Staff horrified by lice on a patient fail to consider the potentially far more serious consequences of bacteria present on their hands. The failure of healthcare workers to decontaminate their hands reflects fundamentals of attitudes, beliefs, and behaviour, and there are no simple solutions. Many attempts have been made to improve hand washing compliance through education, and indeed elementary hygiene practice should be taught explicitly in medical schools. Principles taught in the lecture theatre can be reinforced by experiential learning, such as demonstrating the need for proper hand washing technique by showing microbial growth from unwashed hands9 and by using fluorescent oil- based dyes to illustrate the effectiveness of hand washing. Such methods increase personal impact, but, though they may be temporarily improve compliance, behavioural changes tend not to be maintained.
Role models are important in hospital practice.
Unfortunately, poor practice can also be learnt at the bedside. Junior staff and students taught to wash their hands abandoned the habit when others, especially more senior ward staff, did not bother. 10 Senior staff should take the lead to achieve lasting behavioural change. To increase compliance, medical staff could police each other,11 and it has even been suggested that patients should be encouraged to ask their carers to wash their hands. It is clear that healthcare workers fail to understand the importance of hand washing.