Medical workers in a Nebraska hospital nearly doubled their use of alcohol-based gels, but their generally cleaner hands had no bearing on the rate of infections among patients, according to a new study in the January issue of Infection Control and Hospital Epidemiology.

Dr. Mark Rupp, an infectious disease specialist at the University of Nebraska Medical Center pointed to many villains: Rings and fingernails that are too long and hard to clean, poor handling of catheters and treatment areas that aren’t sanitized.

"Hand hygiene is still important, but it’s not a panacea. … There are many factors that influence the development of hospital-acquired infections. It would be naive to think that a single, simple intervention would fix this problem."

The findings of the new study were based on 300 hours of hand hygiene observations of nurses and doctors in two comparable intensive care units over a two-year period.