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A controlled trial of universal gloving versus contact precautions for preventing the transmission of multidrug-resistant organisms
Journal article   Open access   Peer reviewed

A controlled trial of universal gloving versus contact precautions for preventing the transmission of multidrug-resistant organisms

Gonzalo M L Bearman, Alexandre R Marra, Curtis N Sessler, Wally R Smith, Adriana Rosato, Justin K Laplante, Richard P Wenzel and Michael B Edmond
American journal of infection control, Vol.35(10), pp.650-655
12/2007
DOI: 10.1016/j.ajic.2007.02.011
PMID: 18063129
url
http://doi.org/10.1016/j.ajic.2007.02.011View
Open Access

Abstract

Contact precautions are recommended to reduce the transmission of multidrug-resistant organisms. However, the optimal method for control of multidrug-resistant organisms remains unclear. A controlled trial was conducted in a medical intensive care unit. Phase 1 was a 3-month period of standard practice in which patients were placed in contact precautions per Centers for Disease Control and Prevention guidelines. In the second 3 months, phase 2, gloves were required for all patient contact, and no patients were placed in contact precautions. Compliance with contact precautions in phase 1 versus universal gloving in phase 2 was 75.7% versus 87.0%, respectively (P < .001). Hand hygiene compliance before patient care was significantly higher in phase 1 when compared with phase 2 (18.7% vs 11.4%, respectively, P < .001). Hand hygiene compliance after patient care was 57.7% in phase 1 versus 52.5% in phase 2 (P = .011). Nosocomial infection rates per 1000 device-days in phase 1 versus phase 2 were as follows: bloodstream infection, 6.2 versus 14.1, respectively (P < .001); urinary tract infection, 4.3 versus 7.4, respectively (P < .001); and ventilator-associated pneumonia, 0 versus 2.3, respectively (P < .001). There were no differences in vancomycin-resistant enterococci or methicillin-resistant Staphylococcus aureus acquisition in the 2 study phases; however, in both phases, the majority of vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus conversions were clonal. Compliance with universal gloving was significantly greater than compliance with contact precautions. However, greater compliance with hand hygiene was observed in the contact precautions phase. Measures must be in place to both increase and sustain hand hygiene compliance so as to minimize the risk of nosocomial cross transmission before reevaluating the concept of replacing contact precautions with universal gloving.
 Personnel, Hospital - standards Intensive Care Units Cross Infection - prevention & control Humans Hospitals, University Professional Practice Patient Care - standards Infection Control - methods Guideline Adherence Infection Control - standards Drug Resistance, Multiple, Bacterial Gloves, Protective - standards Gloves, Protective - utilization

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