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Direct observation cannot be considered the gold standard for assessing hand hygiene, because there was no relationship between the observed adherence and the number of dispensing episodes or the volume of product used. Other means to monitor hand hygiene adherence, such as electronic devices and measurement of product usage, should be considered.

A positive deviance strategy yielded a significant improvement in hand hygiene, which was associated with a decrease in the overall incidence of HAIs.

At least two kidney epithelial cell lines, the Madin-Darby canine kidney (MDCK)

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