Hand Hygiene—The Case for Evidence-Based Education:

Among the priorities identified for the National Health Service (NHS) are reductions in hospital-acquired infection and in antimicrobial resistance1. These are to be achieved by improved surveillance, optimal antibiotic prescribing and strengthening of basic infection control procedures such as handwashing. According to recent figures2,3, hospital acquired infection affects 1 in 11 inpatients, carries a 13% mortality and lengthens stay by a factor of 2.5. The extra cost to the NHS is nearly £3000 per patient, and the total annual cost is nearly £1 billion. Between 15% and 30% of hospital-acquired infection is considered preventable, but even a 10% reduction would improve bed management to the tune of 47ooo extra finished consultant episodes per year. The NHS's action plan to reduce hospital-acquired infection4 holds chief executives personally accountable, and requires handwashing to be implemented in line with Department of Health guidance5,6. Healthcare workers' compliance with handwashing is known to be poor, with doctors performing particularly badly7,8. When the Department of Health published its handwashing guidance a storm of correspondence in the BMJ excused low compliance on grounds of lack of time, poor availability of sinks and soaps, skin sensitivity and lack of evidence. This paper reviews the evidence that patient contact results in contamination of the hands by pathogens and that washing with liquid soap and water or, better, use of an alcohol handrub, greatly reduces hand contamination and infection rates, and presents the case for making hand hygiene a medical educational priority9.