Story originally posted on 27 April 2009.

Infection Prevention & Control is a complicated subject and everybody is keen to get it right. Good infection prevention & control improves patient safety, makes the hospital run smoothly and helps staff feel that they are doing a good job. However the subject is full of myths and rituals, for example we expect surgeons to wear face masks - but did you know that there is no evidence that they reduce infections in surgical patients?

Here is a list of commonly held beliefs. Some are justified and some have no basis in fact at all. Do you know which is which?

Dirty hospitals have high rates of infection. This sounds so obvious that it must be true

Actually, rates of infection seem to have little to do with how clean a hospital is. Of course, nobody wants to be treated in a dirty hospital any more than they wish to spend a night in a dirty hotel room. However, even in the cleanest hospitals, if the patients, staff and visitors do not follow the basic infection control procedures like good hand hygiene then patients will get infections.

Alcohol hand gel kills all dangerous microbes

Not true again. Alcohol hand gels are very good at killing most germs causing infection (such as Staphylococci, Streptococci and MRSA) but are not effective against some important causes of diarrhoea (such as Clostridium difficile or Norovirus). That is why Infection Prevention & Control advises using soap and water when there are cases of certain infections on a ward.

Cold weather is good because it gets rid of the bugs

A bit of an old wives' tale here. Bacteria can survive very happily at temperatures below freezing. In fact, laboratories that need to keep germs alive for research store them in freezers.

Poor staffing levels on a ward result in more infections

This one is true. Several studies have shown this and cross infection rates can be increased 60 times if a ward is understaffed. That is one reason why it is important for staff to let their line manager know if they are unwell at an early stage so that the ward or department can make arrangements for the clinical area to be staffed at a safe level.

Giving too many antibiotics is bad because people become immune to them

Partly right here. Overuse of antibiotics is bad because it makes the germs resistant. This means that the antibiotics become less useful at treating infections. Overuse also increases the risk of diarrhoea due to Clostridium difficile. However, people do not become immune to antibiotics but the germs can become resistant to them.

Hand gel makes my hands sore

Actually, hand gel, when used properly, is less likely to cause chapped skin than soap and water. Some people do react badly to the alcohol gels and they should try an alternative product. There is also some evidence that using alcohol gel on wet hands makes the problem of sore skin worse. It is best to use gel only (unless soap and water is needed because of an outbreak of diarrhoea) and, if hands are washed they should be thoroughly dried before any gel is applied.

Hospitals and the Government only care about MRSA and Clostridium difficile

This is not true. Although MRSA and Clostridium difficile are measured by law, we have a duty to reduce all infections as much as possible. Also, the measures we put in place to reduce Clostridium difficile and MRSA, like hand hygiene, good care of intravenous lines and isolation of patients with infections, reduce the risk of other infections as well.

Visitors with colds, diarrhoea or other illnesses should stay away from hospital

Quite right. The outbreaks of diarrhoea that we see every winter are often brought into the hospital by visitors. If you are unwell please don't visit.

You always need to wear a face mask when caring for patients with TB

False. National guidelines advise that masks are only required when carrying out 'high risk' procedures such as suction. They are not needed for general contact such as helping a patient to wash, or giving medication.

Patients who are nursed in a side room due to infection shouldn't be allowed out to use the bath or shower

False. It is important that patients with an infection are able to maintain a good standard of personal hygiene. Patients on MRSA treatment will get better coverage if they can use the wash in the shower. The shower is then cleaned thoroughly before the next patient uses it to prevent transmission.

You don't need to start previous MRSA patients on a 'Staph pack' when they are readmitted unless they have a positive screen

Not true. All patients identified as previously having had MRSA should be treated as positive until their latest results come back. If negative then treatment can stop.

Patients who have Clostridium difficile cannot be discharged from hospital until they are 'clear'

This is untrue. Patients may be discharged either to their own home or into residential care as long as they are physically well enough. Any residential or nursing home should be made aware of their results so they can care for them correctly. It is most important that they complete their full course of treatment, even if they no longer have diarrhoea.