“…Such programs should learn from experiences gained during evaluations of training programs on hand washing practices (Green et al, 2007;Pragle, Harding, & Mack, 2007), on general food safety issues (Egan et al, 2007;Kassa et al, 2010;York et al, 2009) or, in a broader perspective, on effectiveness of programs on surface cleaning in institutional settings (Goodman et al, 2008;Matlow, Wray, & Richardson, 2012) or reducing of infections rates (Schweon, Edmonds, Kirk, Rowland, & Acosta, 2013). Although training and intervention had the intended result in some of these studies, education alone did not always result in improved hand washing practices or improved food safety practices (Egan et al, 2007;Green et al, 2007;Pragle et al, 2007;York et al, 2009). Therefore, these authors argued in favor of multidimensional approaches to also address barriers such as time pressure, inadequate facilities and supplies, lack of accountability, lack of involvement of managers and co-workers, and organizations that are not supportive of changing practices.…”