British athletes are being told not to shake hands at the 2012 Olympics in London, a good idea considering that one-in-five hospitals – hospitals with sick people where everyone is supposed to religiously wash hands – in Australia suck at handwashing.

The Australian government on Tuesday released data on the MyHospitals website about how often staff at 233 public hospitals clean their hands, against an interim benchmark of 70 per cent.

It is the first time such information has been made publicly available.

The figures show that about half of the country's major public hospitals are above the benchmark, while just over 30 per cent were similar to the current standard.

Around 19 per cent were below the benchmark.

The data are based on audits of hand hygiene moments - when there is a perceived or actual risk of pathogen transmission from one surface to another via someone's hands - in public hospitals between July and October last year.

Meanwhile, Dr Ian McCurdie, the British Olympic Association (BOA) chief medical officer, told the Daily Mail that a mild bug which can knock athletes off their stride could be picked up in the "quite stressful environment" of the Games.

When asked whether this means shaking hands should be off-limits, he said, “I think, within reason, yes.

“I think that is not such a bad thing to advise. The difficulty is when you have got some reception and you have got a line of about 20 people you have never met before who you have got to shake hands with.

'Within reason if you do and have to shake hands with people, so long as you understand that regular handwashing and/or also using hand foam can help reduce the risk - that would be a good point.'”

The advice is part of a detailed package of health and resilience issues which the BOA has looked at ahead of the Games.

Tina Rosenberg of the New York Times writes that in the intensive care units at North Shore University Hospital in Manhasset, N.Y., two L.E.D. displays adorn the wall across from each nurses’ station. They show the hand hygiene rate achieved: last Friday in the surgical I.C.U., the weekly rate was 85 percent and the current shift had a rate of 91 percent. “Great Shift!!” the sign said. At the medical I.C.U. next door, the weekly rate was 81 percent, and the current shift 82 percent.

Those L.E.D. displays are very demanding — health care workers must clean their hands within 10 seconds of entering and exiting a patient’s room, or it doesn’t count. Three years ago, using the same criteria, the medical I.C.U.’s hand hygiene rate was appalling — it averaged 6.5 percent. But a video monitoring system that provides instant feedback on success has raised rates of handwashing or use of alcohol rubs to over 80 percent, and kept them there.

Hospitals do impossible things like heart surgery on a fetus, but they are apparently stymied by the task of getting health care workers to wash their hands. Most hospitals report compliance of around 40 percent — and that’s using a far more lax measure than North Shore uses.

How do hospitals even know their rates? Some hospitals track how much soap and alcohol gel gets used — a very rough measure. The current standard of care is to send around the hospital equivalent of secret shoppers — staff members who secretly observe their colleagues and record whether they wash their hands.

This has serious drawbacks: it is expensive and the results are distorted if health care workers figure out they’re being observed. One reason the North Shore staff was so shocked by the 6.5 percent hand-washing rate the video cameras found was that measured by the secret shoppers, the rate was 60 percent.

The North Shore study, published this week in the journal Clinical Infectious Diseases, is the first use of video in promoting hospital handwashing, and the first controlled study in a peer-reviewed journal of a high-tech effort to increase hand hygiene rates.

North Shore instead uses a video monitoring system made by a company called Arrowsight. Cameras on the ceiling are trained on the sinks and hand sanitizer dispensers just inside and outside patient rooms. (Patients are not photographed.) A monitor at each door tracks when someone enters or leaves the room — anyone passing through a door has 10 seconds to wash hands. Arrowsight employees in India monitor random snippets of tape and grade each event as pass or fail.

What makes the system function is not the videotaping alone — it’s the feedback.

The nurse manager gets an e-mail message three hours into the shift with detailed information about hand hygiene rates, and again at the end. The L.E.D. signs are a constant presence in both the surgical and medical I.C.U.s

This is Arrowsight’s first foray into health care. The company’s main business is meat: half the beef processing plants in America use its video system to monitor workers’ hygienic practices.

Adam Aronson, Arrowsight’s chief executive, said that at one plant cameras focused on a hand sanitizer dispenser right outside the bathroom. With monitoring and feedback, hand hygiene rates went from about 4 percent to over 95 percent, and the achievement was sustained.

At first Farber feared he wouldn’t be able to get approval; the conventional wisdom was that employees don’t like being videotaped. But then he thought about a recent experience at the dry cleaner: he had picked up some of his daughter’s clothes, but one of her suits was missing. He went back to the shop and told them the date and approximate time of his visit. They pulled up a video that indeed showed him leaving her suit behind. “If dry cleaners are doing that, we need to do that in the hospital,” he thought.

Joyce Slaton of Chow tracked me down the other day and we had a lovely chat about yucky things after I had taken my daughter to school and before she had to pick up her daughter. Time zones.

Slaton writes that research conducted in the summer of 2011 by Harris Interactive found a solid 79 percent of respondents saying they'd avoid a restaurant after encountering a nasty bathroom. But does the link between a filthy toilet and a dirty prep table even make sense? Hard data is rare. Though health and restaurant inspectors do check for the general appearance of cleanliness in restrooms and dining areas, they save their swabs and scientific gauges for the food-prep areas.

But as Douglas Powell, professor of food safety at Kansas State University, publisher of food safety-focused barfblog.com, and a passionate proponent of proper handwashing (we'll get to that in a moment), says, "There's a yuck factor when you go in and say, 'Eww, this is dirty, what else is?' But there's no proven correlation between having a dirty bathroom and unsafe food. The employees have different sinks to wash their hands in. You don't see those—they're at the back."

Chowhound poster soupkitten makes a good point in a thread titled Freezing Bathrooms=Omen: "Folks who want to point to a smudge on the front window of a restaurant or a smudge on the floor of the men's room as evidence that the kitchen of a restaurant or any other business is unsanitary seriously need to realize that most establishments have divisions of labor and that the brunch crew comes in at 6 a.m. to crack eggs, not wash windows and wipe down toilet seats!"

Meanwhile, Powell (politely) pshaw-ed my notion that a dirty bathroom meant that diners should order differently or avoid a restaurant.

"But," he warns, "if you see a cook or a waiter come in and use the bathroom and start to leave without washing up, say something [like], 'Dude, wash your hands!'" Powell also hopes patrons will speak up when bathrooms don't have the tools for proper handwashing. Which are?

• Vigorously flowing water: "Temperature doesn't matter," says Powell, despite the fact that we've all been told that warm water works better. Microbiologically, it doesn't matter.

• Soap: Lather energetically for 10 seconds, not 20 as you may have heard. It's OK with Powell if you want to sing "Happy Birthday" to yourself while you do it, but he'd rather you count than sing kiddie songs.

• Paper towels: The blow-dryers disperse microorganisms into the air and they don't get your hands dry, says Dr. Powell. Paper towels are better. But don't bother using one to hold the bathroom door handle as you go out: The door handle surface isn't a particularly great place for bacteria to grow.

A study by Kansas State University shows posters can make a difference when it comes to hand hygiene in a health care setting.

The research, based on observations of more than 5,000 patrons at a hospital-based cafeteria, shows that an evidence-based informational poster can increase attempts at hand hygiene. The study appears in the current issue of the American Journal of Infection Control, and was funded by One Health Kansas, a project supported by the Kansas Health Foundation.

The research team included K-State's Katie Filion, a December 2010 master's graduate in biomedical science; Kate KuKanich, assistant professor of clinical sciences; Megan Hardigree, a 2008 master's graduate in kinesiology; and Doug Powell, professor of food safety. Also on the team was Ben Chapman, assistant professor in the department of 4-H youth development and family and consumer sciences at North Carolina State University.

Hand hygiene is important before meals, especially in a hospital cafeteria where patrons may have had recent contact with infectious agents, KuKanich said.

"Few interventions to improve hand hygiene have had measurable success. This study was designed to use a poster intervention to encourage hand hygiene among health care workers and hospital visitors upon entry to a hospital cafeteria," she said.

Over a five-week period, a poster intervention with an accessible hand-sanitizer unit was deployed to improve hand hygiene at the entrance to a hospital cafeteria. An anonymous researcher was able to observe hand hygiene attempts from the adjacent dining area. The study included baseline, intervention and follow-up phases, with each consisting of three randomized days of observation for three hours at lunchtime.

Gains were modest, Powell said. During the 27 hours of observation, 5,551 participants were observed, with hand hygiene attempts increasing from 3.16 per cent to 6.17 per cent.

Hand washing compliance efforts have focused on increasing availability of proper tools for hand hygiene, education and training, and use of prompts such as visual reminders or peer pressure and the presence of others, according to Powell and KuKanich.

"Hand hygiene is still the best way to prevent the spread of infectious diseases. Unfortunately, many of us don't wash our hands as often as we should," KuKanich said.

"Those 'Employees Must Wash Hands' signs in bathrooms may not be the most effective reminder," Powell said. "While improvements in this study were modest, we have set an evaluation framework to work with informational posters that use more graphical messages and reminders that use a shock-and-shame approach."

An abstract of "Observation-based evaluation of hand hygiene practices and the effects of an intervention at a public hospital cafeteria" is available at http://www.ajicjournal.org/article/S0196-6553%2810%2900986-7/abstract