title: [Health professionals facing hand hygiene improvement: state-of-the-art strategies versus extended strategies].
abstract: BACKGROUND
  The hand hygiene (HH) is one of the preventive practices more .widely and effectively implemented in the control of healthcare associated infections. However, there are several barriers to compliance.
  
  
  OBJECTIVE
  To assess which strategy, state-of-the-art strategies (availability of alcohol-based preparations, posters, instructions and training) or extended strategies (feedbacks, formal and informal leadership), are seen as more effective to improve hand hygiene (HH) compliance.
  
  
  METHODS
  Analytical study using a self-completed questionnaire developed by the World Health Organization. 2,068 questionnaires, completed by healthcare professionals (HP) in Andalusia (Spain), were received from 2010 to 2012. Analytical technique: Structural equation modeling and multi group measurement invariance.
  
  
  RESULTS
  Once the reliability of the proposed constructs was achieved (Cronbach α=0.73, 0.84, 0.70), it was found that those HP working in centers with the highest level of commitment with HH are those who see extended strategies as more effective (χ2=298.3, df=39, CFI=0.972, TLI=0.961, RMSEA=0.057, SRMR=0.028).
  
  
  CONCLUSIONS
  Our results have shown that hospitals' HP, compared to primary care HP, see state-of-the-art strategies as more effective, as well as they give less importance to HH, meanwhile nurses, compared to physicians, see effective both strategies. HP contemplate the combination of state-of-the-art and extended strategies as an effective way to improve the HH compliance. In addition, extended strategies are considered more effective amongst the most "advanced" healthcare settings in terms of their commitment to HH.
  
  
  CONCLUSIONS
  The results highlight the need for commitment at management, collective and individual level in order to maintain patient safety.
authors.forename: Manuel
authors.initials: M
authors.lastname: Herrera-Usagre
authors.forename: Pastora
authors.initials: P
authors.lastname: Pérez-Pérez
authors.forename: Marta
authors.initials: M
authors.lastname: Vázquez-Vázquez
authors.forename: Vicente
authors.initials: V
authors.lastname: Santana-López
mesh_terms: D001291:Attitude of Health Personnel; D003428:Cross Infection / Q000517:prevention & control; D003430:Cross-Sectional Studies; D005260:Female; D063373:Hand Hygiene / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D017053:Infection Control / Q000379:methods; D008297:Male; D008503:Medical Staff; D009740:Nursing Staff; D013030:Spain; D011795:Surveys and Questionnaires