Rituals in infection control: what works in the newborn nursery?

Two infection control practices common in the newborn nursery, handwashing and gowning, are compared with regards to historic origins, effectiveness, and extent of practice. The practice of handwashing is the direct result of efforts to prevent puerperal sepsis and has been shown to be effective in reducing neonatal risk of infection. Gowning has evolved from operating room practices and has been shown to be generally ineffective in reducing risk of infant infection. Nevertheless, gowning is practiced extensively and handwashing is often omitted. Such rituals need occasional reexamination so that those practices associated with maximum effectiveness receive appropriate attention.