Hand Washing Practices in Neonatal Intensive Care Units.

One-third of the annual 4 million neonatal deaths occurring worldwide are associated with infections [1,2]. In countries with high neonatal mortality (>45 per 1000 births), 50% of these deaths are attributed to infections [2]. India contributes to one-fifth of the total live births and 27% of global newborn mortality [3]. Essential maternal and newborn care interventions such as clean delivery, hygienic cord care, thermal care and breastfeeding can reduce infection-related neonatal deaths by 20–50% [4,5]. Simultaneously, it is prudent to escalate all measures to decrease health care-associated infections (HCAI) or ‘nosocomial’ infections. Proper hand washing by personnel handling neonates is a simple and effective intervention to prevent HCAI. However, it requires staff accountability and behavioral change. Strict adherence to hand hygiene practices in neonatal intensive care unit (NICU) has the potential to reduce the duration of hospital stay, long-term morbidity, emergence of multiresistant organisms, cost of medical care and unnecessary deaths associated with HCAI. The rationale for hand washing is to reduce transient and resident micro-flora, and there is substantial evidence for the same. Better adherence to hand hygiene guidelines and policies has been shown to reduce the HCAI rate by as much as 40% [6,7].