Nurses are being urged to use the close relationships they form with patients to help make them feel more at ease about challenging other staff about hand hygiene.
The advice is being issued in light of evidence suggesting that a national campaign has made little difference to the number of patients asking staff to clean their hands.
Fewer than half - 47 per cent - of respondents to a survey assessing the Clean Your Hands campaign said it had encouraged patients to confront staff 18 months after it was launched, compared with 46 per cent six months after rollout.
Campaign head Katherine Wilson said: “This is very personal as you’re questioning people about their hygiene.
“The degree of familiarity patients have with the people caring for them makes a big difference as to how comfortable they feel [asking about hand hygiene compliance].”
The fact that patients put so much trust in nurses meant they were well placed to talk about hand hygiene, she said.
Anecdotally, the campaign had found nurses were equally unwilling to challenge healthcare professionals about whether or not they had cleaned their hands when they were admitted to hospital as patients.
The campaign was introduced to all 187 acute hospital trusts between December 2004 and June 2005.
It aims to empower patients, increase the number of alcohol hand rubs located near patient beds and increase awareness of hand hygiene through the use of posters.
It has led to an “significant” increase alcohol hand rub usage in the past four years, but not at the expense of soap, the independent evaluation found.
But the report describes as “disappointing” the fact that compliance has been monitored by infection control teams or staff in only half of inpatient wards over the past six months.
Ms Wilson said: “Although that’s a disappointing response, audit levels are going up.
“Having the opportunity to observe someone can be difficult if care is being delivered in an area where it would be intrusive.”