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An 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 This study 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. The observed hand hygiene practices were discussed at monthly meetings and posted in the ICUs. Nosocomial infections that occurred in the ICUs were recorded according to the CDC definitions of such infections. Baseline and postintervention data of hand hygiene practices were collected by trained in-fection control practitioners. The overall compliance of hand hygiene improved from baseline (23.1%) to the postintervention phase (64.5%).35 Hand hygiene is a simple measure that when imple-mented in the everyday care of patients can reduce SSIs and improve patient safety.36 Hand hygiene practices should always be a priority when participating in patient care. The 2009 WHO Guidelines on Hand Hygiene36 recommend that the healthcare provider engage in hand hygiene in the following situations: When the hands are visibly dirty or visibly soiled with blood or body fluids or after using the toilet If there is exposure to potential spore-forming pathogens, including outbreaks of Clostridium difficile Before and after touching a patient, before handling an invasive device for patient care, regardless of whether or not gloves are used; after contact with body fluids or excretions, mucous membranes, nonintact skin, or wound dressings; if moving from a contaminated body site to another body site during the care of the same patient; after contact with inanimate surfaces and objects (including medical equipment) in the immediate vicinity of the patient; and after removing sterile or nonsterile gloves Before handling medications or preparing food The Institute of Medicine has galvanized attention to issues of quality and medical error as they pertain to healthcare delivery in the US.37 Policymakers, health-care stakeholders, and professional organizations have launched initiatives targeted at improving hospital quality regarding inpatient surgery by minimizing complications, reducing medical expenses, and increasing favorable outcomes. As the need for transparency in healthcare heightens, the demand for positive surgical patient outcomes will intensify. The anesthesia provider can deliver transparent high-quality care by implement-ing timely and appropriate antibiotic use, maintenance of normothermia, and hand hygiene practices in accordance with evidence-based guidelines REFERENCES1. Meeks DW, Lally KP, Carrick MM, et al. Compliance with guidelines to prevent surgical site infections: as simple as 1-2-3? Am J Surg. 2011;201(1):76-83. 2. Prokuski L. Prophylactic antibiotics in orthopedic surgery. J Am Acad Orthop Surg. 2008;16(5):283-293. 3. Anderson DJ, Sexton DJ. Epidemiology and pathogenesis of and risk factors for surgical site infection. UpToDate. 2008. http://www. upto-date.com. 4. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection: 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;20(4):250-278. 5. Anderson DJ. Surgical site infections. Infect Dis Clin North Am. 2011;25(1):135-153. 6. Bratzler DW, Hunt DR. The Surgical Infection Prevention and Surgical Care Improvement projects: national initiatives to improve outcomes for patients having surgery.