Proper hand hygiene protocols are a way to prevent infections in neonates admitted to the NICU. A total of 771 observations on hand sanitizer use before and after patient contact and 208 observations for level of touch were made. Adherence increased significantly since the introduction of waterless individual bedside hand sanitizers: 73% vs. 80% before and 83% vs. 90% after patient contact. The suboptimal adherence to the hand hygiene protocol could not be fully explained by the emergency nature of patient contact, suggesting that time and convenience are not the main concerns that infection control needs to address. The system improvement should focus on providing the tools for perfect hygiene, on optimizing staff education and on improving staff motivation.



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