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Joanna Whichever method you decide to adopt, be cautious. I have on my files here details of a number of different approaches to the auditing of hand hygiene. Some use simple techniques, others more complex ones. However, when you consider them, none can be said to be the ultimate answer. All have a variety of shortcomings. Additionally, keep in mind the Hawthorne factor. How you allow for this is something that has never been completely resolved. Furthermore, hand hygiene is not the be all and end all of infection prevention. At the time the editor of the Journal of Hospital Infection, Dr. S.J.Dancer wrote: "It is time to balance the current obsession with hand hygiene by prioritising some of the other infection control options that we have, which, while undoubtedly more costly than posters and alcohol gel, provide some evidence for patient benefit regarding the risks of HCAI." And this brings me to the patient. I was taken ill back in 2008 and rushed to A+E. When I was finally transferred to a ward I was handed a card about ensuring that I challenged health care personnel about sanitising or washing their hands before touching me. Nothing about my own personal hand hygiene. Yet there are studies showing that a significant number of HCAIs are due to the patient infecting themselves. Whilst there was a dispenser of alcohol gel in my bed space, it was at the foot of the bed and unreachable by me. Of course, my wife on her first visit brought me a dispenser of alcohol gel! Interestingly, health care staff approaching me without sanitising their hands, on noticing this dispenser on my bedside cabinet, returned to the foot of the bed to use the gel there! Indeed, the whole topic is much more complex than many realise, even some of those working in infection prevention. For example, excessive hand washing can actually make the skin more easily colonised by infective micro-organisms, which are then more difficult to remove, thereby negating the benefit of hand washing. Many nurses I observed during my time in a hospital bed whilst attempting to wash their hands failed to rinse adequately, thereby negating the whole purpose of the hand washing. Will this be reflected in the audit and if so how? What is really needed is a comprehensive approach, covering design of facilities and equipment, proper risk assessment and the introduction of appropriate control measures, which will, of course, include, but not be limited to, hand hygiene. Best regards Chris Chris Packham FRSPH, FIIRSM, FInstSMM, MCMI, RSP, MBICSc EnviroDerm Services Unit 10, Building 11, The Mews, Mitcheldean, GL17 0SN Tel: 01386 832 311 Mobile: 07818 035 898 www.enviroderm.co.uk ******************************** Please remove this footer before replying. OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html CONFERENCES AND STUDY DAYS: http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH