Gowning in Newborn and Special-Care Nurseries

Clinical Question

Does gowning attendants and visitors in newborn and special-care nurseries improve outcomes?

Evidence-Based Answer

There is no evidence that gowning in newborn nurseries and neonatal intensive care units (NICUs) improves clinically important outcomes.

Practice Pointers

Gowns are an uncomfortable and not very fashionable fact of life at many newborn nurseries. It is thought that they reduce transmission of infection from clinicians to infants and limit the introduction of infectious agents by visitors from outside the nursery. Webster and Pritchard reviewed the literature and identified 12 relevant studies, four of which were excluded because they were not randomized or used historical controls (i.e., outcomes before and after a gowning requirement was begun or stopped were compared).

Three studies randomly assigned staff and visitors to a gown or no gown and observed their handwashing behavior (n = 2,285 infants). Five studies alternated periods when gowning was or was not required for all staff and visitors; all of these studies examined infants (n = 3,979) in special-care nurseries or NICUs. Not wearing a gown was associated with a lower death rate (relative risk, 0.84; 95 percent CI, 0.70 to 1.02) in the four NICU studies that studied this outcome.

The five NICU studies did not show any effect on the incidence of nosocomial infections such as septicemia, meningitis, necrotizing enterocolitis, or pneumonia. The relative risk of infection ranged from 0.62 (less infection with gowning) to 2.52 (more infection with gowning), but none of the differences between groups was significant, and the overall relative risk of 0.95 was not statistically significant. Four studies of localized nosocomial infection also found no benefit from gowning. Secondary outcomes such as length of hospital stay, likelihood that patients or clinicians would wash hands, or colonization rates did not differ between groups.