The story of hospital acquired infections is one of shirked responsibility amongst people who are rarely identifiable and who are never brought to task. First of all, let me put my hands up: as a junior doctor in a busy London hospital, I should probably be washing my hands at least 50 times a day, not just after I see patients (which is what my mum tells me to do), but before.

Of course there are times when I don't do it. And of course it's not acceptable. It's been drilled into me from an early age. I was marked on hand-washing in my finals. There is even a Handwashing Taskforce in my hospital whose sole purpose is to cajole me. I am a murderer by omission. What do I have to say in my defence? And what can you do to defend yourself from my poisonous mitts?

Firstly, antibiotic resistant infections (the nasty ones I give you in hospital) are something we all share responsibility for. Every time you bully your GP into giving amoxycillin syrup to your children for their viral earache (or rather, every time the GP gives in just to get rid of you) you are contributing to the pool of resistant infections in the community.

Every time you stop taking antibiotics before the course is finished, just because your symptoms have cleared up, you allow all the remaining bacteria in your body (the ones that were most resistant to the drug) to live on to fight another day, with someone else's immune system.

Farmers, who, like doctors, alternate between saint and sinner in the popular press, routinely use animal feed containing low levels of antibiotics, because (and no one knows how) they increase the body mass of livestock by a lucrative 10%. In some parts of the world, farmers even use antibiotic spray to reduce the rate of bacterial infections on their crops.

Bacteria are clever little things. Once one of them has evolved a trick to make it resistant to antibiotics, it tells all its friends, by sharing little blobs of DNA around so that the others can make copies and share in the secret. The more we use antibiotics, the more we send them into battle, the more chance bacteria have to see what we've got, and to develop new tricks for resistance.

So now I've got that off my chest, how does it get me off the hook with not washing my hands in hospital? Of course it doesn't. But there are things that could be done to make things easier for doctors and nurses.

Firstly, I don't see little pots of moisturising cream being handed out on morning ward rounds. There is a little patch of skin on my left hand which has been red, cracked and dry ever since I began working. There are (ahem) marginally more expensive brands of hospital handwashing product that come with moisturiser already in them.

There are also (more expensive) alcohol-based handwashing solutions which take 10 seconds, rather than 90, to use. The infection control guidelines in my last hospital stated that these should be at the foot of the bed of every patient who was a high risk for infection: the ward managers, who run their own budgets like the ward was a franchise, have their own ideas.

But smaller initiatives like these make much more of a difference to whether or not we give you nasty infections in hospital than punitive measures or nagging posters, because there are serious workforce implications to washing your hands.

Studies have shown that if nurses on intensive care washed their hands every time it was appropriate, it would take up a fifth of their working day. I already work an unholy number of hours a week, much of it unpaid overtime, so do I add handwashing to my list of things worth ruining my social life for?

Where is the initiative to increase staffing levels by 20% to fund our way out of this scourge of unwashed hands? Where is the evidence to demonstrate that the problem warrants that expenditure? Should I wash my hands after I shake a patient's hand? After I place a concerned hand on their relative's shoulder?

And it's not just hands. There are numerous "humourous" articles in the Christmas editions of medical journals about the disgusting bacteria that reside on the white coat sleeves of junior doctors. My hospital laundry is only open four hours a day. And what about my stethoscope?

So all of this fuss about handwashing guidelines and dirty hospitals (more cleaners, please) was a missed opportunity to promote real initiatives. Which is all very well, but you want to know how to stay alive once you find yourself trapped in my apparently filthy hospital.

The first thing to remember is to get out as soon as you can. I fight a never-ending battle with certain social workers who give old people stuck in hospital a low priority for services in the community, because they labour under the mistaken impression that hospital is a safe place to be if you're medically stable. Of course it's not.

Old people - or rather, people who are run down and weak - are vulnerable wherever they are. You won't catch me going down with one of those nasty infections I carry around under my fingernails: sometimes I don't even wash my hands before I go to the hospital sandwich bar. You could inject me with 10ml of pus from their festering bed-sores and I'd still be back for more. If you're in hospital and there is any chance you could get home, you should be campaigning tirelessly for your release.

But what if you're stuck? The first thing to remember is that just because someone's in hospital, it doesn't mean that all responsibility for their existence is passed over to the state. If your elderly mother needs food to keep her strength up, then the best I can honestly suggest is that you bring her some, because all the jokes about hospital food are true (a prison meal is said to cost 50% more than a hospital one).

If you think someone has been given a catheter for convenience's sake, ask the doctors about it. It's a route of entry for bacteria, and the same goes for cannulae, and both can sometimes get overlooked.

And if you think that the state of hygiene of a patient or a part of the ward really is poor, then mention it to someone, tactfully, referring to specific events and choosing your target - a doctor, a friendly nurse - or even write to the infection control team. It's easy to get labelled a "difficult patient", of course, but most people work in hospitals for the best motives, and in every hospital the majority, however busy they might be, want to be aware of the problem.