If the nurse
documented “no” (meaning the patient did not
receive hand hygiene), the nurse was required to
enter a comment explaining the rationale. Implementation
and adherence were achieved through
the 10-week training process, where study team
members were present for each scheduled hand
hygiene time (8 AM, 2 PM, and 8 PM). After the training
period, auditing and observation were used to
assess compliance. Resistance was met, as with
any change, and was addressed on a 1-to-1 basis.