Universal Glove and Gown Use and Acquisition of Antibiotic-Resistant Bacteria in the ICU A Randomized Trial

Harris, Anthony D.; Pineles, Lisa; Belton, Beverly; Kristie Johnson, J.; Shardell, Michelle; Loeb, Mark; Newhouse, Robin; Dembry, Louise; Braun, Barbara; Perencevich, Eli N.; Hall, Kendall K.; Morgan, Daniel J.
October 2013
JAMA: Journal of the American Medical Association;10/16/2013, Vol. 310 Issue 15, p1571
Academic Journal
IMPORTANCE 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. OBJECTIVE 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. DESIGN, SETTING, AND PARTICIPANTS Cluster-randomized trial in 20 medical and surgical ICUs in 20 US hospitals from January 4, 2012, to October 4, 2012. INTERVENTIONS 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. MAIN OUTCOMES AND MEASURES The primary outcomewas 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. RESULTS 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 thatwas not statistically significant (difference, -1.71 acquisitions per 1000 person-days, 95%CI, -6.15 to 2.73; P = .57). For key secondary outcomes, therewas 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 persondays; 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). CONCLUSIONS AND RELEVANCE 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. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT0131821


Related Articles

  • Preventing Infections in the ICU One Size Does Not Fit All. Malani, Preeti N. // JAMA: Journal of the American Medical Association;10/16/2013, Vol. 310 Issue 15, p1567 

    The author discusses factors to consider in minimizing infections in the intensive care unit (ICU). He references the article "Universal Glove and Gown Use and Acquisition of Antibiotic-Resistant Bacteria in the ICU: A Randomized Trial" by A. D. Harris and colleagues, published within the issue....

  • Infection control in the ICU. Girou, E.; Oppein, F. // Intensive Care Medicine;Jan2000, Vol. 26 Issue 1, p131 

    Focuses on the nosocomial infection control in the intensive care units (ICU). Emergence of microorganisms resistant to antibiotic agents; Transmission of multi-resistant bacteria in ICU; Importance of improving compliance with handwashing.

  • POINT / COUNTER.  // Infectious Diseases in Children;Jun2014, Vol. 27 Issue 6, p11 

    The article presents an argumentative discourse on whether hand hygiene or environmental disinfection is the most important tool for infection control in hospital.

  • Infection prevention in hospitals: The importance of hand hygiene. Shafer, Emily // Infectious Diseases in Children;Jun2014, Vol. 27 Issue 6, p1 

    The article discusses the importance of hand hygiene and mentions topics including examples of patient-care activities that may transmit bacteria to health care worker (HCW) hands, the organisms found on HCW hands after patient contact, and the available methods to measure hand hygiene compliance.

  • Reducing hospital infections with simple technology.  // Australian Nursing Journal;Aug2007, Vol. 15 Issue 2, p22 

    The article discusses research being done on reducing infection rates through hand-washing. It references a study by Li-Chi Chang and colleagues published in the June 2007 issue of the "Journal of Clinical Nursing." Researchers found that simple hand-washing videos in health care settings is an...

  • Auditing hand hygiene practice. Gould, Dinah // Nursing Standard;9/15/2010, Vol. 25 Issue 2, p50 

    Hand hygiene is regarded as the most effective way of preventing healthcare-associated infections. Thus hand hygiene audits are frequently undertaken by infection prevention and control teams. Although apparently straightforward, hand hygiene audit requires careful planning and conduct....

  • Control of Endemic Vancomycin-Resistant Enterococcus among Inpatients at a University Hospital. Calfee, David P.; Giannetta, Eve T.; Durbin, Lisa J.; Germanson, Teresa P.; Farr, Barry M. // Clinical Infectious Diseases;8/1/2003, Vol. 37 Issue 3, p326 

    Determines the ability of surveillance cultures and isolation of vancomycin-resistant Enterococcus (VRE)-colonized patients to control nosocomial VRE infection and colonization. Identification and isolation of patients with asymptomatic colonization; Sustained control of the spread of VRE...

  • Dutch Guideline for Preventing Nosocomial Transmission of Highly Resistant Microorganisms (HRMO). Kluytmans-VandenBergh, M. F. O.; Kluytmans, J. A. J. W.; Voss, A. // Infection;Oct2005, Vol. 33 Issue 5/6, p309 

    Hospitals are faced with the increasingly rapid emergence and dissemination of antimicrobial–resistant microorganisms. US and European guidelines on the prevention of antimicrobial resistance in hospitals were, until recently, mainly directed at methicillin–resistant Staphylococcus...

  • VOICES. Carter, Peter // Nursing Standard;10/20/2010, Vol. 25 Issue 7, p26 

    International Infection Prevention Week needs you, says Peter Carter.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics