COMMENTARY

Universal Gown and Glove Use: Proceed With Care

Emily Toth Martin, MPH, PhD

Disclosures

November 25, 2013

Editorial Collaboration

Medscape &

Impact of Gowning and Gloving on Patients

Unfortunately, the use of universal gowns and gloves affected healthcare worker patterns negatively. Intervention ICUs had, on average, 1 fewer healthcare worker visit per hour, although this did not affect the rate of adverse events in the ICU. This finding is complemented by 2 other recent studies. A study by Mehrotra and colleagues in Infection Control and Hospital Epidemiology[1] found that among 528 non-ICU patients, those under contact precautions were more likely to report perceived concerns with care.

A second study by Karki and colleagues[2] found that the rate of nonpressure injuries, a category that includes falls, skin tears, or self-injury, was 3 times higher in patients under contact precautions compared with those for whom contact precautions were not used. This finding contradicts the results of the analysis of adverse events in the JAMA article, although it should be acknowledged that the JAMA study did not evaluate all patients for adverse events and used random sampling of charts with application of the Institute for Healthcare Improvement Global Trigger Tool to determine adverse event rates. On the basis of these data, more study into the impact and risk-benefit ratio of contact precautions may be warranted. 

Viewpoint

The study by Harris and colleagues provides encouraging findings that universal precautions appear to reduce the transmission of MRSA in the ICU but unfortunately do not seem to influence rates of other resistant pathogens or HAIs. An unanswered question is how these findings are affected by and compare with the universal use of chlorhexidine bathing.

These 3 studies also offer a word of caution to healthcare workers caring for those under contact precautions. Universal contact precautions, although potentially useful for infection prevention, should be implemented in a way that doesn't leave patients feeling isolated or increase the risk for injury.

Abstract

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