Hand hygiene compliance rises 22% after a multipronged campaign. A concerted effort to improve hand hygiene at Tufts Medical Center, described in the January issue of the Joint Commission Journal on Quality and Patient Safety, worked well and could be easily adapted to other settings. Key features of the campaign included the installation of alcohol-based hand sanitizer dispensers in all public areas and the use of handouts and posters, as well as stickers and pins worn by employees. Hospital administrators headed the campaign, and monthly feedback on compliance was provided, spurring competitiveness. Compliance was assessed using unannounced direct observations by trained personnel. Hand hygiene compliance not only increased, from 72% to 94%, but rates of methicillin-resistant Staphylococcus aureus, and vancomycin-resistant Enterococcus, infection declined steadily. Clostridium difficile rates increased, however, probably owing to the alcohol resistance of C. difficile spores.