Healthcare workers' use of disposable gowns and gloves upon entering all patient rooms on an intensive care unit (ICU), versus only in rooms on standard isolation protocol, helped reduce patient acquisition of methicillin-resistant Staphylococcus aureus (MRSA) by approximately 40 percent, according to new research co-led by the University of Maryland School of Medicine and the Yale New Haven Health System Center for Healthcare Solutions. While the study did not show statistically significant results for preventing patient acquisition of another common bacteria, vancomycin-resistant Enterococcus (VRE), the use of gowns and gloves increased handwashing frequency among healthcare workers and did not result in any increase in adverse events for patients.
The study, funded by the Agency for Healthcare Research and Quality (AHRQ), appears online in JAMA in conjunction with presentation of the data at IDWeek, an annual meeting of more than 5,500 professionals in healthcare epidemiology and infectious diseases.
Although recent data have indicated that healthcare-associated infections (HAIs) are becoming less pervasive across the United States, HAIs still represent one of the most common complications of hospital care, affecting an estimated one of every 20 patients. Numerous studies have shown that healthcare workers acquire bacteria on their hands and clothing through patient contact, resulting in transmission of bacteria to other patients. Current Centers for Disease Control and Prevention (CDC) guidelines recommend contact precautions (gowns and gloves) by healthcare workers when caring for patients colonized or infected with antibiotic-resistant bacteria such as MRSA and VRE. However, if these infections haven't been detected, gowns and gloves do not have to be worn.
"We set out to find whether having healthcare workers wear gowns and gloves for all ICU patient contact could decrease the acquisition of antibiotic-resistant bacteria such as MRSA without causing any harm to the patient -- and the answer was yes," says the study's principal investigator, Anthony D. Harris, M.D., MPH, professor of epidemiology and public health at the University of Maryland School of Medicine. Dr. Harris, who is also vice president of the Society for Healthcare Epidemiology of America (SHEA), adds: "From a public health perspective, it's important that we evaluate interventions that may continue to drive these infection rates down, especially as concerns persist about antibiotic-resistant bacteria."
The study involved 20 medical and surgical ICUs across 15 states, and examined nearly 92,000 cultures from more than 26,000 patients over a nine-month period in 2012. Participating ICUs were randomly assigned to either the intervention or control group. Healthcare workers in the intervention group were required to wear gloves and gowns for all patient contact when entering any patient room. Healthcare workers in the control group followed CDC guidelines for patient contact, and only wore gloves and gowns for contact with patients with known antibiotic-resistant bacteria.
While researchers did not find a decrease in VRE, the reduction in MRSA was notable, as was an increase in handwashing by the healthcare workers upon leaving patient rooms.
The study also sought to determine if usage of contact precautions such as gowns and gloves would adversely impact patients as previous studies have shown, such as increased instances of pressure sores, falls or other unintended physical injury resulting from medical care or hospitalization. However, there was no statistically significant increase in adverse events, and investigators observed a trend towards lower adverse events in the intervention group.
"Infection control studies such as this are important to advance the science and lead to important discoveries that can decrease health care-associated infections," says Daniel J. Morgan, M.D., M.S., the study's senior author and assistant professor of epidemiology and public health at the University of Maryland School of Medicine. "In conjunction with the evolution of hospital cleaning practices, increased handwashing frequency and other measures, patients in hospitals can be safer than they've ever been from HAIs."
Beverly Belton, RN, MSN, a study co-author from Yale New Haven Health System Center for Healthcare Solutions, and PhD student at Yale University adds: "Based on the results of this study, it would be prudent for ICUs to consider adoption of universal gowning and gloving policies on intensive care units at highest risk for MRSA infections, regardless of whether patients have been positively cultured. Concerns about healthcare personnel acceptance of and compliance with universal gowning and gloving can be overcome with creative efforts focused on early engagement and positive reinforcement."
E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland and the John Z. and Akiko K. Bowers Distinguished Professor and Dean of the University of Maryland School of Medicine, says, "Studies such as this continue to advance the knowledge and understanding of healthcare-associated infections and how they can be prevented. These results will certainly prove useful in evaluating public health policies and recommendations for how to best protect patients and advance their healing in the hospital setting."
- Anthony D. Harris. Universal Glove and Gown Use and Acquisition of Antibiotic-Resistant Bacteria in the ICU. JAMA, 2013; DOI: 10.1001/jama.2013.277815
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