In March 2000 the Plastic Surgery Unit of our 600-bedded district general hospital agreed to be the pilot ward for the introduction of a new standard of hand hygiene, emphasizing the use of alcohol gel on socially clean hands between clinical contact with patients. Hand hygiene practice of healthcare workers (HCWs) was observed using Formic forms. The data from completed forms were scanned into an Excel database, and results fed back to HCWs in graphical form. The case notes of patients newly affected by methicillin-resistant Staphylococcus aureus (MRSA), likely to have been acquired as inpatients, were reviewed for one year before and after this performance feedback of hand hygiene. The cost of teicoplanin use (for MRSA infections) was also determined for the two periods. There was a significant reduction in the number of patients newly affected by MRSA (P<0.05), and in the use of teicoplanin, suggesting that performance feedback of hand hygiene reduces nosocomial MRSA infection rates and antibiotic use.