Stevenson 2014.

Methods	Design: cluster‐randomised trial Study period: March 2003‐February 2004 4‐month baseline, intervention period of 5 months USA
Participants	Healthcare workers in 10 community hospitals
Interventions	Multimodal, customised to the unit: education, feedback at the unit level, posters/signs, ABHR, admin support, staff involvement, recognition and rewards programme (candy, buttons) Control: usual infection control practices
Outcomes	Observation of hand hygiene compliance
Notes	Mixed effects logistic regression: appropriate analysis Funding source: None Declaration of interest: None
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Not specified how random allocation was done
Allocation concealment (selection bias)	Low risk	Unit of allocation was institution and performed at start of study after baseline assessment
Blinding of participants and personnel (performance bias) All outcomes	High risk	Individualised campaigns so participants aware of the intervention
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Outcomes were assessed blindly but local observers were used
Incomplete outcome data (attrition bias) All outcomes	Low risk	Missing data (missed opportunities) unlikely to be very different in different arms 1 withdrew early from the control group but this was unlikely to affect results
Selective reporting (reporting bias)	Low risk	No evidence of selective reporting
Other bias	Low risk	No evidence
Baseline outcomes	Unclear risk	Baseline hand hygiene not reported; they compared absolute changes from baseline
Baseline characteristics	High risk	No baseline characteristics reported
Protection from contamination	Low risk	Allocation was by institution