Trial of universal gloving with emollient-impregnated gloves to promote skin health and prevent the transmission of multidrug-resistant organisms in a surgical intensive care unit.
OBJECTIVE
To compare the efficacy of universal gloving with emollient-impregnated gloves with standard contact precautions for the control of multidrug-resistant organisms (MDROs) and to measure the effect on healthcare workers' (HCWs') hand skin health.


METHODS
Prospective before-after trial.


METHODS
An 18-bed surgical intensive care unit.


METHODS
During phase 1 (September 2007 through March 2008) standard contact precautions were used. During phase 2 (March 2008 through September 2008) universal gloving with emollient-impregnated gloves was used, and no contact precautions. Patients were screened for vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). HCW hand hygiene compliance and hand skin health and microbial contamination were assessed. The incidences of device-associated infection and Clostridium difficile infection (CDI) were determined.


RESULTS
The rate of compliance with contact precautions (phase 1) was 67%, and the rate of compliance with universal gloving (phase 2) was 78% (P = .01). Hand hygiene compliance was higher during phase 2 than during phase 1 (before patient care, 40% vs 35% of encounters; P = .001; after patient care, 63% vs 51% of encounters; P < .001). No difference was observed in MDRO acquisition. During phases 1 and 2, incidences of device-related infections, in number of infections per 1,000 device-days, were, respectively, 3.7 and 2.6 for bloodstream infection (P = .10), 8.9 and 7.8 for urinary tract infection (P = .10), and 1.0 and 1.1 for ventilator-associated pneumonia (P = .09). The CDI incidence in phase 1 and in phase 2 was, respectively, 2.0 and 1.4 cases per 1,000 patient-days (P = .53). During phase 1, 29% of HCW hand cultures were MRSA positive, compared with 13% during phase 2 (P = .17); during phase 1, 2% of hand cultures were VRE positive, compared with 0 during phase 2 (P = .16). Hand skin health improved during phase 2.


CONCLUSIONS
Compared with contact precautions, universal gloving with emollient-impregnated gloves was associated with improved hand hygiene compliance and skin health. No statistically significant change in the rates of device-associated infection, CDI, or patient MDRO acquisition was observed. Universal gloving may be an alternative to contact precautions.
Bearman
Gonzalo
G
Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298-0019, USA. gbearman@mcvh-vcu.edu
Rosato
Adriana E
AE
Duane
Therese M
TM
Elam
Kara
K
Sanogo
Kakotan
K
Haner
Cheryl
C
Kazlova
Valentina
V
Edmond
Michael B
MB
D003422:Critical Care; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D024901:Drug Resistance, Multiple, Bacterial; D004643:Emollients; D016983:Enterococcus / Q000187:drug effects; D017575:Gloves, Protective / Q000592:standards / Q000706:statistics & numerical data*; D005932:Gloves, Surgical / Q000592:standards / Q000706:statistics & numerical data; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology / Q000517:prevention & control; D019983:Guideline Adherence; D006235:Hand Disinfection; D006282:Health Personnel; D006801:Humans; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units; D055624:Methicillin-Resistant Staphylococcus aureus; D012867:Skin / Q000382:microbiology; D020713:Vancomycin Resistance / Q000187:drug effects
D004643:Emollients