Universal Glove and Gown Use and Acquisition of Antibiotic-Resistant Bacteria in the ICU – D.Salera

BACKGROUND
Antibiotic-resistance is associated with increased patient morbidity and mortality and considerable costs. Methicillin-resistant Staphylococcus Aureus (MRSA) and vancomycin-resistant Enterococcus. Numerous studies have shown that health care workers acquire bacteria on their hands and clothing by touching patients. The Centers for Disease Control and Prevention (CDC) recommend the use of contact precautions (wearing gloves and gowns) when caring for patients colonized or infected with antibiotic resistant bacteria. However, colonization with MRSA,VRE or other antibiotic resistant bacteria often is not detected,and contact precautions,therefore,are not applied. Small non randomized trials suggest that wearing gloves and gowns for all patient contact may decrease acquisition of antibiotic-resistant bacteria and Health care-Associated Infections (HAIs).

METHODS
Harris et al. conducted a cluster randomized trial to access whether wearing gloves and gowns for all patient contact in the intensive care unit (ICU) compared with the use of contact precautions only for patients with known antibiotic-resistant bacteria reduces colonization acquisition rates of MRSA and VRE. 26180 patients were enrolled,92241 swabs were collected from 20 different ICUs. A cluster randomized trial was necessary to answer these questions because a behavioral infection control intervention could not be studied using traditional patient-level randomization.
One of the strongest points of this study was the protocol fidelity. Many precautions were taken:
o each site designated a study coordinator and physician champion to lead implementation
o all sites were trained via webinar on proper technique for collecting and shipping cultures
o study coordinator from each site attended a study initiation meeting where they received personal training
o staff of every ICU were required to view standardized Power point presentations developed by the CDC on National Health Safety Network definitions and complete a test on these definitions.
o biweekly conference calls were held with site coordinators to discuss questions, challenges, and solutions.
o All sites received at least one visit from study investigators

OUTCOMES
Primary outcome was acquisition of either MRSA or VRE as a composite.
Key secondary outcomes were:
1. MRSA and VRE acquisition as two separate outcomes.
2. Health care-associated infections
3. adverse events
4. frequency of health care worker room entry and hand hygiene compliance

RESULTS AND DISCUSSION
Results show that health care workers wearing gloves and gowns for all ICU patient contact did not reduce the composite primary outcome of VRE or MRSA acquisition.
Regarding key secondary outcomes,the intervention did not reduce VRE acquisition but it reduced MRSA acquisition. Better hand hygiene compliance on room exit occurred in the intervention ICUs. The intervention led to fewer health care worker-patient visits but this didn't increase the frequency of adverse events. JAMA.2013;310(15):1571-1580

writed  at 05-11-2013 01:57:01