Pittet asks in the preface, “Does hand hygiene deserve a textbook?” It is refreshing for a textbook writer to ask this question about his own book, and the answer, as the foreword suggests, is a resounding “yes.”While hand hygiene is essential, compliance is complicated. Additionally, actual rates of compliance are difficult to measure as are the number of HAIs that can be prevented with high hand hygiene compliance rates. With these issues in mind, Pittet and colleagues present this new work with a noble objective, “to save many more millions of lives every year worldwide.”The edition includes many important, but often overlooked, areas in chapters covering topics such as handhygiene promotion strategies, human factors, barriers to compliance, and skin reaction to hand hygiene. Ofparticular importance, the book includes chapters on the safety climate as well as personal accountability. Of note, a chapter on religion and cultural practices sheds light on interesting issues that are often marginalised. The book is organised logically, beginning with a review of the data on HAI......We have a real problem with hand hygiene among medical professionals, and now is the time to embrace change. This handbook takes an important step in that direction. Pittet believes that a renewed commitment by providers will “drive excellence in hand hygiene practices, research, and attitudes for many years to come.” The editors and authors should be commended for this laudable goal and outstanding handbook" (The Lancet Vol 17 August 17)"This well-written book, coupled with its excellent editing, is easy to read. It succeeds in appealing to a diverse population of healthcare professionals. All healthcare facility leaders in patient safety and infection prevention would be well served by this guide and reference to improving hand hygiene" Doodys, Sept 2017

• Contributors xiPreface xvForeword xvii1. The Burden of Healthcare-Associated Infection 1Benedetta Allegranzi, Sepideh Bagheri Nejad, and Didier Pittet2. Historical Perspectives 8Andrew J. Stewardson and Didier Pittet3. Flora and Physiology of Normal Skin 12Gürkan Kaya and Didier Pittet4. Dynamics of Hand Transmission 18Andrew J. Stewardson, Benedetta Allegranzi, and Didier Pittet5. Mathematical Models of Handborne Transmission of Nosocomial Pathogens 28Ben S. Cooper and Nantasit Luangasanatip6. Methodological Issues in Hand Hygiene Science 36Matthew Samore and Stephan Harbarth7. Statistical Issues: How to Overcome the Complexity of Data Analysis in Hand Hygiene Research? 42Angèle Gayet-Ageron and Eli Perencevich8. Hand Hygiene Agents 51Pascal Bonnabry and Andreas Voss9. Methods to Evaluate the Antimicrobial Efficacy of HandHygiene Agents 58Manfred L. Rotter, Syed A. Sattar, and Miranda Suchomel10. Hand Hygiene Technique 70Marie-Noëlle Chraïti and Andreas F. Widmer11. Compliance with Hand Hygiene Best Practices 76Benedetta Allegranzi, Andrew J. Stewardson, and Didier Pittet12. Barriers to Compliance 85John M. Boyce, Benedetta Allegranzi, and Didier Pittet13. Physicians and Hand Hygiene 89Benedetta Allegranzi, Andrew J. Stewardson, and Didier Pittet14. Surgical Hand Preparation 94Andreas F. Widmer and Joseph Solomkin15. Skin Reaction to Hand Hygiene 101Elaine Larson16. Alcohol-Based Handrub Safety 105John M. Boyce and M. Lindsay Grayson17. Rinse, Gel, Foam, Soap … Selecting an Agent 109Andreas Voss18. Behavior and Hand Hygiene 115Mary-Louise McLaws and Hugo Sax19. Hand Hygiene Promotion Strategies 123Benedetta Allegranzi and Didier Pittet20. My Five Moments for Hand Hygiene 134Hugo Sax, Benedetta Allegranzi, and Didier Pittet21. System Change 144Benedetta Allegranzi, Andreas Voss, and Didier Pittet22. Education of Healthcare Professionals 152Elaine Larson, Marie-Noëlle Chraïti, and Wing-Hong Seto23. Glove Use and Hand Hygiene 156Marie-Noëlle Chraïti, Benedetta Allegranzi, and Elaine Larson24. Monitoring Hand Hygiene Performance 162Hugo Sax and John M. Boyce25. Performance Feedback 172Andrew J. Stewardson and Hugo Sax26. Marketing Hand Hygiene 180Julie Storr and Hugo Sax27. Human Factors Design 185Lauren Clack and Hugo Sax28. Institutional Safety Climate 193Enrique Castro-Sánchez, Alison Holmes, and Didier Pittet29. Personal Accountability for Hand Hygiene 201Robert M. Wachter and Peter Pronovost30. Patient Participation and Empowerment 206Yves Longtin, Susan E. Sheridan, and Maryanne McGuckin31. Religion and Hand Hygiene 216Jaffar A. Al-Tawfiq and Ziad A. Memish32. Hand Hygiene Promotion from the US Perspective: PuttingWHO and CDC Guidelines into Practice 221Katherine Ellingson33. WHO Multimodal Promotion Strategy 230Benedetta Allegranzi and Didier Pittet34. Monitoring Your Institution (Hand Hygiene Self-Assessment Framework) 244Benedetta Allegranzi, Andrew J. Stewardson, and Didier Pittet35. National Hand Hygiene Campaigns 249Claire Kilpatrick and Julie Storr36. Hand Hygiene Campaigning: From One Hospital to the Entire Country 256Philip L. Russo and M. Lindsay Grayson37. Improving Hand Hygiene through Joint Commission Accreditation and the Joint Commission Center for Transforming Healthcare 263Mark R. Chassin, Barbara I. Braun, and Anne Marie Benedicto38. A Worldwide WHO Hand Hygiene in Healthcare Campaign 275Claire Kilpatrick, Julie Storr, and Benedetta Allegranzi39. The Economic Impact of Improved Hand Hygiene 285Nicholas Graves40. Hand Hygiene: Key Principles for the Manager 294Eleanor Murray, Alison Holmes, and Didier Pittet41. Effect of Hand Hygiene on Infection Rates 299Benedetta Allegranzi, Stephan Harbarth, and Didier Pittet42A.Hand Hygiene in Specific Patient Populations and Situations: Critically Ill Patients 317Caroline Landelle, Jean-Christophe Lucet, and Didier Pittet42B. Hand Hygiene in Specific Patient Populations and Situations: Neonates and Pediatrics 324Walter Zingg and Hanan H. Balkhy42C. Hand Hygiene in Long-Term Care Facilities and Home Care 329Maria Luisa Moro, Marie-Noëlle Chraïti, and Benedetta Allegranzi42D.Hand Hygiene in Ambulatory Care 337Marie-Noëlle Chraïti, Sepideh Bagheri Nejad, and Benedetta Allegranzi42E. Hand Hygiene in Hemodialysis 344Marie-Noëlle Chraïti, Sepideh Bagheri Nejad, and Benedetta Allegranzi42F. Hand Hygiene in Specific Patient Populations and Situations: Anesthesiology 350François Stéphan43. Hand Hygiene in Resource-Poor Settings 357Nizam Damani, Shaheen Mehtar, and Benedetta Allegranzi44A. Role of Hand Hygiene in MRSA Control 367Stephan Harbarth44B. Role of Hand Hygiene in Clostridium difficile Control 373John M. Boyce and Walter Zingg44C. Role of Hand Hygiene in Respiratory Diseases Including Influenza 378Wing Hong Seto and Benjamin J. Cowling44D. Handborne Spread of Noroviruses and its Interruption 385Syed A. Sattar and Yves Longtin45. Conducting a Literature Review on Hand Hygiene 391Daniela Pires, Fernando Bellissimo-Rodrigues, and Didier PittetAppendix 400Index 409

Didier Pittet MD, MS, CBE, Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland John M. Boyce MD, Hospital Epidemiology and Infection Control, Yale-New Haven Hospital, and Yale University School of Medicine, New Haven, CT, USA Benedetta Allegranzi MD, Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization, and Faculty of Medicine, University of Geneva, Geneva, Switzerland

"In their new textbook, Hand Hygiene: A Handbook for Medical Professionals, Didier Pittet, John Boyce, and Benedetta Allegranzi turn to leading experts on patient safety and infection control to produce an impressive book with 45 chapters focusing on every aspect of hand hygiene. But, as Pittet asks in the preface, “Does hand hygiene deserve a textbook?” It is refreshing for a textbook writer to ask this question about his own book, and the answer, as the foreword suggests, is a resounding “yes.”While hand hygiene is essential, compliance is complicated. Additionally, actual rates of compliance are difficult to measure as are the number of HAIs that can be prevented with high hand hygiene compliance rates. With these issues in mind, Pittet and colleagues present this new work with a noble objective, “to save many more millions of lives every year worldwide.”The edition includes many important, but often overlooked, areas in chapters covering topics such as handhygiene promotion strategies, human factors, barriers to compliance, and skin reaction to hand hygiene. Ofparticular importance, the book includes chapters on the safety climate as well as personal accountability. Of note, a chapter on religion and cultural practices sheds light on interesting issues that are often marginalised. The book is organised logically, beginning with a review of the data on HAI......We have a real problem with hand hygiene among medical professionals, and now is the time to embrace change. This handbook takes an important step in that direction. Pittet believes that a renewed commitment by providers will “drive excellence in hand hygiene practices, research, and attitudes for many years to come.” The editors and authors should be commended for this laudable goal and outstanding handbook" (The Lancet Vol 17 August 17)"This well-written book, coupled with its excellent editing, is easy to read. It succeeds in appealing to a diverse population of healthcare professionals. All healthcare facility leaders in patient safety and infection prevention would be well served by this guide and reference to improving hand hygiene" Doodys, Sept 2017

• Contributors xiPreface xvForeword xvii1. The Burden of Healthcare-Associated Infection 1Benedetta Allegranzi, Sepideh Bagheri Nejad, and Didier Pittet2. Historical Perspectives 8Andrew J. Stewardson and Didier Pittet3. Flora and Physiology of Normal Skin 12Gürkan Kaya and Didier Pittet4. Dynamics of Hand Transmission 18Andrew J. Stewardson, Benedetta Allegranzi, and Didier Pittet5. Mathematical Models of Handborne Transmission of Nosocomial Pathogens 28Ben S. Cooper and Nantasit Luangasanatip6. Methodological Issues in Hand Hygiene Science 36Matthew Samore and Stephan Harbarth7. Statistical Issues: How to Overcome the Complexity of Data Analysis in Hand Hygiene Research? 42Angèle Gayet-Ageron and Eli Perencevich8. Hand Hygiene Agents 51Pascal Bonnabry and Andreas Voss9. Methods to Evaluate the Antimicrobial Efficacy of HandHygiene Agents 58Manfred L. Rotter, Syed A. Sattar, and Miranda Suchomel10. Hand Hygiene Technique 70Marie-Noëlle Chraïti and Andreas F. Widmer11. Compliance with Hand Hygiene Best Practices 76Benedetta Allegranzi, Andrew J. Stewardson, and Didier Pittet12. Barriers to Compliance 85John M. Boyce, Benedetta Allegranzi, and Didier Pittet13. Physicians and Hand Hygiene 89Benedetta Allegranzi, Andrew J. Stewardson, and Didier Pittet14. Surgical Hand Preparation 94Andreas F. Widmer and Joseph Solomkin15. Skin Reaction to Hand Hygiene 101Elaine Larson16. Alcohol-Based Handrub Safety 105John M. Boyce and M. Lindsay Grayson17. Rinse, Gel, Foam, Soap … Selecting an Agent 109Andreas Voss18. Behavior and Hand Hygiene 115Mary-Louise McLaws and Hugo Sax19. Hand Hygiene Promotion Strategies 123Benedetta Allegranzi and Didier Pittet20. My Five Moments for Hand Hygiene 134Hugo Sax, Benedetta Allegranzi, and Didier Pittet21. System Change 144Benedetta Allegranzi, Andreas Voss, and Didier Pittet22. Education of Healthcare Professionals 152Elaine Larson, Marie-Noëlle Chraïti, and Wing-Hong Seto23. Glove Use and Hand Hygiene 156Marie-Noëlle Chraïti, Benedetta Allegranzi, and Elaine Larson24. Monitoring Hand Hygiene Performance 162Hugo Sax and John M. Boyce25. Performance Feedback 172Andrew J. Stewardson and Hugo Sax26. Marketing Hand Hygiene 180Julie Storr and Hugo Sax27. Human Factors Design 185Lauren Clack and Hugo Sax28. Institutional Safety Climate 193Enrique Castro-Sánchez, Alison Holmes, and Didier Pittet29. Personal Accountability for Hand Hygiene 201Robert M. Wachter and Peter Pronovost30. Patient Participation and Empowerment 206Yves Longtin, Susan E. Sheridan, and Maryanne McGuckin31. Religion and Hand Hygiene 216Jaffar A. Al-Tawfiq and Ziad A. Memish32. Hand Hygiene Promotion from the US Perspective: PuttingWHO and CDC Guidelines into Practice 221Katherine Ellingson33. WHO Multimodal Promotion Strategy 230Benedetta Allegranzi and Didier Pittet34. Monitoring Your Institution (Hand Hygiene Self-Assessment Framework) 244Benedetta Allegranzi, Andrew J. Stewardson, and Didier Pittet35. National Hand Hygiene Campaigns 249Claire Kilpatrick and Julie Storr36. Hand Hygiene Campaigning: From One Hospital to the Entire Country 256Philip L. Russo and M. Lindsay Grayson37. Improving Hand Hygiene through Joint Commission Accreditation and the Joint Commission Center for Transforming Healthcare 263Mark R. Chassin, Barbara I. Braun, and Anne Marie Benedicto38. A Worldwide WHO Hand Hygiene in Healthcare Campaign 275Claire Kilpatrick, Julie Storr, and Benedetta Allegranzi39. The Economic Impact of Improved Hand Hygiene 285Nicholas Graves40. Hand Hygiene: Key Principles for the Manager 294Eleanor Murray, Alison Holmes, and Didier Pittet41. Effect of Hand Hygiene on Infection Rates 299Benedetta Allegranzi, Stephan Harbarth, and Didier Pittet42A.Hand Hygiene in Specific Patient Populations and Situations: Critically Ill Patients 317Caroline Landelle, Jean-Christophe Lucet, and Didier Pittet42B. Hand Hygiene in Specific Patient Populations and Situations: Neonates and Pediatrics 324Walter Zingg and Hanan H. Balkhy42C. Hand Hygiene in Long-Term Care Facilities and Home Care 329Maria Luisa Moro, Marie-Noëlle Chraïti, and Benedetta Allegranzi42D.Hand Hygiene in Ambulatory Care 337Marie-Noëlle Chraïti, Sepideh Bagheri Nejad, and Benedetta Allegranzi42E. Hand Hygiene in Hemodialysis 344Marie-Noëlle Chraïti, Sepideh Bagheri Nejad, and Benedetta Allegranzi42F. Hand Hygiene in Specific Patient Populations and Situations: Anesthesiology 350François Stéphan43. Hand Hygiene in Resource-Poor Settings 357Nizam Damani, Shaheen Mehtar, and Benedetta Allegranzi44A. Role of Hand Hygiene in MRSA Control 367Stephan Harbarth44B. Role of Hand Hygiene in Clostridium difficile Control 373John M. Boyce and Walter Zingg44C. Role of Hand Hygiene in Respiratory Diseases Including Influenza 378Wing Hong Seto and Benjamin J. Cowling44D. Handborne Spread of Noroviruses and its Interruption 385Syed A. Sattar and Yves Longtin45. Conducting a Literature Review on Hand Hygiene 391Daniela Pires, Fernando Bellissimo-Rodrigues, and Didier PittetAppendix 400Index 409