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DOCTORS are by far the worst health workers when it comes to washing their hands, with fewer than half managing to do so despite knowing its importance in reducing infection rates, a survey of public hospitals has found.

The study, published in the Medical Journal of Australia today, found that the compliance rate for hand hygiene among doctors was just 39 per cent in July last year.

NSW Health introduced alcohol-based hand rub and conducted the Clean Hands Saves Lives campaign in all hospitals from February, 2006 to February, 2007.

The study, by researchers at the University of NSW and the Clinical Excellence Commission, found that before the campaign, the hand hygiene compliance rate was only 30 per cent for doctors. It improved to 58 per cent by November, 2006, at the peak of the campaign, but dropped again to 39 per cent in July last year.

This was despite doctors wearing "It's OK to ask" badges during the campaign, encouraging patients to check whether they had washed their hands.

Compliance by nurses was much better, the study found.

Before the campaign, 55 per cent of nurses complied, which steadily climbed to 68 per cent in February 2007 and then fell slightly to 65 per cent in July last year.

The overall rate for health workers over the pre-campaign survey and four post-campaign surveys improved from 47 per cent to 61 per cent.

The rates are based on a mean of 7747 hand hygiene opportunities.

The NSW president of the Australian Medical Association, Brian Morton, said mandatory education was needed because there was "a perception that not every time you touch a patient you pick up a handful of germs".

But Dr Morton also blamed the poor rates on a lack of time and not enough hand basins and supplies of alcoholic-based rub, which was introduced to all hospitals in 2006.

He did not support punitive measures, which NSW Health said it would introduce, in line with the Garling recommendations, by the end of the year. The policy would see doctors potentially sacked after three warnings or even deregistered for persistent non-compliance.

Halving infections rates could save 1500 lives a year, NSW Health said.

One of the study's authors, Mary-Louise McLaws, the director of Public Health Programs at the University of NSW, said she was sympathetic to doctors, and punitive measures were "draconian".

Frequent hand washing is one of the best ways to avoid getting sick and spreading illness. Hand washing requires only soap and water or an alcohol-based hand sanitizer — a cleanser that doesn't require water.

When to wash your hands
As you touch people, surfaces and objects throughout the day, you accumulate germs on your hands. In turn, you can infect yourself with these germs by touching your eyes, nose or mouth. Although it's impossible to keep your hands germ-free, washing your hands frequently can help limit the transfer of bacteria, viruses and other microbes.

Always wash your hands before:
Preparing food
Eating
Treating wounds or giving medicine
Touching a sick or injured person
Inserting or removing contact lenses

Always wash your hands after:
Preparing food, especially raw meat or poultry
Using the toilet
Changing a diaper
Touching an animal or animal toys, leashes or waste
Blowing your nose, coughing or sneezing into your hands
Treating wounds
Touching a sick or injured person
Handling garbage or something that could be contaminated, such as a cleaning cloth or soiled shoes
Of course, it's also important to wash your hands whenever they look dirty.

How to wash your hands
It's generally best to wash your hands with soap and water. Follow these simple steps:
Wet your hands with running water.
Apply liquid, bar or powder soap.
Lather well.
Rub your hands vigorously for at least 20 seconds. Remember to scrub all surfaces, including the backs of your hands, wrists, between your fingers and under your fingernails.
Rinse well.
Dry your hands with a clean or disposable towel or air dryer.
If possible, use your towel to turn off the faucet.
Keep in mind that antibacterial soap is no more effective at killing germs than is regular soap. Using antibacterial soap may even lead to the development of bacteria that are resistant to the product's antimicrobial agents — making it harder to kill these germs in the future.