title: A simple effective clean practice protocol significantly improves hand decontamination and infection control measures in the acute surgical setting.
abstract: BACKGROUND
  The Hand Hygiene Liaison Group and Epic Projects (Pratt et al., J Hosp Infect 47[Suppl A], 2001) have asked specifically for further trials of educational interventions to improve hand decontamination compliance and infection control in the hospital setting. This study investigates the efficacy of a 'clean practice protocol' (CPP), derived from international guidelines, to improve compliance of infection-control practices by surgical teams in a large UK teaching hospital.
  
  
  METHODS
  The key infection-control activities were summated to form the CPP presented here. An undisclosed infection-control audit of consultant-led ward-rounds from breast, gastrointestinal, vascular, urological, and intensive care departments was performed. The audit results were presented to the surgical teams, after which an education/awareness program was implemented. A repeat undisclosed audit was performed 3 months later. In both audits, infection-control activities were recorded together with consultation time and any patient infective complications.
  
  
  RESULTS
  The surgical teams performed as follows in the initial audit: hand decontamination (28% of consultations), correct use of gloves (2%), instrument cleaning (0%), garment contamination (49%), and notes contamination (34%). Introduction of the CPP education program significantly improved hand decontamination to 87% (p < 0.0001), the correct use of gloves/aprons to 50% (p < 0.0001), and overall infection-control practice from 63% to 89% (p < 0.05).
  
  
  CONCLUSIONS
  The introduction of the CPP significantly improved compliance of hand decontamination, correct usage of gloves and aprons, and overall infection-control in a large teaching hospital. The CPP is a highly effective auditing and educational tool that can be readily adapted for use in hospitals globally to monitor and improve infection-control practices.
authors.affiliation: Department of Surgery, Oxford Radcliffe Hospitals Trust, Oxford, UK. pj@doctors.net.uk
authors.forename: D P J
authors.initials: DP
authors.lastname: Howard
authors.forename: C
authors.initials: C
authors.lastname: Williams
authors.forename: S
authors.initials: S
authors.lastname: Sen
authors.forename: A
authors.initials: A
authors.lastname: Shah
authors.forename: J
authors.initials: J
authors.lastname: Daurka
authors.forename: R
authors.initials: R
authors.lastname: Bird
authors.forename: A
authors.initials: A
authors.lastname: Loh
authors.forename: A
authors.initials: A
authors.lastname: Howard
mesh_terms: D001291:Attitude of Health Personnel; D003428:Cross Infection / Q000517:prevention & control; D004517:Education, Professional; D017575:Gloves, Protective / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006235:Hand Disinfection / Q000379:methods*; D006282:Health Personnel; D006784:Hospitals, Teaching; D006801:Humans; D017053:Infection Control / Q000379:methods*; D013530:Surgical Wound Infection / Q000517:prevention & control; D006113:United Kingdom