Table 3.

Description of the implementation strategies with the planned activities

State-of-the-art strategy	Team and leaders-directed strategy
Education	All elements of the state-of-the-art strategy
Distribution of educational material/ written information (leaflet) about HH that contained:	• Education, reminders, feedback, facilities and products, see above
• The importance of HH	Setting norms and targets within the team
• Misconceptions about alcohol-based HH disinfection	• Three interactive team sessions (1 h-1.5 h each) that included goal setting in HH performance at group level. Team sessions were guided by the team manager and a external coach.
• Theory and practical indications for the use of HH	◦ Exploring nurses’ knowledge and perception of current HH behaviour (individual- and team level) and discussing actual HH compliance rates
Website http://www.gewoonhandenschoon.nl	◦ Transition from individual responsibility to a shared team responsibility
• Educational material/ written information about HH	◦ Creating a participatory and non-threatening climate for team interaction
• Knowledge quiz with feedback. Visitors could test their knowledge about HH	◦ Commitment to high standards of HH performance
• The nursing ward with the highest number of visitors to the website was rewarded	◦ Defining and documenting improvement activities
Educational sessions on prevention of hospital acquired infections	• Analysis of barriers and facilitators to determine how nurses could best adapt their behaviour in order to reach their goal.
• Launching hospital-wide campaign with practical demonstrations of HH	• Nurses address each other in case of undesirable HH behaviour
Reminders	Gaining active commitment and initiative of ward management
• Distribution of posters that emphasised the importance of HH, particularly alcohol-based hand disinfection. Posters were displayed in several strategic areas within the units and replaced by another poster after 12 weeks.	• Ward manager designated HH as a priority
• Interviews and messages in newsletters or hospital magazines	• Ward manager actively supported team members and informal leaders
• General reminders by opinion leaders/ ward management	• Ward manager discussed HH compliance rates with team members
Feedback	Modeling by informal leaders at the ward
• Bar charts of HH rates of every nursing ward were sent to the ward manager twice. This also included a comparison of ward performance and hospital performance	• Informal leaders demonstrated good HH behaviour
Facilities and products	• Informal leaders modeled social skills of team members in addressing HH behaviour of colleagues
• Screening and if necessary adapt products and appropriate facilities	• Informal leaders instructed and stimulated their colleagues in providing good HH behaviour