Level 2: Mid-level evidence

Preterm birth is estimated to occur in 11.1% of all live births worldwide and is the most frequent cause of infant death in the United States (Lancet. 2012;379[9832]:2162; Pediatrics. 2006;118[4]:1566).

Infection is a major cause of morbidity and mortality in preterm neonates, and infection prevention measures are therefore extremely important when treating patients in neonatal intensive care units. Hand hygiene and glove use are simple measures that have been shown to reduce infections in cohort studies of preterm neonates and other pediatric populations (Arch Dis Child Fetal Neonatal Ed. 2004;89[4]:F336; Pediatrics. 2013;131[5]:e1515).

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A recent randomized trial compared nonsterile glove use plus hand hygiene versus hand hygiene alone for all patient, bed, or catheter contact with 124 premature neonates younger than 8 days old in the neonatal intensive care unit. All included neonates had a birth weight <1,000 grams or were born before 29 weeks gestation (JAMA Pediatr. 2014;168[10]:909).

The trial defined hand hygiene as the use of alcohol hand sanitizer or handwashing with antimicrobial soap. Late onset infection was defined as one or more episodes of bloodstream infection, urinary tract infection, meningitis, or necrotizing enterocolitis with clinical signs and symptoms at more than 72 hours after birth.

Hand hygiene compliance was 79%. Nonsterile glove use was associated with significantly fewer Gram-positive blood stream infections (15% vs. 32%; P=0.03; NNT 6) and a decreased rate of possible central line-associated blood stream infections (3.4 per 1,000 line days vs. 9.4 per 1,000 line days; P=0.01), but there was no significant difference in late-onset infections overall (32% vs. 45%; P=0.13).