Hand Hygiene (HH) is a major strategy for decreasing hospital acquired infections. At MARH, ensuring that health care providers maintain strict hand hygiene is a key patient safety focus. The effort to increase adherence to the 4 moments of hand hygiene involved a strong senior management support, support of physician-leaders and collaboration among Infection Prevention and Control (IPAC), decision-support, and frontline healthcare providers, patients and visitors to create a culture that recognize the HH as the most important patient safety initiatives. Standardized Mortality Rate Our efforts to continuously analyze performance and identify areas where improvement opportunities may be found.