To assess the effects of an automated sink on handwashing practices and attitudes of staff.

Quasi-experimental crossover design.

Two high-risk patient care areas, one postanesthesia recovery room (Site 1), and one neonatal intensive care unit (Site 2) in two tertiary care hospitals.

All patient care staff on study units; approximately 55 individuals.

An automated sink was installed to replace one handwashing sink for about five weeks; the sink was then crossed-over for an equivalent time period to the other location. Handwashing practices of all unit staff were observed in three two-hour observation periods/week. Questionnaires were distributed to staff two weeks after sink installation and at the study's end.

One thousand, six hundred ten handwashes were observed. Handwashing practices differed significantly by site. For both sites, hands were washed significantly better but significantly less often with the automated sink (all p<.001). Staff expressed negative attitudes, however, about certain features of the sink, and these negative attitudes increased over the study period.

Automated devices must be flexible enough to allow adjustments based on staff acceptance. Application of new technology to improve hand hygiene requires a multifaceted approach to behavior change. (Infect Control Hosp Epidemiol. 1991;12:422-428.)