We did a case-control study in five Hong Kong hospitals, with 241 non-infected and 13 infected staff with documented exposures to 11 index patients with severe acute respiratory syndrome (SARS) during patient care. All participants were surveyed about use of mask, gloves, gowns, and hand-washing, as recommended under droplets and contact precautions when caring for index patients with SARS. 69 staff who reported use of all four measures were not infected, whereas all infected staff had omitted at least one measure (p=0.0224). Fewer staff who wore masks (p=0.0001), gowns (p=0.006), and washed their hands (p=0.047) became infected compared with those who didn't, but stepwise logistic regression was significant only for masks (p=0.011). Practice of droplets precaution and contact precaution is adequate in significantly reducing the risk of infection after exposures to patients with SARS. The protective role of the mask suggests that in hospitals, infection is transmitted by droplets.

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Opinion leaders (OLs) are members within a social group with significant social influence over others. A guideline on urinary catheter care was introduced in three groups (A, B and C) of two randomly allocated wards. Two OLs per ward were identified by nurses in groups A and B, using a sociometric method. For education, inservice lectures for 30% of nurses and OLs tutorials for all nurses were used in group A; OLs tutorials in B, lectures in C and ward nurses were in turn responsible for educating new arrivals of student nurses. Before and after the education programme, the guideline's frequency of practice was assessed by surveying 30% of randomly selected nurses and by direct observation for incorrect practices. A student's quiz on the guideline was also conducted. For all three methods of measurement, the best results were in group A followed by B and C; and the differences for the three groups were significant (p less than 0.05). This indicates that continuing education in the hospital can be effectively conducted by the enlistment of ward OLs.