Strict hand hygiene in healthcare facilities is essential to control the spread of infection, but the practice often falls short of the theory.
In the UK, for example, almost a third of staff in the NHS say that basic supplies, such as soap, hot water, paper towels or sanitising rubs, are not always available when they are needed.
And the situation seems to be getting worse: in a recent survey of the workforce, the proportion who said supplies were always available when needed fell to 68% from 71% in 2009.
Nor are things better in the US. Two of the world's foremost experts on infection prevention, speaking recently at a forum organised by Loyola University Medical Center and Medline Industries, said that US healthcare facilities are grossly underperforming in hand hygiene compliance.
According to Professor Didier Pittet, director of the infection control programme at the University of Geneva, it takes from 60 to 90 seconds to perform proper hand washing. If workers wash their hands 15–20 times in an hour, that would take about half an hour, which is totally unrealistic.
Alcohol-based hand rubs not only take just 15–30 seconds, but they are also portable and more effective than soap and water. However, many of the products used in the US would not pass European norms because their ethanol content is only 62%.
Innovative systems to monitor hand hygiene practices are now reaching the market; these will not only determine the extent of the problem, but also encourage compliance.
But while you can lead a horse to water and encourage it to drink, it is a pointless exercise if the trough is dry.