Mandatory Gloving Decreases Pediatric Infection Risk

Jennifer Garcia

April 22, 2013

Mandatory glove use was associated with a decreased risk for healthcare-associated bacterial infections in pediatric units, according to a new study published online April 22 in Pediatrics.

Researchers led by Jun Yin, MS, from the College of Public Health, University of Iowa, Iowa City, evaluated the association between mandatory gloving and the incidence of hospital-acquired infections (HAIs) in pediatric units of a tertiary care center between 2002 and 2010. The center required clinicians to use gloves for all patient contact in pediatric units during respiratory syncytial virus (RSV) season. Among the 686 HAIs that occurred during the study, 362 occurred during standard care periods and 324 during mandatory gloving periods.

The researchers found a 25% decrease in the risk for any HAI during mandatory gloving periods compared with nongloving periods (relative risk [RR], 0.75; 95% confidence interval [CI], 0.69 - 0.93; P = .010). The decrease in HAI risk was significant in the pediatric intensive care unit (RR, 0.63; 95% CI, 0.42 - 0.93; P = .021), the neonatal intensive care unit (RR, 0.62; 95% CI, 0.39 - 0.98; P = .043), and the Pediatric Bone Marrow Transplant Unit (RR, 0.52; 95% CI, 0.29 - 0.91; P = .022). Glove use was not associated with a decrease in HAIs, however, in either the pediatric hematology/oncology special care unit (RR, 1.36; 95% CI, 0.86 - 2.16; P = .189) or the pediatric medical/surgical mixed acuity unit (RR, 0.86; 95% CI, 0.49 - 1.52; P = .607).

The risk for central line–associated bloodstream infections (CLABSIs) was significantly decreased during periods of mandatory gloving (RR, 0.61; 95% CI, 0.44 - 0.84; P = .003), as was the risk for bloodstream infections (BSIs; RR, 0.63; 95% CI, 0.49 - 0.81; P < .001). There was no significant difference, however, in the incidence of ventilator-associated pneumonia (VAP) or hospital-acquired pneumonia (HAP).

"These findings suggest a potential clinical benefit for extending a universal gloving policy beyond RSV season and provide evidence to support using universal gloving throughout the year in acute care pediatric units," the authors write.

The authors acknowledge study weaknesses such as the data being limited to a single center, a lack of patient-level data, and the quasi-experimental study design. The researchers also note that although randomized trials are required to rigorously evaluate the efficacy of mandatory gloving, ethical considerations may preclude this.

The authors speculate that the lack of effect on the incidence of VAP and HAP may be a result of the low incidence of these infections overall, as well as the subjective nature of HAP and VAP diagnosis. In addition, the fact that there was decrease in infection rate during periods of mandatory glove use in the neonatal intensive care unit, pediatric intensive care unit, and Pediatric Bone Marrow Transplant Unit, but not in the general pediatric units, may be a result of "the higher level of acuity in [intensive care units] with differential frequency or duration of patient to health care worker contact," the authors write.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online April 22, 2013.