A Simple Effective Clean Practice Protocol Significantly Improves Hand Decontamination and Infection Control Measures in the Acute Surgical Setting D.P.J. Howard, C. Williams, S. Sen, A. Shah, J. Daurka, R. Bird, A. Loh, A. Howard 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 interven- tions to improve hand decontamination compliance and infection control in the hospital setting. This study investi- gates 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 sum- mated 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, infec- tion-control activities were recorded together with consul- tation time and any patient infective complications. Results: The surgical teams performed as follows in the ini- tial audit: hand decontamination (28% of consultations), correct use of gloves (2%), instrument cleaning (0%), gar- ment contamination (49%), and notes contamination (34%). Introduction of the CPP education program significantly im- proved 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 im- proved 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 hos- pitals globally to monitor and improve infection-control practices. Infection 2009; 37: 34–38 DOI 10.1007/s15010-008-8005-3 Introduction The importance of hand decontamination and generalized cleanliness in hospitals has been recognized since the time of Joseph Lister and Dr. Ignaz Semmelweis in the mid- nineteenth century. Despite the development of many precautions against the transmission of infection, approximately one in ten patients in hospital will develop a hospital-acquired infection (HAI). A recent report estimates that annually, HAI causes 5,000 deaths and costs the health service one billion pounds in England alone with incidences of methicillin-resistant Staphylo- coccus aureus (MRSA) and Clostridium difficile on the rise. An individual patient with a HAI spends approxi- mately two and half times longer in hospital, and costs £3,000 more to treat [1]. According to the World Health Organization (WHO), world-wide over 1.4 million people at any on time suffer from infectious complications ac- quired in hospital [2]. The emergence of antimicrobial resistant microor- ganisms, such as MRSA, multi-resistant Gram-negative aerobes, C. difficile, and enterococci, have increased the severity of HAI in patients who acquire such infections [3] and have made the task of infection control even more important. While it is unlikely that HAI can be com- pletely eradicated, the Department of Health guidelines suggest that approximately 30% of HAI are preventable [4]. The national guidelines for preventing HAIs highlight hand decontamination and the use of personal protective equipment as specific areas for the development of rec- ommendations [2, 5, 6], and evidence indicates that these practices can significantly reduce infection rates in the hospital environment [5, 6, 7]. The Hand Hygiene Liaison Group and Epic Project groups [5] have asked specifically for further trials of behavioral and educational tools to improve hand D.P.J. Howard Dept. of Surgery, Oxford Radcliffe Hospitals Trust, Oxford, UK C. Williams, S. Sen, A. Shah, J. Daurka, R. Bird, A. Loh, A. Howard Dept. of Surgery, Barnet General Hospital, London, UK D.P.J. Howard (corresponding author) 45 Surman House, Mandelbrote Drive, Littlemore, Oxford, OX4 4XG, UK; Phone: (+44/771) 4244-247, e-mail: pj@doctors.net.uk Received: December 22, 2007 Æ Revision accepted: May 5, 2008 Published online: December 5, 2008 Infection Clinical and Epidemiological Study 34 Infection 37 Æ 2009 Æ No. 1 Ó URBAN &VOGEL