title: Nosocomial pneumonia is not prevented by protective contact isolation in the surgical intensive care unit.
abstract: Nosocomial pneumonia (NP) is the leading cause of death from hospital-acquired infection in intubated surgical intensive care unit (SICU) patients. To determine whether protective contact isolation would lower the incidence of NP in intubated patients we performed a prospective, randomized, and controlled study in two SICUs in a tertiary medical center. Over a period of 15 months two identical ten-bed SICUs alternated for 3-month periods between protective contact isolation (isolation group) and standard "universal precautions" (control group). In the isolation group all personnel and visitors donned disposable gowns and nonsterile gloves before entering an intubated patient's room; handwashing was required before entry and on leaving the room. In the control group caregivers utilized only "standard precautions" including handwashing and nonsterile gloves for intubated patients. Respiratory cultures were obtained 48 hours after SICU admission and every 48 hours thereafter until extubation, transfer to floor care, or death. Airway colonization (AC) occurred in 72.7 per cent of isolated patients and 69.0 per cent of control patients (P = 0.61). The incidence of NP was significantly higher in the isolation group (36.4%) compared with the control group (19.5%) (P = 0.02). There was no statistically significant difference between groups in days from SICU admission to AC, days to NP, and mortality. We conclude that protective contact isolation with gowns, gloves, and handwashing is not superior to gloves and handwashing alone in the prevention of AC and NP in SICU patients and may in fact be detrimental.
authors.affiliation: Burns and Allen Research Institute, Department of Surgery, Cedars-Sinai Medical Center and the UCLA School of Medicine, Los Angeles, California 90048, USA.
authors.forename: W G
authors.initials: WG
authors.lastname: Koss
authors.forename: T M
authors.initials: TM
authors.lastname: Khalili
authors.forename: J F
authors.initials: JF
authors.lastname: Lemus
authors.forename: M M
authors.initials: MM
authors.lastname: Chelly
authors.forename: D R
authors.initials: DR
authors.lastname: Margulies
authors.forename: M M
authors.initials: MM
authors.lastname: Shabot
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D017575:Gloves, Protective; D006235:Hand Disinfection; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010356:Patient Isolation; D011014:Pneumonia / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies