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Appropriate hand hygiene plus gloving led to fewer infections
BOSTON — Gloving after hand hygiene prior to patient and line contact was associated with fewer gram-positive and potential central line-associated bloodstream infection in preterm infants, according to findings presented during the 2012 Pediatric Academic Societies Meeting held here.
“Gloving after hand hygiene with all patient line contact was associated with a 60% decrease in CLABSIs, a 50% decrease in any gram-positive BSIs and a 50% decrease in UTIs,” David A. Kaufman, MD, lead author of the study, said.
Studies have shown that non-sterile gloving plus hand hygiene can prevent transmission of methicillin-resistant Staphyloccus aureus (MRSA) and other infections, but little evidence exists in randomized controlled trials (RCTs) in the NICU. The efficacy of appropriate hand hygiene does not always achieve the desired “sterile” hands because microorganisms may still be present more than 50% of the time, therefore Kaufman and colleagues from Virginia School of Medicine, Charlottesville, Va., undertook a study to evaluate trials of non-sterile gloving after hand hygiene compared with hand hygiene alone before patient and line contact.
“Infection control measures are a simple approach to preventing invasive infections in high-risk preterm infants while they have lines in place,” Kaufman said. “For pre-term infants weighing less than 1,000 g, it’s a unique situation. With various types of infections that can affect these infants, including bloodstream infections (BSIs) — whether CLABSIs [central line-associated BSI (CLABSIs] or other BSIs — necrotizing enterocolitis (NEC), urinary tract infection (UTIs) and meningitis, there is high mortality, increased length of stay, significant neurodevelopmental impairment and significant health care costs.”
Kaufman and colleagues conducted a RCT to examine the difference between nonsterile gloving after hand hygeine to hand hygiene alone prior to all patient and line (peripheral or central) contact on the incidence of late-onset infections (more than 72 hours old), classified as one or more episodes of BSI, UTI meningitis and/or NEC with clinical signs and symptoms.
For both groups, hand hygiene was defined as using alcohol hand rub or washing hands with antimicrobial soap. Patients were enrolled in the first 7 days after birth. The study intervention period was set for a minimum of the first 4 weeks after birth and continued while patients still required intravenous access (peripheral or central). At the bedside of enrolled patients, signs were placed as to group assignment and the details of the protocol.
Sixty patients were randomized to the gloving after hand hygiene and 60 patients to the hand hygiene-only group, with no differences in baseline characteristics (25.7 vs. 25.9 weeks gestational age and 790 vs. 803 g body weight, respectively).
Results of the study indicated that late-onset infection rates for one or more episodes of BSI, UTI, meningitis and/or NEC were similar between groups. However, gram-positive BSIs were more than 40% lower in patients in the gloving after hand hygeine group compared with the hand hygiene-alone group (OR 0.42, 95% CI 0.18 to 0.97).
For more information:
- Kaufman DA. #2420.1. Presented at: 2012 PAS Meeting; April 28-May 1, 2012; Boston.
Disclosure: Dr. Kaufman reports no relevant financial disclosures.