As the Government announces tighter hospital hygiene controls to tackle the deadly superbugs that have killed 5,000 patients in British hospitals, Health Editor Barry Nelson takes the hand-washing test... and finds it surprisingly difficult.

OK, so what's so hard about washing your hands properly? That was the question going around my head as I walked across the Darlington Memorial Hospital car park.

With headline writers apparently obsessed with the threat of MRSA (which we now know stands for Methicillin-resistant Staphylococcus Aureus) hospital officials thought it might be interesting to challenge The Northern Echo's health editor to beat the dreaded bug.

The infection control team at the 1,000 bed County Durham and Darlington Acute Hospitals NHS Trust wanted to show me just how hard it is to get rid of common bacteria from your hands and the lengths to which hospitals have to go to beat the menace.

This apparently simple issue of good hand hygiene is at the heart of a national crusade against MRSA and other hospital-acquired infections.

With around 5,000 NHS patients dying after becoming infected in hospital, the Government is taking a hard line.

Earlier this week the Government announced that tighter hospital hygiene controls will be imposed to tackle MRSA rates during the next Parliament. MRSA is particularly worrying because it is resistant to most hospital antibiotics and is difficult to treat.

New Health Secretary Patricia Hewitt said she was horrified that food factories seemed to have stricter hygiene controls than hospitals.

As part of the new Health Improvement and Protection Bill it is expected that special anti-MRSA task forces will be sent into hospitals which have a problem with infection control.

In common with every other hospital trust in the North-East and North Yorkshire, the County Durham trust has a team of specially trained consultants and nurses in charge of infection control. They are responsible for policing anti-infection procedures and enforcing strict hand washing on wards.

Within minutes of meeting members of the infection control team, I was invited to place my hand, palm down, on a special glass plate. The plate was then sent to a laboratory where any traces of bacteria could be specially grown.

Then the doctors and nurses asked me to thoroughly coat my hands with a cream which is only visible under fluorescent light and then nip off to the nearby washroom to try and wash it off.

Taking a good dollop of good hospital soap, I carefully washed and rubbed my hands until they were completely clean. Or so I thought...

But when I thrust my hands under the fluorescent 'glow-box', I found patches of the previously invisible cream all over my hands.

I could have sworn I had washed every square centimetre but the glow box does not lie. The tips of my fingers were particularly 'dirty', which I found amazing.

"This is something we do with trainee nurses to show them how difficult it is to clean your hands properly with soap," says Moira McCauley, infection control nurse at the trust. "The cream you put on before trying to wash it off highlights the commonest missed areas during hand washing, such as between the fingers, fingertips and the dominant thumb."

In recognition of the need to find a better way to clean the hands of medical and nursing staff, anti-bacterial alcohol-based gels have become increasingly common. Quick and easy to use and drying within seconds, they can be applied between patients.

Considering that nurses can have to wash their hands up to 70 times an hour, the gel alternative is extremely practical, and it is hoped it will have an impact on MRSA figures.

Until February, the County Durham trust only had a limited number of gel dispensers scattered through the trust but now, as part a national policy which applies to every NHS acute hospital in England, gel dispensers must be available at every bedside.

As part of the crackdown on poor hygiene, a poster campaign aimed at staff, patients and visitors is also being promoted across all English hospitals. Visitors are being asked to wash their hands thoroughly before and after any contact with patients.

The use of gel was pioneered by a handful of hospitals around the country a few years ago, including York District Hospital, where doctors and nurses carried small bottles of gel around with them, dangling from hooks and pockets. It was so successful that the Department of Health has made the practice mandatory.

"It is certainly a simple, efficient and quick way to decontaminate hands. It evaporates after 20 seconds, which makes it ideal for use between patients," says Moira.

Dr David Allison, a consultant microbiologist at the County Durham trust and a member of the infection control team, is realistic about the prospects of completely eliminating MRSA.

"I am afraid the genie is very definitely out of the bottle. We have to face the fact that MRSA is in the population at large," says Dr Allison, who provides consultant back-up to the specialist nursing team. "The most vulnerable to organisms such as MRSA are the elderly and people with wounds. As we carry out more and more serious procedures on older people, the risks are building up. Some people in the community have MRSA living on their skin and most of the time they will live perfectly happily with this situation. It is only when it causes illness that we tend to take notice."

While Dr Allison acknowledges that from the public and Press points of view MRSA is the big bogeyman, he points out that not all deaths from hospital-acquired infections are caused by this particular organism.

"Five thousand deaths is a figure which is bandied about but it is not all MRSA. It is other organisms as well. That is why it is important that we try to get all hospital staff doing the right thing all of the time as far as hygiene is concerned."

In an actual outbreak, extra hygiene measures are introduced and the patient is usually isolated, sometimes in a side ward. Nurses and doctors have to wear gloves and aprons if they handling the infected patient.

In March, the Government claimed that hospitals in England have reached the turning point in the battle to reduce MRSA, with confirmed cases falling from 3,744 in the six months from April to September 2003 to 3,519 in the same period last year, but officials acknowledge there is a long way to go.

The County Durham and Darlington trust had 22 cases during the same period (0.12 per thousand bed days) which puts them in the middle of North-Eastern hospital trusts.

The lowest MRSA rate in the region was at the Harrogate Health Care NHS Trust, which had just three cases (0.05) and the larger North Tees and Hartlepool trust which had seven cases (0.06).

A couple of weeks have passed since a sample of my personal microbiological fauna was donated to the Darlington hospital lab.

Its report demonstrated that I had a cross-section of everyday bacteria living on the skin of my hands which had absolutely no effect on my health but could potentially cause problems for a sick and elderly patient recovering from an operation.

The message could not be clearer. We all have a responsibility not to take potentially dangerous germs into a hospital environment.

Bring on the gel, now.