Forty per cent of health workers fail to clean their hands as often as they should, putting patients at increased risk of harmful infections, hospital audits show.

Universal compliance with hand-hygiene rules is the goal under World Health Organisation guidelines. It is considered a crucial way of reducing rates of harmful and sometimes fatal infections picked up in hospitals.

Reports obtained by the Herald under the Official Information Act from the Auckland, Counties Manukau and Waikato district health boards show Waikato has the highest compliance rate - 60 per cent.

"Scrubbing" is a well-known hand-washing procedure for surgical staff, but the initial zeal of many ward staff has waned for cleansing hands every time they should with alcohol-based gel or soap and water.

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Quality-improvement experts say huge progress has been made since the introduction of the WHO-based hand hygiene campaign in 2009 but much more work is needed.

In pilot wards at Counties Manukau, compliance measured by designated observers soared from 45 per cent in May 2009, to a peak of 81 per cent in January last year, before slumping to 58 per cent in the latest "gold audit" in January.

Counties wards also conduct self-audits as a way of staff taking responsibility for improving hand hygiene. Self-audited compliance was 83 per cent on average in May in 13 of 22 wards.

In January's gold audit, nurses came out top at 68 per cent compliance, with doctors on 46 per cent, blood-taking phlebotomists on 51 per cent and student health workers lowest on 29 per cent.

At Middlemore Hospital, intensive care unit staff are now asked to be "naked below the elbow", keeping their arms and hands free of clothing, jewellery and watches, to make it easier to clean their hands.

At Auckland DHB, the neonatal intensive care unit (NICU) has consistently scored best, reaching 90 per cent in a March audit, well above the 58 per cent average of seven wards followed closely. Among units audited only annually, the adults' emergency department was worst, on 37 per cent.

"This sustained improvement in hand hygiene compliance rates in NICU has resulted in lower healthcare-associated bloodstream infection rates in vulnerable infants," DHB chief executive Garry Smith said. "We want to make improving hand hygiene compliance a reality, not just something we talk about."

But Mr Smith said overseas efforts showed that changing staff behaviour was complex. "We are learning what is necessary to sustain a successful culture change."

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HOW CLEAN
The requirement:
* That staff always clean their hands before and after touching a patient, before and after a procedure, and after touching patient surroundings.

Percentage of health workers who comply:
*Auckland District Health Board - 57

*Counties Manukau DHB - 58

*Waikato DHB - 60

From observation audits in selected wards.