Universal Glove and Gown Protocol to Fight MRSA

Laird Harrison

October 09, 2013

SAN FRANCISCO — The spread of methicillin-resistant Staphylococcus aureus (MRSA) can be reduced in the intensive care unit (ICU) if staff wear gloves and gowns for all contact with patients, a new study shows.

"We saw a large effect on MRSA," said Anthony Harris, MD, from the University of Maryland in Baltimore. However, he added, a protocol of gloves and gowns did not affect the spread of vancomycin-resistant Enterococcus faecium (VRE).

Dr. Harris presented the results here at IDWeek 2013.

Previous research has shown that healthcare workers play a role in spreading antibiotic-resistant bacteria; even some small studies have suggested that the greater use of gloves and gowns can reduce the spread.

To determine the effectiveness of a gloves and gowns protocol, Dr. Harris and his team collected data on the acquisition of antibiotic-resistant bacteria from 20 ICUs. They defined acquisition as a negative culture on hospital admission and a positive culture on discharge.

One group of ICUs, comprising 9936 hospital admissions, used standard contact precautions, requiring gloves and gowns for patients known to be infected or colonized by antibiotic-resistant bacteria.

The other group, of 9920 hospital admissions, instituted a universal policy of gloves and gowns when entering any patient room.

The 2 groups had similar rates of MRSA and VRE acquisition at baseline. They also had similar rates of compliance with their patient-contact protocol — from 80% to 90%.

The decline in MRSA acquisition during the study period was significantly greater with the universal protocol than with the standard protocol.

Table. Change in Acquisition During the Study Period

Acquisition Universal Protocol, % Standard Protocol, % P Value
MRSA –40.18 –14.97 .046
VRE –10.53 –17.30 .70

 

Hand hygiene was also greater with the universal protocol than with the standard protocol (78.9% vs 62.9%; P = .015)

There was a trend toward fewer adverse events with the universal protocol, but this was not statistically significant.

There was no difference between the 2 groups in rates of central line-associated blood stream infection, catheter-associated urinary tract infection, or ventilator-associated pneumonia.

"This is pretty predictable," John Bartlett, MD, professor emeritus of medicine at Johns Hopkins University in Baltimore, told Medscape Medical News.

However, getting compliance with a policy of gloves and gowns for all patient contact over a long term could be challenging, he said. "People are rushing, trying to get from place to place."

Johns Hopkins sometimes uses undercover monitors to document how well units in the hospital are complying with patient contact protocols, he noted.

This study was funded by the US Agency for Healthcare Research and Quality. Dr. Harris reports being a consultant to Cubist, Premier, Sanogiene, and UpToDate. Dr. Bartlett has disclosed no relevant financial relationships.

IDWeek 2013: Abstract 1145. Presented October 4, 2013.

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