Background: According to the AAP and ACOG Guidelines for Perinatal Care, hand-washing before and after patient contact is considered the single most important routine practice to prevent spread of nosocomial infections. It is noteworthy that despite such well-known guidelines, Brown et al. showed that physicians and nurses washed their hands less than 25% of the time before patient contact in a neonatal intensive care unit (NICU), (Pediatr Infect Dis J 1996; 15: 908-910).

Objectives: To determine the barriers to full compliance with hand-washing prior to patient contact in the NICU, including health care providers' attitudes, inaccurate understanding of hand-washing guidelines, and physical barriers to hand-washing.

Methods: An anonymous and voluntary survey of nurses, neonatal nurse practitioners, pediatric residents, and attending neonatologists in a 56 bed NICU was conducted between October and December, 1997. A questionnaire was used to explore knowledge and attitudes about hand-washing in the NICU and perceived barriers to full compliance with hand-washing guidelines. The questionnaire allowed for both Likert scale assessments and open-ended answers.

Results: Survey response rate was 53% (98 of 185 completed and returned). Thirty of 46 (65%) physicians and 68 of 139 (49%) of nurses returned the questionnaire. Forty-four percent of respondents reported that hand-washing took too much time. Ten percent responded that hand-washing is not as important if the infant is receiving antibiotics. Twenty-six percent answered that one thorough hand-washing at the start of the day may prevent the spread of most serious infections. Likewise, 25% answered that wearing gloves and changing them between patients may be an appropriate alternative to hand-washing. Significantly more physicians, 15/30 (50%), than nurses, 9/68(13%), responded that gloves could substitute for hand-washing, (Odds Ratio 6.6; 95% CI, 2.4-17.9). Respondents indicated a lack of soap (54%), malfunctioning soap dispensers (57%), and lack of paper towels (65%) are sometimes barriers to hand-washing. On nights and weekends, lack of soap and paper towels become more frequent barriers to hand-washing in the NICU.

Conclusions: We found attitudinal, educational, and physical barriers to full compliance with hand-washing guidelines in the NICU which may respond to specific interventions.