No overall benefit with universal gown, glove use

IDSA: Universal Glove, Gown Use Doesn't Cut MRSA, VRE in ICU
IDSA: Universal Glove, Gown Use Doesn't Cut MRSA, VRE in ICU

HealthDay News -- Wearing gloves and gowns for all patient contact in the intensive care unit (ICU) did not reduce the risk of transmitting two major multidrug resistant pathogens, researchers reported at IDWeek and in the Journal of the American Medical Association .

Intensive care units (ICUs) where workers always wore gloves and gowns had no significant decreases in the rate at which patients reached a composite endpoint of acquiring methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) compared with usual care, according to Anthony D. Harris, MD, MPH, of the University of Maryland School of Medicine in Baltimore and colleagues.

When analyzed separately, however, universal gloves and gowns significantly reduced MRSA transmission rates, but not VRE transmission.

"Healthcare workers are the most important vector in the spread of antibiotic-resistant bacteria," Harris said.

He and colleagues conducted a cluster-randomized trial in 20 medical or surgical ICUs to examine whether wearing gloves and gowns for all patient contact in the ICU is associated with a reduction in acquisition of MRSA or VRE compared with usual care.

After a three-month baseline period, 10 units instituted universal gowns and gloves and 10 followed CDC guidelines for wearing gowns and gloves only when in contact with patients who are known to have resistant bacteria.

The primary outcome was a change in the composite rate of MRSA or VRE acquisition after nine months based on surveillance cultures taken at admission and discharge. A total of 92,241 swabs were collected from 26,180 patients.

The intervention units had a baseline rate of 21.35 acquisitions of either MRSA or VRE per 1,000 patient days, which fell to 16.91 acquisitions per 1,000 patient-days during the study period. 

In the control units, the acquisition rate fell from 19.02  to 16.29 per 1,000 patient-days. The difference in changes for both MRSA and VRE acquisitions between the intervention and control units was not statistically significant (P=0.57).

There were significantly fewer MRSA acquisitions in the intervention ICUs vs. the control ICUs -- a difference of 2.98 acquisitions per 1,000 patient-days (P=0.046) -- but no difference in VRE acquisitions.

Use of universal gowns and gloves also reduced the number of times healthcare workers entered patient rooms, and encouraged better hand hygiene when workers left patient rooms, the researchers reported. There was no significant effect on the rate of adverse events in the intervention group.

In an accompanying editorial, Preeti Malani, MD, of the University of Michigan Health System in Ann Arbor, Mich., called the study "a meaningful addition to a growing cadre of high-quality infection prevention trials."

Although there was no overall benefit of universal gloves and gowns, the approach may be useful in high-risk settings, such as surgical ICUs in which MRSA transmission is high, Malani suggested.

"Although it is appealing to believe there is a simple approach to what should and should not be done to prevent infection in the ICU, best practices are more nuanced and unfortunately, one size does not fit all," Malani wrote. "The final approach must be adapted to fit the epidemiology of specific ICUs and should also consider the type of resources available."

References

  1. Harris AD et al. JAMA. 2013; doi:10.1001/jama.2013.277815.
  2. Malani PN. JAMA. 2013; DOI: 10.1001/jama.2013.277816.
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