Evidence-based practices to increase hand hygiene compliance in health care facilities: An integrated review. 
Hand hygiene (HH) in health care facilities is a key component to reduce pathogen transmission and nosocomial infections.  However, most HH interventions (HHI) have not been sustainable.  This review aims to provide a comprehensive summary of recently published evidence-based HHI designed to improve HH compliance (HHC) that will enable health care providers to make informed choices when allocating limited resources to improve HHC and patient safety.  The Medline electronic database (using PubMed) was used to identify relevant studies.  English language articles that included hand hygiene interventions and related terms combined with health care environments or related terms were included.  Seventy-three studies that met the inclusion criteria were summarized.  Interventions were categorized as improving awareness with education, facility design, and planning, unit-level protocols and procedures, hospital-wide programs, and multimodal interventions.  Past successful HHIs may not be as effective when applied to other health care environments.  HH education should be interactive and engaging.  Electronic monitoring and reminders should be implemented in phases to ensure cost-effectiveness.  To create hospitalwide programs that engage end users, policy makers should draw expertise from interdisciplinary fields.  Before implementing the various components of multimodal interventions, health care practitioners should identify and examine HH difficulties unique to their organizations.  Future research should seek to achieve the following: replicate successful HHI in other health care environments, develop reliable HHC monitoring tools, understand caregiver-patient-family interactions, examine ways (eg, hospital leadership, financial support, and strategies from public health and infection prevention initiatives) to sustain HHC, and use simulated lab environments to refine study designs.