Methods: Our objectives were to (1) evaluate implementation and compliance with clinical practices recommended in the new
Centers for Disease Control and Prevention (CDC) Hand Hygiene Guideline, (2) compare rates of health care-associated infections
(HAI) before and after implementation of the Guideline recommendations, and (3) examine the patterns and correlates of changes
in rates of HAI. We used pre- and post-Guideline implementation site visits and surveys in the setting of 40 US hospitals—members
of the National Nosocomial Infections Surveillance System—and measured HAI rates 1 year before and after publication of the CDC
Guideline and used direct observation of hand hygiene compliance and Guideline implementation scores