HCWs' compliance was improved after the initiation of the bed-rail approach in department B (51.5%, vs 36.4% P = .005). In department A, where this system already existed, no changes were observed. The bed-rail AHRA system (P = .007 [OR 1.8(1.2-3.0)]) and nurses (P<.0001[OR 5.6 (3.1-9.9)]) were predictors of hand hygiene in department B. HCWs' compliance declined in department B (26.5% vs 51.5%, P<.0001) and department A (27.5% vs 35.9%, P = .1) during period III.