title: Impact of universal gowning and gloving on health care worker clothing contamination.
abstract: OBJECTIVE
  To determine whether gowning and gloving for all patient care reduces contamination of healthcare worker (HCW) clothing, compared to usual practice.
  
  
  METHODS
  Cross-sectional surveys.
  
  
  METHODS
  Five study sites were recruited from intensive care units (ICUs) randomized to the intervention arm of the Benefits of Universal Gown and Glove (BUGG) study.
  
  
  METHODS
  All HCWs performing direct patient care in the study ICUs were eligible to participate.
  
  
  METHODS
  Surveys were performed first during the BUGG intervention study period (July-September 2012) with universal gowning/gloving and again after BUGG study conclusion (October-December 2012), with resumption of usual care. During each phase, HCW clothing was sampled at the beginning and near the end of each shift. Cultures were performed using broth enrichment followed by selective media. Acquisition was defined as having a negative clothing culture for samples taken at the beginning of a shift and positive clothing culture at for samples taken at the end of the shift.
  
  
  RESULTS
  A total of 348 HCWs participated (21-92 per site), including 179 (51%) during the universal gowning/gloving phase. Overall, 51 (15%) HCWs acquired commonly pathogenic bacteria on their clothing: 13 (7.1%) HCWs acquired bacteria during universal gowning/gloving, and 38 (23%) HCWs acquired bacteria during usual care (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.2-0.6). Pathogens identified included S. aureus (25 species, including 7 methicillin-resistant S. aureus [MRSA]), Enterococcus spp. (25, including 1 vancomycin-resistant Enterococcus [VRE]), Pseudomonas spp. (4), Acinetobacter spp. (4), and Klebsiella (2).
  
  
  CONCLUSIONS
  Nearly 25% of HCWs practicing usual care (gowning and gloving only for patients with known resistant bacteria) contaminate their clothing during their shift. This contamination was reduced by 70% by gowning and gloving for all patient interactions.
authors.affiliation: 1Department of Medicine,Christiana Care Health System,Newark,Delaware.
authors.forename: Calvin
authors.initials: C
authors.lastname: Williams
authors.affiliation: 1Department of Medicine,Christiana Care Health System,Newark,Delaware.
authors.forename: Patty
authors.initials: P
authors.lastname: McGraw
authors.affiliation: 2Department of Laboratory Medicine,Christiana Care Health System,Newark,Delaware.
authors.forename: Elyse E
authors.initials: EE
authors.lastname: Schneck
authors.affiliation: 3Department of Medicine,Emory University School of Medicine,Atlanta,Georgia.
authors.forename: Anna
authors.initials: A
authors.lastname: LaFae
authors.affiliation: 3Department of Medicine,Emory University School of Medicine,Atlanta,Georgia.
authors.forename: Jesse T
authors.initials: JT
authors.lastname: Jacob
authors.affiliation: 4Department of Medicine,Henry Ford Hospital,Detroit,Michigan.
authors.forename: Daniela
authors.initials: D
authors.lastname: Moreno
authors.affiliation: 4Department of Medicine,Henry Ford Hospital,Detroit,Michigan.
authors.forename: Katherine
authors.initials: K
authors.lastname: Reyes
authors.affiliation: 5Department of Medicine,University of Miami Miller School of Medicine,Miami,Florida.
authors.forename: G Fernando
authors.initials: GF
authors.lastname: Cubillos
authors.affiliation: 5Department of Medicine,University of Miami Miller School of Medicine,Miami,Florida.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Kett
authors.affiliation: 6Department of Medicine,University Health System,San Antonio,Texas.
authors.forename: Ronald
authors.initials: R
authors.lastname: Estrella
authors.affiliation: 7Department of Epidemiology & Public Health,University of Maryland School of Medicine,Baltimore,Maryland.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Morgan
authors.affiliation: 7Department of Epidemiology & Public Health,University of Maryland School of Medicine,Baltimore,Maryland.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harris
authors.affiliation: 1Department of Medicine,Christiana Care Health System,Newark,Delaware.
authors.forename: Marci
authors.initials: M
authors.lastname: Drees
mesh_terms: D003020:Clothing / Q000592:standards; D003428:Cross Infection / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D017575:Gloves, Protective / Q000009:adverse effects*; D006801:Humans; D007362:Intensive Care Units; D010564:Personnel, Hospital; D011481:Protective Clothing / Q000009:adverse effects*; D016635:Universal Precautions