Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-20T05:45:56.216Z Has data issue: false hasContentIssue false
  • English
  • Français

A Prospective Study to Determine Whether Cover Gowns in Addition to Gloves Decrease Nosocomial Transmission of Vancomycin-Resistant Enterococci in an Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Arjun Srinivasan ,
Xiaoyan Song ,
Tracy Ross ,
William Merz ,
Roy Brower  and
Trish M. Perl
Arjun Srinivasan*
Affiliation:
Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, Maryland Department of Infection Control and Hospital Epidemiology, Johns Hopkins Medical Institutions, Baltimore, Maryland
Xiaoyan Song
Affiliation:
Department of Infection Control and Hospital Epidemiology, Johns Hopkins Medical Institutions, Baltimore, Maryland
Tracy Ross
Affiliation:
Division of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
William Merz
Affiliation:
Division of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
Roy Brower
Affiliation:
Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
Trish M. Perl
Affiliation:
Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, Maryland Department of Infection Control and Hospital Epidemiology, Johns Hopkins Medical Institutions, Baltimore, Maryland
*
Carnegie Building, Room 284, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287-5425
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Vancomycin-resistant enterococci (VRE) remain a significant nosocomial pathogen. Current guidelines of the Hospital Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) recommend the use of gowns and gloves for some interactions with VRE-infected or -colonized patients to prevent nosocomial transmission of VRE.

Objective:

To assess the effect of disposable cover gowns on preventing nosocomial transmission of VRE.

Design and Setting:

Prospective study in a 16-bed medical intensive care unit of a university teaching hospital.

Patients:

All patients who were at risk to acquire VRE, were admitted to the intensive care unit from August 1998 to January 1999, and had at least two perirectal cultures were included in the analysis of VRE acquisition.

Intervention:

VRE isolation precautions were changed from gowns and gloves to gloves alone.

Main Outcome Measure:

VRE acquisition rates and risk factors for VRE acquisition.

Results:

The VRE acquisition rate was 1.80 cases per 100 days at risk in the gown and gloves period compared with 3.78 in the gloves only period (P= .04). In a proportional hazards model adjusted for length of stay, gloves only precautions with a hazard ratio of 2.5 (P = .02; 95% confidence interval, 1.2 to 5.3) were the only independent risk factor for VRE acquisition.

Conclusion:

Our data lend support to current HICPAC recommendations for the use of cover gowns to decrease nosocomial transmission of VRE.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 8 , August 2002 , pp. 424 - 428
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.National Nosocomial Infections Surveillance (NNIS) System report, data summary from January 1990-May 1999, issued June 1999. Am J Infect Control 1999;27:520–532.Google Scholar
2.Linden, PK, Pasculle, AW, Manez, R, et al. Differences in outcomes for patients with bacteremia due to vancomycin-resistant Enterococcus faecium or vancomycin-susceptible E. faecium. Clin Infect Dis 1996;22:663–670.Google Scholar
3.Lucas, GM, Lechtzin, N, Puryear, DW, et al. Vancomycin-resistant and vancomycin-susceptible enterococcal bacteremia: comparison of clinical features and outcomes. Clin Infect Dis 1998;26:1127–1133.Google Scholar
4.Montelcavo, MA, Uman, J, Petrullo, C. The cost-benefit of enhanced infection control strategies (EICS) to prevent transmission of vancomycin-resistant enterococci (VRE). Presented at the 37th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy; September 28-October 1,1997; San Diego, CA Abstract.Google Scholar
5.Rhinehart, E, Smith, NE, Wennersten, C, et al. Rapid dissemination of beta-lactamase-producing, aminoglycoside-resistant Enterococcus faecalis among patients and staff on an infant-toddler surgical ward. N Engl J Med 1990;323:1814–1818.CrossRefGoogle Scholar
6.Boyce, JM, Opal, SM, Chow, JW, et al. Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol 1994;32:1148–1153.Google Scholar
7.Livornese, LL, Dias, S, Samel, C, et al. Hospital-acquired infection with vancomycin-resistant Enterococcus faecium transmitted by electronic thermometers. Ann Intern Med 1992;117:112–116.Google Scholar
8.Noskin, GA, Stosor, V, Cooper, I, et al. Recovery of vancomycin-resistant enterococci on fingertips and environmental surfaces. Infect Control Hosp Epidemiol 1995;16:577–581.Google Scholar
9.Weber, DJ, Rutala, WA. Role of environmental contamination in the transmission of vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 1997;18:306–309.Google Scholar
10. Anonymous. Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1995;44(RR-12):1–13.Google Scholar
11.Boyce, JM, Mermel, IA, Zervos, MJ, et al. Controlling vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 1995;16:634–637.Google Scholar
12.Slaughter, S, Hayden, MK, Nathan, C, et al. A comparison of the effect of universal use of gloves and gowns with that of glove use alone on acquisition of vancomycin-resistant enterococci in a medical intensive care unit. Ann Intern Med 1996;125:448–456.Google Scholar
13.Weinstein, JW, Tallapragada, S, Farrel, P, et al. Comparison of rectal and perirectal swabs for detection of colonization with vancomycin-resistant enterococci. J Clin Microbiol 1996;34:210–212.Google Scholar
14.Kirkpatrick, BD, Harrington, SM, Smith, D, et al. An outbreak of vancomycin-dependent Enterococcus faecium in a bone marrow transplant unit. Clin Infect Dis 1999;29:1268–1273.Google Scholar
15.Goering, RV. Molecular epidemiology of nosocomial infection: analysis of chromosomal restriction fragment patterns by pulsed-field gel electrophoresis. Infect Control Hosp Epidemiol 1993;14:595–600.Google Scholar
16.Murray, BE. Vancomycin-resistant enterococcal infections. N Engl J Med 2000;342:710–721.Google Scholar
17.Bhavnani, SM, Drake, JA, Forrest, A, et al. A nationwide, multicenter, case-control study comparing risk factors, treatment, and outcome for vancomycin-resistant and -susceptible enterococcal bacteremia. Diagn Microbiol Infect Dis 2000;36:145–158.Google Scholar
18.Jordens, JZ, Bates, J, Griffiths, DT. Faecal carriage and nosocomial spread of vancomycin-resistant Enterococcus faecium. J Antimicrob Chemother 1994;34:515–528.Google Scholar
19.Uttley, AH, Collins, CH, Naidoo, J, et al. Vancomycin-resistant enterococci. Lancet 1988;1:57–58.Google Scholar
20.Uttley, AH, George, RC, Naidoo, J, et al. High-level vancomycin-resistant enterococci causing hospital infections. Epidemiol Infect 1989;103:173–181.Google Scholar
21.de Lencastre, H, Brown, AE, Chung, M, et al. Role of transposon Tn5482 in the epidemiology of vancomycin-resistant Enterococcus faecium in the pediatric oncology unit of a New York City Hospital. Microb Drug Resist 1999;5:113–129.Google Scholar
22.Frieden, TR, Munsiff, SS, Low, DE, et al. Emergence of vancomycin-resistant enterococci in New York City. Lancet 1993;342:76–79.Google Scholar
23.Carmeli, Y, Samore, MH, Huskins, C. The association between antecedent vancomycin treatment and hospital-acquired vancomycin-resistant enterococci: a meta-analysis. Arch Intern Med 1999;159:2461–2468.Google Scholar
24.Edmond, MB, Ober, JF, Weinbaum, DL, et al. Vancomycin-resistant Enterococcus faecium bacteremia: risk factors for infection. Clin Infect Dis 1995;20:1126–1133.Google Scholar
25.Handwerger, S, Raucher, B, Altarac, D, et al. Nosocomial outbreak due to Enterococcus faecium highly resistant to vancomycin, penicillin, and gentamicin. Clin Infect Dis 1993;16:750–755.Google Scholar
26.Montecalvo, MA, Horowitz, H, Gedris, C, et al. Outbreak of vancomycin-, ampicillin-, and aminoglycoside-resistant Enterococcus faecium bacteremia in an adult oncology unit. Antimicrob Agents Chemother 1994;38:1363–1367.Google Scholar
27.Quale, J, Landman, D, Saurina, G, et al. Manipulation of a hospital antimicrobial formulary to control an outbreak of vancomycin-resistant enterococci. Clin Infect Dis 1996;23:1020–1025.Google Scholar
28.Bonten, MJ, Slaughter, S, Ambergen, AW, et al. The role of “colonization pressure” in the spread of vancomycin-resistant enterococci: an important infection control variable. Arch Intern Med 1998;158:1127–1132.Google Scholar
29.Puzniak, LA, Leet, T, Mayfield, J, Kollef, M, Mundy, LM. To gown or not to gown: the effect on acquisition of vancomycin-resistant enterococci. Clin Infect Dis 2002;35:18–25.Google Scholar