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1. There was no difference in the overall acquisition of methicillin-resistant Staphyloccocus aureus (MRSA) or vancomycin-resistant Enteroccocus (VRE) between medical and surgical intensive care units (ICUs) in which gloves and gowns were utilized universally for all patient contact compared to usual standard of care guidelines.
2. As a secondary outcome, universal glove and gown use was associated with decreased MRSA-only acquisition.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Antibiotic-resistance is associated with great cost and poor patient outcomes. In an effort to curtail the incidence of such infections, the Centers for Disease Control and Prevention recommend the use of contact precautions, including gloves and gowns, for health care workers caring for patients colonized or infected with antibiotic-resistant bacteria. This study aimed to determine whether or not the universal use of gloves and gowns for all patient contact in the intensive care unit (ICU) would decrease the acquisition of antibiotic-resistant bacteria compared to the usual standard of care. The authors concluded that the universal use of gloves and gowns in such settings did not decrease the overall risk of MRSA or VRE acquisition, thereby arguing against the efficacy of such an intervention at decreasing the transmission of antibiotic-resistant bacteria. Limitations of this study include the inherent inability to blind ICUs to the intervention status. Moreover, the potential for false-negatives on initial MRSA and VRE colonization screening tests may have confounded results. Nonetheless, until future research shows otherwise, the study does not support the implementation of universal glove and gown use in intensive care settings.
Click to read the study, published today in JAMA
Click to read an accompanying editorial in JAMA
Relevant Reading: Benefits of universal gloving on hospital-acquired infections in acute care pediatric units
In-Depth [cluster-randomized trial]: 20 ICUs were randomly assigned to the intervention or control group in this study. While the 10 control group ICUs followed CDC indications for contact precautions, all health care workers at the intervention group ICUs were required to wear gloves and gowns for all patient contact including entering patient rooms. All patients underwent admission and discharge surveillance cultures for MRSA and VRE, and the study data was collected over 10 months in 2012. There was no statistically difference in changes of MRSA or VRE acquisition over the study period (p=0.57). There was a significant difference in change for MRSA acquisition between the two groups of -2.98 acquisitions per 1000 patient-days (P=0.046) whereas the difference in change for VRE acquisition of.89 per 1000 patient-days was not significant (P=0.70).
By Priyanka Vedak and Rif Rahman
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