Table 3. Modal responses for leadership criteria in the World Health Organization Hand Hygiene Self-Assessment Framework: n = 63.

bottomic	Question	Modal response	%
System change	Has a cost-benefit analysis of infrastructure changes required for the performance of optimal hand hygiene at the point of care been performed?	No	62.9
	Does alcohol-based hand rubbing account for at least 80% of hand hygiene actions performed in your facility?	Yes	93.7
Training and education	Has the hand hygiene team undertaken training of representatives from other facilities in the area of hand hygiene promotion?	No	54.8
	Have hand hygiene principles been incorporated into local medical and nursing educational curricula?	Yes	90.5
Evaluation and feedback	Are specific HAIs monitored? (eg, Staphylococcus aureus bacteremia, gram-negative bacteremia, device-related infections)	Yes	100.0
	Is a system in place for monitoring of HAI in high-risk settings? (eg, intensive care and neonatal units)	Yes	88.9
	Is a facility-wide prevalence survey of HAI performed (at least) annually?	Yes	98.4
	Are HAI rates presented to facility leadership and health care workers in conjunction with hand hygiene compliance rates?	Yes	96.8
	Is a structured evaluation undertaken to understand the obstacles to optimal hand hygiene compliance and the causes of HAI at local level with results reported to the facility leadership?	Yes	88.9
Reminders in the workplace	Is a system in place for the creation of new posters designed by local health care workers?	Yes	60.3
	Are posters created in your facility used in other facilities?	No	71.4
	Have innovative types of hand hygiene reminders been developed and tested at the facility?	Yes	58.7
Institutional safety climate	Has a local hand hygiene research agenda addressing issues identified by the WHO guidelines as requiring further investigation been developed?	No	76.2
	Has your facility participated actively in publications or conference presentations (oral or poster) in the area of hand hygiene?	No	58.7
	Are patients invited to remind health care workers to perform hand hygiene?	Yes	91.9
	Are patients and visitors educated to correctly perform hand hygiene?	Yes	85.7
	Does your facility contribute to and support the national hand hygiene campaign (if existing)?	Yes	79.4
	Is impact evaluation of the hand hygiene campaign incorporated into forward planning of the infection control program?	Yes	95.2
	Does your facility set an annual target for improvement of hand hygiene compliance facility wide?	Yes	93.7
	If the facility has such a target, was it achieved last year?	Yes	72.6

HAI, health care-associated infection.