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Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial
Journal article   Open access   Peer reviewed

Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial

Anthony D Harris, Lisa Pineles, Beverly Belton, J Kristie Johnson, Michelle Shardell, Mark Loeb, Robin Newhouse, Louise Dembry, Barbara Braun, Eli N Perencevich, …
JAMA : the journal of the American Medical Association, Vol.310(15), pp.1571-1580
10/16/2013
DOI: 10.1001/jama.2013.277815
PMCID: PMC4026208
PMID: 24097234
url
https://doi.org/10.1001/jama.2013.277815View
Published (Version of record) Open Access

Abstract

Antibiotic-resistant bacteria are associated with increased patient morbidity and mortality. It is unknown whether wearing gloves and gowns for all patient contact in the intensive care unit (ICU) decreases acquisition of antibiotic-resistant bacteria. To assess whether wearing gloves and gowns for all patient contact in the ICU decreases acquisition of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) compared with usual care. Cluster-randomized trial in 20 medical and surgical ICUs in 20 US hospitals from January 4, 2012, to October 4, 2012. In the intervention ICUs, all health care workers were required to wear gloves and gowns for all patient contact and when entering any patient room. The primary outcome was acquisition of MRSA or VRE based on surveillance cultures collected on admission and discharge from the ICU. Secondary outcomes included individual VRE acquisition, MRSA acquisition, frequency of health care worker visits, hand hygiene compliance, health care–associated infections, and adverse events. From the 26,180 patients included, 92,241 swabs were collected for the primary outcome. Intervention ICUs had a decrease in the primary outcome of MRSA or VRE from 21.35 acquisitions per 1000 patient-days (95% CI, 17.57 to 25.94) in the baseline period to 16.91 acquisitions per 1000 patient-days (95% CI, 14.09 to 20.28) in the study period, whereas control ICUs had a decrease in MRSA or VRE from 19.02 acquisitions per 1000 patient-days (95% CI, 14.20 to 25.49) in the baseline period to 16.29 acquisitions per 1000 patient-days (95% CI, 13.48 to 19.68) in the study period, a difference in changes that was not statistically significant (difference, −1.71 acquisitions per 1000 person-days, 95% CI, −6.15 to 2.73; P = .57). For key secondary outcomes, there was no difference in VRE acquisition with the intervention (difference,  0.89 acquisitions per 1000 person-days; 95% CI, −4.27 to 6.04, P = .70), whereas for MRSA, there were fewer acquisitions with the intervention (difference, −2.98 acquisitions per 1000 person-days; 95% CI, −5.58 to −0.38; P = .046). Universal glove and gown use also decreased health care worker room entry (4.28 vs 5.24 entries per hour, difference, −0.96; 95% CI, −1.71 to −0.21, P = .02), increased room-exit hand hygiene compliance (78.3% vs 62.9%, difference, 15.4%; 95% CI, 8.99% to 21.8%; P = .02) and had no statistically significant effect on rates of adverse events (58.7 events per 1000 patient days vs 74.4 events per 1000 patient days; difference, −15.7; 95% CI, −40.7 to 9.2, P = .24). The use of gloves and gowns for all patient contact compared with usual care among patients in medical and surgical ICUs did not result in a difference in the primary outcome of acquisition of MRSA or VRE. Although there was a lower risk of MRSA acquisition alone and no difference in adverse events, these secondary outcomes require replication before reaching definitive conclusions. clinicaltrials.gov Identifier: NCT0131821.
 Enterococcus Surgical Attire Intensive Care Units - standards Cross Infection - prevention & control Humans Middle Aged Vancomycin Resistance Male Infection Control - methods Methicillin-Resistant Staphylococcus aureus Guideline Adherence Hand Disinfection Gloves, Protective Female Staphylococcal Infections - prevention & control Aged Personnel, Hospital Gram-Positive Bacterial Infections - prevention & control

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