Hand washing can reduce the frequency of HAIs, but health care workers rarely achieve greater than 50% compliance with guidelines for hand washing and other infection control measures. 26Washing and decontaminating hands before and after contact with patients and wearing gloves are important actions in the prevention of VAP.27,28 Trick et al27 determined risk factors for hand contamination and compared the efficacy of 3 randomly allocated hand hygiene agents in a group of health care workers, mostly nurses. Specimens for culture were obtained from one hand before hand hygiene and from the other hand after hand hygiene was performed. Ring wearing was associated with a 10-fold higher risk of skin organism counts and contamination with S aureus, gram-negative bacilli, or Candida species. In addition, use of an alcohol-based hand rub resulted in significantly less frequent hand contamination. A wash-glove-wash protocol was established by the nursing staff at Lankenau Hospital on the basis of evidence from hand-washing studies. Adherence to this protocol was determined on a monthly basis. Random monthly observations of hand washing were conducted by personnel selected by the quality department.