Comparison of routine glove use and contact-isolation precautions to prevent transmission of multidrug-resistant bacteria in a long-term care facility.
OBJECTIVE
To compare routine glove use by healthcare workers for all residents, without use of contact-isolation precautions, with contact-isolation precautions for the care of residents who had vancomycin-resistant enterococci or methicillin-resistant Staphylococcus aureus isolated from a clinical culture.


METHODS
Random allocation of two similar sections of the skilled-care unit to one of the infection-control strategies during an 18-month study period.


METHODS
Skilled-care unit of a 667-bed acute- and long-term care facility.


METHODS
All residents present or admitted to the skilled-care unit from June 1, 1998, through December 7, 1999.


METHODS
Resident acquisition of four antimicrobial-resistant organisms (methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, or extended-spectrum beta-lactamase-producing Klebsiella pneumoniae or Escherichia coli). All isolates were strain typed. The facility level costs associated with each strategy were estimated.


RESULTS
Resident acquisition of antimicrobial-resistant organisms was no different in the glove-use and isolation-precautions sections (31 episodes (1.5 per 1,000 resident-days) vs 38 episodes (1.6 per 1,000 resident-days)). Acquisition of either of two prevalent K. pneumoniae strains was more likely (P=.06) in residents in the isolation-precautions section. The estimated costs of contact-isolation precautions were 40% greater than those of routine glove use.


CONCLUSIONS
There was a similar frequency of transmission of antimicrobial-resistant bacteria in the two study sections; there was evidence for resident-to-resident K. pneumoniae transmission in the isolation-precautions section. Routine glove use for healthcare workers, which decreases resident social isolation and healthcare facility costs, may be preferable in many long-term care facilities.
Trick
William E
WE
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. wtrick@cchil.org
Weinstein
Robert A
RA
DeMarais
Patricia L
PL
Tomaska
Wanda
W
Nathan
Catherine
C
McAllister
Sigrid K
SK
Hageman
Jeffrey C
JC
Rice
Thomas W
TW
Westbrook
Glennis
G
Jarvis
William R
WR
D000368:Aged; D000704:Analysis of Variance; D001424:Bacterial Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D018432:Drug Resistance, Multiple; D016983:Enterococcus; D005260:Female; D017575:Gloves, Protective / Q000191:economics; D016908:Gram-Positive Bacterial Infections / Q000517:prevention & control; D017048:Health Care Costs; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D009735:Nursing Homes; D010356:Patient Isolation / Q000191:economics; D013203:Staphylococcal Infections / Q000517:prevention & control; D018709:Statistics, Nonparametric; D020713:Vancomycin Resistance