Assessment of Awareness, Adherence, and Barriers to Device-Associated Infection Prevention Measures in Intensive Care Units: A Multi-Center Cross-Sectional Study

• Overall adherence to device-associated infection prevention was 77.9%. • Adherence was lowest for VAP prevention (73.5%) and highest for CAUTI (82.0%). • Surgical ICUs had higher catheter-care adherence than general ICUs. • Primary barriers were organizational: insufficient training & staff shortages. Overall adherence to device-associated infection prevention was 77.9%. Adherence was lowest for VAP prevention (73.5%) and highest for CAUTI (82.0%). Surgical ICUs had higher catheter-care adherence than general ICUs. Primary barriers were organizational: insufficient training & staff shortages. Adherence to prevention guidelines for device-associated infections (DAIs) in intensive care units (ICUs) is critical but often suboptimal. This study assessed awareness, adherence, and barriers to implementing preventive measures for ventilator-associated pneumonia (VAP), central line-associated bloodstream infections (CLABSI), and catheter-associated urinary tract infections (CAUTI) in Iranian ICUs. In a multi-center, cross-sectional study using census sampling, a structured questionnaire was administered to the head nurse and attending physician in all 20 eligible medical, surgical, and general ICUs in Iranian teaching hospitals. The survey assessed awareness, self-reported adherence to core preventive practices and perceived implementation barriers. Adherence rates were compared by ICU type. Mean overall adherence was 77.9%; rates were highest for CAUTI (82.0%) and lowest for VAP (73.5%). Surgical ICUs demonstrated significantly higher adherence for CLABSI (p=.008) and CAUTI (p=.015) prevention compared to general ICUs. The most frequently cited barrier was a lack of periodic staff training (reported by 50% for CLABSI). Adherence to DAI prevention protocols was moderate, with VAP prevention a key challenge. The primary barriers were organizational, including insufficient training and staff shortages, not a lack of guidelines. Improving adherence requires systemic solutions that address institutional infrastructure, provide sustained training, and ensure adequate staffing.