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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. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS *
Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA Karen N Wharton & M Gary Karlowicz Authors * Karen N Wharton View author publications You can also search for this author
inPubMed Google Scholar * M Gary Karlowicz View author publications You can also search for this author inPubMed Google Scholar ADDITIONAL INFORMATION (Spon by: E. Stephen Buescher) RIGHTS
AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Wharton, K., Karlowicz, M. Barriers to Full Compliance with Hand-washing Guidelines in a Neonatal Intensive Care
Unit 1487. _Pediatr Res_ 43 (Suppl 4), 254 (1998). https://doi.org/10.1203/00006450-199804001-01508 Download citation * Issue Date: 01 April 1998 * DOI:
https://doi.org/10.1203/00006450-199804001-01508 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is
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