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Universal gloves, gowns in ICU reduced MRSA acquisition
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SAN FRANCISCO — When health care workers wore gloves and gowns for all patient contact in the intensive care unit, the spread of methicillin-resistant Staphylococcus aureus was reduced by 40%, according to data presented here at ID Week 2013.
However, there was no effect of a universal gown and glove use policy on vancomycin-resistant Enterococcus (VRE).
“Universal gown and gloving is a feasible intervention across a range of ICUs that decreases rates of MRSA without an increase in adverse events,” Anthony Harris, MD, MPH, professor of epidemiology and public health at the University of Maryland School of Medicine, told Infectious Disease News. “Intensive care units may wish to evaluate adoption of universal glove and gown policies, especially for units that have higher rates of MRSA.”
Anthony Harris
Harris and colleagues conducted a cluster-randomized trial of 20 ICUs in hospitals throughout the United States. In the intervention arm, health care personnel wore gloves and gowns for all patient contact in the ICU. Those in the control arm followed standard procedures. The current CDC guidelines recommend gowns and gloves only when caring for patients known to be colonized or infected with antibiotic-resistant bacteria.
The study included 26,180 patients and 92,241 swabs were collected to determine the acquisition of MRSA and VRE. The primary outcome was the acquisition of MRSA or VRE based on cultures collected on admission and discharge from ICU, and there was no difference between the control and intervention arms for this outcome. However, for the secondary outcomes, although there was no difference in VRE acquisition, there was a 40% reduction in MRSA acquisition.
In addition, the universal glove and gown intervention decreased the health care worker room entry, increased compliance with room exit hand hygiene procedures and had no effect on patient adverse events.
“We need to understand why we saw an effect on MRSA but no effect on VRE, and the next step is to continue to encourage funding agencies to fund these types of trials,” Harris said. “In hospital epidemiology, we are finally raising the bar of evidence-based studies. This leads to the development and implementation of interventions that can decrease health care-associated infections and decrease the spread of antibiotic-resistant bacteria.”
For more information:
Harris A. #1145. Presented at: ID Week 2013; Oct. 2-6; San Francisco.
Disclosure: Harris is a consultant for Premier, Cubist, Sanogiene and UpToDate. Other researchers report financial relationships with BioMed Protect, Welch Allyn and Sanogiene.