A detailed survey of hand hygiene in 16 intensive care units (ICUs) in Yorkshire was undertaken with the aim of following up the results of a national survey of infection control policies and practices which had been conducted in 1990 (Inglis et al., Br J Anaesthesia 1992; 68, 216-220). The main problems associated with infection control were identified as: the limited relevance of some infection control policies to the specialist nature of intensive care, poor compliance by nurses to local infection control policies, sub-optimal hand hygiene by all healthcare professionals and a need for more effective communication of research-based infection control recommendations in the ICU. Our results suggest that hand hygiene practice in the ICU is sub-optimal as a consequence of ineffective communication of infection control recommendations, insufficient promotion and enforcement of agreed research-based infection control practices, and a deficiency in infection control education. The current methods of communicating infection control recommendations have a limited effect on compliance rates in the ICU and are not evaluated adequately. Recommendations for further development in this field are to prioritise surveillance of infection rates in ICUs and to feedback infection rates to intensive care staff, to identify local priorities for infection control and to introduce continuous infection control education for all healthcare professionals. Further research is required to investigate and understand why educated health professionals are not complying with recommended research-based infection control practices.