Nurses' hand decontamination practice: results of a local study.

Cross-infection in hospital occurs mainly via hands. Hand washing is the most effective means of prevention, yet it has been reported that hands are washed too seldom, often inappropriately and that technique is poor. However, these claims are often made without explaining precisely how data were collected. This study employed more rigorous criteria than earlier research to judge the appropriateness and technique of nurses' hand contamination. During the 2 h that they were observed nurses decontaminated hands after 28.7% patient contacts. The data were then reanalysed so that only those activities likely to result in heavy contamination were examined. This revealed that such 'essential' decontaminations were performed on 49.8% occasions. Differences were found between hospitals related to the availability of hand decontaminating agents, particularly when nursing workload became high. A scoring system to assess technique was developed for the study. Mean score was 8.6 out of 12. Technique was superior for nurses employed in intensive care units regardless of the hospital in which data were collected (P < 0.0001). Nurses' knowledge of infection control was poor, but those with more knowledge decontaminated hands more appropriately (P < 0.004), although they did not have a better technique. It is recommended that future research move beyond mere description, with its inevitable conclusion that clinical staff should improve performance, turning toward the identification of local barriers to effective practice. This could be followed by improvement in resources and educational intervention should these emerge as problematic.