Healthcare News & Insights

Antibiotic-resistant bacteria: Is universal use of gloves & gowns the answer to containment?

When it comes to the spread of antibiotic-resistant bacteria, which are associated with increased patient morbidity and mortality, healthcare workers are a key factor. That’s why hospitals implement sanitary protocols. But do those protocols really work? 

178581366A recent study in the Journal of the American Medical Association (JAMA), found that having intensive care workers wear gloves and gowns during all patient contact  in the intensive care unit (ICU) didn’t reduce the risk of transmission of  Vancomycin-resistant enterococcus (VRE) and methicillin-resistant straphylococcus aureus (MRSA) when compared with usual care.

Study background

In a cluster-randomized trial in 20 medical and surgical ICUs in 20 U.S. hospitals, 10 units used the universal gowns and gloves protocol. The other 10 units followed the Centers for Disease Control and Prevention’s (CDC) guidelines, which require gloves and gowns be worn only when caring for patient known to have resistant bacteria.

Baseline data on the primary outcome of MRSA or VRE acquisition, was collected from September 2011 to December 2011. The actual study period ran from Jan. 4, 2012 to Oct. 4, 2012.

The ICUs were paired up based on matching baseline MRSA or VRE acquisition rates as a composite outcome. One ICU was then randomly selected using a computer-generated sequence as the control group and the other was designated the intervention group.

What the researchers were looking for was a change in the rates of acquisition after nine months of the composite of MRSA or VRE, based on cultures collected on admission and discharge.

In total, the study involved 26,180 patients and 92,241 swabs were tested for VRE or MRSA acquisition.

Surprising results

After reviewing all the data, the researchers found the use of gloves and gowns for all patient contact compared with usual care among patients in ICUs didn’t result in a difference in the acquisition of MRSA or VRE.

The statics were:

  • Intervention ICUs had a decrease in the primary outcome of MRSA or VRE from 21.35 acquisitions per 1,000 patient-days in the baseline period to 16.91 acquisitions per 1,000 patient-days in the study period, and
  • Control ICUs had a decrease in MRSA or VRE from 19.02 acquisitions per 1,000 patient-days in the baseline period to 16.29 acquisitions per 1,000 patient-days in the study period.

According to the researchers, the difference in changes wan’t statistically significant.

But don’t throw the baby out with the bathwater.

There were some interesting secondary outcomes reported  from the universal use of gloves and gowns, such as:

  • a decrease of healthcare worker room entry (4.28 vs 5.24 entries per hour)
  • an increase in room-exit hand hygiene compliance (78.3% vs 62.9%), and
  • no statistically significant effect on rates of adverse events (58.7 events per 1,000 patient days vs 74.4 events per 1,000 patient days).

 

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