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The study ob-served the hand hygiene practices of anesthesia provid-ers following the World Health Organization (WHO) Guidelines on Hand Hygiene in Health Care over a 4-week period. The results were daunting: “[T]he overall failure of hand hygiene ranged from 64% to 93% by pro-vider group with a mean aggregate failure rate of 82%”.32 The major categories where hand hygiene failures oc-curred were moving between patients in the preoperative phase, performing pain service interventions, using the keyboard when documenting in an electronic medical record, placing intravenous catheters and blood draws, preparing drugs and equipment for the following case, leaving soiled gloves on after airway manipulation, Foley catheter insertion or central or arterial line manipulation, and picking up something from the floor and using it.32An academic hospital in the Netherlands also reported results of poor hand hygiene, when an observer evaluated the hand hygiene practices in an OR. This study used an observational scoring tool that documented the hand hygiene practices of the staff members who touched pa-tients without the application of hand hygiene.34 The OR staff was categorized by profession, and staff members who were considered sterile were excluded. The observer evaluated 28 surgical procedures for more than 60 hours in a variety of surgical specialties. The results of this study revealed that the OR staff was observed participat-ing in hand hygiene in 7 of 363 opportunities (2%) and in 28 of 333 opportunities on leaving the OR (8.4%).34 This66 AANA Journal n February 2015 n Vol. 83, No. 1 www.aana.com/aanajournalonlinestudy also revealed that compliance with gloving guide-lines varied from 0% to 87%.34 Many providers donned gloves when performing invasive procedures such as intubation/extubation of the trachea, but the providers wore the gloves for long periods without appropriate hand hygiene.34A tertiary care hospital in Argentina revealed that with education and improved hand hygiene practices, there could possibly be a reduction in nosocomial infec-tions. This study was conducted in 2 ICUs in a 180-bed teaching hospital in Buenos Aires over a 2-year period. An intervention, which included educational classes on hand hygiene, the distribution of an infection control manual, and guidelines for appropriate hand hygiene practices, was provided to all healthcare providers.35 A trained nurse observed the hand hygiene practices of the healthcare practitioners.