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A Simple Effective Clean Practice Protocol Significantly Improves Hand Decontamination and Infection Control Measures in the Acute Surgical Setting

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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.


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 intensivecare 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.


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).


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.

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Correspondence to D. P. J. Howard.

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Howard, D.P.J., Williams, C., Sen, S. et al. A Simple Effective Clean Practice Protocol Significantly Improves Hand Decontamination and Infection Control Measures in the Acute Surgical Setting. Infection 37, 34–38 (2009).

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