Hand Hygiene Alone Effective in Preventing Drug-Resistant Infections in NICUs: JAMA

To make an unbiased comparison of these infection control approaches without jeopardizing the safety of the infants, a cluster randomized open label crossover study was conducted among 12 neonatal intensive care units in Germany. The research spanned from 2020 to 2023 and enrolled only infants at high risk of developing Gram-negative infections. In each hospital, the chosen approach was used for one year after which it switched to the other intervention modality for another year, generating 24 distinct clusters.

For the control periods, the participants were compelled to follow the current best practice guideline which involves careful hand disinfection and additional barrier protection using gown and gloves for providing routine care to all the infants suspected of having 3GCR-GNB. During the intervention period, the use of gown and gloves was not required; only standard hand hygiene procedure was to be followed. After completing the data curation process up to December 31, 2024, and conducting the statistical analysis until July 31, 2025, the main outcome measure rate of healthcare associated GNB BSIs on an individual infant level, keeping in view a delta of 5% was considered.

Key findings:

• The major analysis considered an enormous population sample involving 24 clusters made up of 9,731 highly vulnerable neonates in need for intensive care.
• During the periods for simplified standard hand hygiene disinfection process, 22 out of 4,699 neonates (0.5%) were found to acquire a GNB BSI, which was nearly the same as in the extended barrier precaution period, whereby 25 out of 5,032 neonates (0.5%) acquired a GNB BSI, and this demonstrated clear noninferiority with RD being –0.03% (95% CI, –0.43% to 0.38%; noninferiority P < .001).
• Bacterial transmission was observed to occur within 41 out of 144 months when hand hygiene procedure alone was used as against 54 out of 144 months for the extended barrier control period (RD, –9.03%; 95% CI, –27.79% to 9.74%).
• Nationally, genetically proven nosocomial transmission affected 116 patients (2.5%) during the hand-hygiene-alone intervention period against 149 patients (3.0%) under gown-and-glove control period (RD, –0.44%; 95% CI, –2.47% to 1.58%).
• The general rate of bloodstream infections was observed at 2.1% among neonates during the intervention period against 2.0% for the control period without any divergence between them (RD, 0.12%; 95%CI, −1.39% to 1.64%).

In summary, this large cluster-randomized clinical trial demonstrates that hand hygiene disinfection, which is used for treating infants colonized with 3GCR-GNB, is not inferior to hygiene disinfection plus additional barrier precautions. The data presented makes a strong case for eliminating mandatory gowns and gloves for infants colonized without signs of active containment of secretions.

Reference:

Faust K, Strecker F, Haug C, et al. Extended Barrier Precautions vs Hand Hygiene Alone and Neonatal Sepsis in Intensive Care Patients: The BALTIC Cluster-Randomized Clinical Trial. JAMA Netw Open. 2026;9(5):e2612759. doi:10.1001/jamanetworkopen.2026.12759