suchassuboptimalnurse-to-patientratios,and the inadequate education, training, and com- petence of health care personnel.5 To bring best practices to the bedside level, improvement efforts must change practice patterns.22 Implementation strategies that are multifaceted and multidisciplinary, and that include sufficient resources and explicit sup- port from organizational leaders, are most likely to be successful.20,23 The challenge comes in identifying which multifaceted ap- proaches are likely to be most effective in a given organization, as there is no “one-size- fits-all” approach; instead, it is important that implementation strategies are customized to specific problem areas within a given organi- zation in order to be most effective. As a first step, consider using a systematic approach to identify, prioritize, and remove local barriers that can diminish best practices. The following is a brief overview of several internalandexternalfactorsthatcanaffectthe success of any improvement initiative that is designed to reduce or eliminate HAIs, includ- ing