"The time has come for the infection control community to move on; please, no more cheerleading louder and harder to get thousands of people to improve their hygiene. We have to accept that our age-old dream of solving a complex problem cheaply and simply has failed. Instead, we must reacquaint ourselves with that lonely feeling familiar to clinicians when they realize a case is much more difficult than it appeared at first glance. In other words, we should embrace the intellectual audacity of our beloved Semmelweis but let go of his how-to manual. As he might tell us (loudly): an ineffective remedy is much worse than no remedy at all."
Is he right? I don't think so. There have been only 4 hand-hygiene intervention studies in the past few decades of high enough quality to warrant inclusion in the 2011 Cochrane Review. I say before we throw in the towel, bury our collective heads in the sand and go all Eeyore, we should probably do a few more than 4 good studies. I also suspect that if we could really figure out why MRSA has declined in recent years, it would come down to hand hygiene improvements and not some expensive PCR.