A controlled trial of universal gloving versus contact precautions for preventing the transmission of multidrug-resistant organisms.
BACKGROUND
Contact precautions are recommended to reduce the transmission of multidrug-resistant organisms. However, the optimal method for control of multidrug-resistant organisms remains unclear.


METHODS
A controlled trial was conducted in a medical intensive care unit. Phase 1 was a 3-month period of standard practice in which patients were placed in contact precautions per Centers for Disease Control and Prevention guidelines. In the second 3 months, phase 2, gloves were required for all patient contact, and no patients were placed in contact precautions.


RESULTS
Compliance with contact precautions in phase 1 versus universal gloving in phase 2 was 75.7% versus 87.0%, respectively (P < .001). Hand hygiene compliance before patient care was significantly higher in phase 1 when compared with phase 2 (18.7% vs 11.4%, respectively, P < .001). Hand hygiene compliance after patient care was 57.7% in phase 1 versus 52.5% in phase 2 (P = .011). Nosocomial infection rates per 1000 device-days in phase 1 versus phase 2 were as follows: bloodstream infection, 6.2 versus 14.1, respectively (P < .001); urinary tract infection, 4.3 versus 7.4, respectively (P < .001); and ventilator-associated pneumonia, 0 versus 2.3, respectively (P < .001). There were no differences in vancomycin-resistant enterococci or methicillin-resistant Staphylococcus aureus acquisition in the 2 study phases; however, in both phases, the majority of vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus conversions were clonal.


CONCLUSIONS
Compliance with universal gloving was significantly greater than compliance with contact precautions. However, greater compliance with hand hygiene was observed in the contact precautions phase. Measures must be in place to both increase and sustain hand hygiene compliance so as to minimize the risk of nosocomial cross transmission before reevaluating the concept of replacing contact precautions with universal gloving.
Department of Internal Medicine, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, VA, USA. gbearman@vcu.edu
Gonzalo M L
GM
Bearman
Alexandre R
AR
Marra
Curtis N
CN
Sessler
Wally R
WR
Smith
Adriana
A
Rosato
Justin K
JK
Laplante
Richard P
RP
Wenzel
Michael B
MB
Edmond
D003428:Cross Infection / Q000517:prevention & control*; D024901:Drug Resistance, Multiple, Bacterial; D017575:Gloves, Protective / Q000592:standards* / Q000706:statistics & numerical data; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards; D007362:Intensive Care Units; D005791:Patient Care / Q000592:standards; D010564:Personnel, Hospital / Q000592:standards; D011364:Professional Practice