We read the six commentaries about our paper with great interest. It is clear from the breadth of the contributors' expertise that controlling the spread of infectious diseases in healthcare settings is indeed a multi-factorial problem that requires a team-based multidisciplinary response. Indeed, it is this multi-factorial nature that makes improving our record all the more challenging. For example, one could focus on, and sustain significant improvements in, cleaning and yet have a limited impact on infection rates because of poor compliance with hand hygiene and isolation procedures.
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