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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

Published online by Cambridge University Press:  02 January 2015

Gonzalo Bearman ,
Adriana E. Rosato ,
Therese M. Duane ,
Kara Elam ,
Kakotan Sanogo ,
Cheryl Haner ,
Valentina Kazlova  and
Michael B. Edmond
Gonzalo Bearman*
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
Adriana E. Rosato
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
Therese M. Duane
Affiliation:
Division of Trauma, Critical Care and Emergency Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
Kara Elam
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
Kakotan Sanogo
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
Cheryl Haner
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
Valentina Kazlova
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
Michael B. Edmond
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
*
Virginia Commonwealth University Medical Center, P.O. Box 980019, Richmond, VA 23298-0019, ([email protected])
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Abstract

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.

Design.

Prospective before-after trial.

Setting.

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 5 , May 2010 , pp. 491 - 497
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1.Siegel, J, Rhinehart, E, Jackson, M, Chiarello, L. 2007 guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35(10suppl 2):S65–S164.Google Scholar
2.Morgan, D, Diekema, D, Sepkowitz, K, Perencevich, E. Adverse outcomes associated with contact precautions: a review of the literature. Am J Infect Control 2009;37(2):85–93.Google Scholar
3.Diekema, D, Edmond, M. Look before you leap: active surveillance for multidrug-resistant organisms. Clin Infect Dis 2007;44(8):1101–1107.Google ScholarPubMed
4.Edmond, M, Lyckholm, L, Diekema, D. Ethical implications of active surveillance cultures and contact precautions for controlling multidrug resistant organisms in the hospital setting. Public Health Ethics 2008;1:235–245.CrossRefGoogle Scholar
5.Golan, Y, Doron, S, Griffith, J, et al.The impact of gown-use requirement on hand hygiene compliance. Clin Infect Dis 2006;42(3):37O–376.CrossRefGoogle ScholarPubMed
6.McCormick, RD, Buchman, TL, Maki, DG. Double-blind, randomized trial of scheduled use of a novel barrier cream and an oil-containing lotion for protecting the hands of health care workers. Am J Infect Control 2000;28(4):302–310.CrossRefGoogle Scholar
7.Larson, E, Girard, R, Pessoa-Silva, C, Boyce, J, Donaldson, L, Pittet, D. Skin reactions related to hand hygiene and selection of hand hygiene products. Am J Infect Control 2006;34(10):627–635.CrossRefGoogle ScholarPubMed
8.Davis, D, Harper, R. Using gloves coated with a dermal therapy formula to improve skin condition. AORN J 2005;81(1):157–162.Google Scholar
9.Tenover, EC, Arbeit, RD, Goering, RV, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
10.Larson, E, Friedman, C, Cohran, J, Treston-Aurand, J, Green, S. Prevalence and correlates of skin damage on the hands of nurses. Heart Lung 1997;26(5):404–412.CrossRefGoogle Scholar
11.Bannerman, TL, Hancock, GA, Tenover, FC, Miller, JM. Pulsed-field gel electrophoresis as a replacement for bacteriophage typing of Staphylococcus aureus. J Clin Microbiol 1995;33:551–555.CrossRefGoogle ScholarPubMed
12.Forbes, BA, Bombicino, K, Plata, K, et al.Unusual form of oxacillin resistance in methicillin-resistant Staphylococcus aureus clinical strains. Diagn Microbiol Infect Dis 2008;61:387–395.CrossRefGoogle ScholarPubMed
13.Puzniak, L, Leet, T, Mayfield, J, Kollef, M, Mundy, L. To gown or not to gown: the effect on acquisition of vancomycin-resistant enterococci. Clin Infect Dis 2002;35(1):18–25.CrossRefGoogle ScholarPubMed
14.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(6):448–456.CrossRefGoogle Scholar
15.Kirkland, KB, Weinstein, JM. Adverse effects of contact isolation. Lancet 1999;354(9185):1177–1178.CrossRefGoogle ScholarPubMed
16.Arenas, MD, Sánchez-Payá, J, Barril, G, et al.A multicentric survey of the practice of hand hygiene in haemodialysis units: factors affecting compliance. Nephrol Dial Transplant 2005;20(6):1164–1171.Google Scholar
17.Bearman, GML, Marra, A, Sessler, C, et al.A controlled trial of universal gloving versus contact precautions for preventing the transmission of multidrug-resistant organisms. Am J Infect Control 2007;35(10):650–655.CrossRefGoogle ScholarPubMed
18.Stevens, M, Hunter, J, Ober, J, Bearman, G, Edmond, M. Watching them wash: a hand hygiene observation program. In: Program and Abstracts of the Society for Healthcare Epidemiology of America Annual Meeting; March 19-22, 2009; San Diego, California. Abstract 112.Google Scholar
19.Trick, W, Weinstein, R, DeMarais, P, et al.Comparison of routine glove use and contact-isolation precautions to prevent transmission of multidrug-resistant bacteria in a long-term care facility. J Am Geriatr Soc 2004;52(12):2003–2009.Google Scholar
20.Larson, E. Skin hygiene and infection prevention: more of the same or different approaches? Clin Infect Dis 1999;29(5):1287–1294.Google Scholar
21.Stelfox, H, Bates, D, Redelmeier, D. Safety of patients isolated for infection control. JAMA 2003;290(14):1899–1905.Google Scholar
22.Catalano, G, Houston, S, Catalano, M, et al.Anxiety and depression in hospitalized patients in resistant organism isolation. South Med J 2003;96(2):141–145.CrossRefGoogle ScholarPubMed
23.Gasink, L, Singer, K, Fishman, N, et al.Contact isolation for infection control in hospitalized patients: is patient satisfaction affected? Infect Control Hosp Epidemiol 2008;29(3):275–278.CrossRefGoogle ScholarPubMed
24.McLemore, A, Bearman, G, Edmond, M. The effect of contact precautions on wait time from emergency room disposition to inpatient admission. In: Program and Abstracts of the Society for Healthcare Epidemiology of America Annual Meeting; March 19-22, 2009; San Diego, California. Abstract 415.Google Scholar
25.Kirkland, K. Taking off the gloves: toward a less dogmatic approach to the use of contact isolation. Clin Infect Dis 2009;48(6):766–771.Google Scholar