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Use of gloves after hand hygiene may lower rates of bloodstream infections
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Recent data show using gloves after appropriate hand hygiene was associated with fewer gram-positive bloodstream infections and potential central line-associated bloodstream infections among preterm infants.
David A. Kaufman, MD, of the University of Virginia School of Medicine in Charlottesville, Va., and colleagues randomized 120 preterm infants to receive care from health care professionals (HCPs) who used gloves after hand hygiene or used hand hygiene alone prior to all patient, bed, and catheter contact. The study was conducted in the University of Virginia neonatal ICU from December 2008 to June 2011.
David A. Kaufman
Each bed space had its own alcohol hand rub dispenser within arm’s reach. All HCPs followed WHO’s Five Moments for Hand Hygiene guidelines. Hand hygiene was defined as using alcohol hand rub or washing hands with antimicrobial soap.
Late-onset invasive infection was defined as one or more episodes per patient of a bloodstream infection, urinary tract infection, meningitis, and/or necrotizing enterocolitis associated with clinical symptoms of infection and treated with antimicrobials.
Infants who received care with gloves after hand hygiene (group A) had a primary outcome of late-onset infection of 32% compared with 45% among infants who received hand hygiene alone (group B). Infections were predominantly caused by gram-positive organisms. Infants in group A had 53% fewer gram-positive bloodstream infections than those in group B (15% vs. 32%).
Possible central line-associated bloodstream infections were reduced by 64% among infants who received care with gloves after hand hygiene, with an incidence of 3.4 infections per 1,000 central line days vs. 9.4 infections per 1,000 central line days among infants in group B.
Hand hygiene compliance was 79% (2,675 of 3,385 observations).
“Gloving after hand hygiene prior to all patient and line contact should became part of our care of preterm infants. Many neonatal ICUs already practice non-sterile gloving with any patient contact. Studies have shown that some microorganisms still remain on health care workers’ hands after excellent hand hygiene. These can be a significant exposure to certain patients who may be immunocompromised, have a central catheter, or are in an ICU. While much attention is focused on reducing central line-associated bloodstream infections in NICUs, many bloodstream infections with other sources still occur in preterm infants with significant mortality and associated neurodevelopmental impairment in survivors,” Kaufman told Infectious Diseases in Children.
Susan E. Coffin
In an accompanying editorial, Susan E. Coffin, MD, MPH, from the department of pediatrics at the Perelman School of Medicine at the University of Pennsylvania, wrote that this study had mixed results.
“Unfortunately for the investigators — but fortunately for their patients — the background rate of late-onset infections spears to have dropped significantly from the time they performed their sample size calculations to the study period, thus rendering their study underpowered,” Coffin wrote. “Despite these issues, the study by Kaufman and colleagues provides an important precedent for a future pragmatic clinical trial to determine whether glove use can truly reduce infections in vulnerable NICU patients.”
Disclosure: The researchers report no relevant financial disclosures.
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