AHRQ-Funded Study Looks at Benefits of Universal Glove and Gown Use in ICUs

AHRQ has funded one of the first cluster randomized trials to assess the potential benefits of universal glove and gown use in preventing the transmission of antibiotic-resistant bacteria. The trial was conducted in medical and surgical intensive care units (ICUs) in 20 hospitals across the country, and results were published in the Journal of the American Medical Association (JAMA). Researchers found that universal glove and gown use, when compared with usual care, did not result in a significant reduction in the primary outcome of combined methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) acquisition. For secondary outcomes, there was a statistically significant reduction in the acquisition of MRSA and no reduction in VRE acquisition. The authors indicate the need for more research before definitive conclusions are reached. Other findings include no significant increase in adverse events and increased handwashing by caregivers in the intervention group. Full study results can be found in “Universal Glove and Gown Use and Acquisition of Antibiotic-Resistant Bacteria in the ICU: A Randomized Trial,” published in the October 4 online issue of JAMA. Select to access the abstract on PubMed®.

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2013 Oct 16;310(15):1571-80.

Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial.

Abstract

IMPORTANCE:

Antibiotic-resistant bacteria are associated with increased patient morbidity and mortality. It is unknown whether wearing gloves and gowns for all patient contact in the intensive care unit (ICU) decreases acquisition of antibiotic-resistant bacteria.

OBJECTIVE:

To assess whether wearing gloves and gowns for all patient contact in the ICU decreases acquisition of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) compared with usual care.

DESIGN, SETTING, AND PARTICIPANTS:

Cluster-randomized trial in 20 medical and surgical ICUs in 20 US hospitals from January 4, 2012, to October 4, 2012.

INTERVENTIONS:

In the intervention ICUs, all health care workers were required to wear gloves and gowns for all patient contact and when entering any patient room.

MAIN OUTCOMES AND MEASURES:

The primary outcome was acquisition of MRSA or VRE based on surveillance cultures collected on admission and discharge from the ICU. Secondary outcomes included individual VRE acquisition, MRSA acquisition, frequency of health care worker visits, hand hygiene compliance, health care–associated infections, and adverse events.

RESULTS:

From the 26,180 patients included, 92,241 swabs were collected for the primary outcome. Intervention ICUs had a decrease in the primary outcome of MRSA or VRE from 21.35 acquisitions per 1000 patient-days (95% CI, 17.57 to 25.94) in the baseline period to 16.91 acquisitions per 1000 patient-days (95% CI, 14.09 to 20.28) in the study period, whereas control ICUs had a decrease in MRSA or VRE from 19.02 acquisitions per 1000 patient-days (95% CI, 14.20 to 25.49) in the baseline period to 16.29 acquisitions per 1000 patient-days (95% CI, 13.48 to 19.68) in the study period, a difference in changes that was not statistically significant (difference, −1.71 acquisitions per 1000 person-days, 95% CI, −6.15 to 2.73; P = .57). For key secondary outcomes, there was no difference in VRE acquisition with the intervention (difference, 0.89 acquisitions per 1000 person-days; 95% CI, −4.27 to 6.04, P = .70), whereas for MRSA, there were fewer acquisitions with the intervention (difference, −2.98 acquisitions per 1000 person-days; 95% CI, −5.58 to −0.38; P = .046). Universal glove and gown use also decreased health care worker room entry (4.28 vs 5.24 entries per hour, difference, −0.96; 95% CI, −1.71 to −0.21, P = .02), increased room-exit hand hygiene compliance (78.3% vs 62.9%, difference, 15.4%; 95% CI, 8.99% to 21.8%; P = .02) and had no statistically significant effect on rates of adverse events (58.7 events per 1000 patient days vs 74.4 events per 1000 patient days; difference, −15.7; 95% CI, −40.7 to 9.2, P = .24).

CONCLUSIONS AND RELEVANCE:

The use of gloves and gowns for all patient contact compared with usual care among patients in medical and surgical ICUs did not result in a difference in the primary outcome of acquisition of MRSA or VRE. Although there was a lower risk of MRSA acquisition alone and no difference in adverse events, these secondary outcomes require replication before reaching definitive conclusions.