BACKGROUND:Hand hygiene compliance remains low, despite its effectiveness in preventing infections. Gowns are routinely used to reduce dissemination of organisms within hospitals. Use of gowns is time consuming and costly, and their effectiveness, compared with that of hand hygiene alone, is debated. Among the arguments supporting a gown-use requirement is the potential to boost awareness of infection control, leading to improved hand hygiene compliance. METHODS:Hand hygiene compliance was recorded in a 14-month crossover trial comparing compliance at 2 intensive care units during periods with and without a gown-use requirement. RESULTS: During 170 h of observation, 1619 hand hygiene opportunities were recorded. Compliance was 10% before care was given and 36% after care was given. Compliance with glove and gown use was 62% and 63%, respectively. After-care hand hygiene compliance for nurses, physicians, and therapists was 40%, 38%, and 22%, respectively. Compliance after patient contact, body fluid contact, and other in-room activity was 42%, 48%, and 22%, respectively. For periods with and without a gown-use requirement, overall after-care compliance (37% vs. 34%) and rates by personnel and activity type were similar. In the subgroup of patients on contact precautions, hand hygiene compliance during the period with a gown-use requirement versus the period without a gown-use requirement was 11% versus 10% (P=.85) before care was given and 45% versus 39% (P=.09) after care was given. In this subgroup, after adjustment for type of in-room activity, medical personnel, intensive care unit, and observer, the predicted after-care hand hygiene compliance during periods with and without a gown-use requirement was 48% versus 41% (P=.02). CONCLUSIONS: The hypothesis that a gown-use requirement might improve hand hygiene compliance in the intensive care unit could not be confirmed. In the subgroup of patients on contact precautions, improvement in hand hygiene compliance associated with the gown-use requirement was small and did not affect precare rates.
RCT Entities:
BACKGROUND: Hand hygiene compliance remains low, despite its effectiveness in preventing infections. Gowns are routinely used to reduce dissemination of organisms within hospitals. Use of gowns is time consuming and costly, and their effectiveness, compared with that of hand hygiene alone, is debated. Among the arguments supporting a gown-use requirement is the potential to boost awareness of infection control, leading to improved hand hygiene compliance. METHODS: Hand hygiene compliance was recorded in a 14-month crossover trial comparing compliance at 2 intensive care units during periods with and without a gown-use requirement. RESULTS: During 170 h of observation, 1619 hand hygiene opportunities were recorded. Compliance was 10% before care was given and 36% after care was given. Compliance with glove and gown use was 62% and 63%, respectively. After-care hand hygiene compliance for nurses, physicians, and therapists was 40%, 38%, and 22%, respectively. Compliance after patient contact, body fluid contact, and other in-room activity was 42%, 48%, and 22%, respectively. For periods with and without a gown-use requirement, overall after-care compliance (37% vs. 34%) and rates by personnel and activity type were similar. In the subgroup of patients on contact precautions, hand hygiene compliance during the period with a gown-use requirement versus the period without a gown-use requirement was 11% versus 10% (P=.85) before care was given and 45% versus 39% (P=.09) after care was given. In this subgroup, after adjustment for type of in-room activity, medical personnel, intensive care unit, and observer, the predicted after-care hand hygiene compliance during periods with and without a gown-use requirement was 48% versus 41% (P=.02). CONCLUSIONS: The hypothesis that a gown-use requirement might improve hand hygiene compliance in the intensive care unit could not be confirmed. In the subgroup of patients on contact precautions, improvement in hand hygiene compliance associated with the gown-use requirement was small and did not affect precare rates.
Authors: W Charles Huskins; Charmaine M Huckabee; Naomi P O'Grady; Patrick Murray; Heather Kopetskie; Louise Zimmer; Mary Ellen Walker; Ronda L Sinkowitz-Cochran; John A Jernigan; Matthew Samore; Dennis Wallace; Donald A Goldmann Journal: N Engl J Med Date: 2011-04-14 Impact factor: 91.245
Authors: Sarah M Bartsch; Susan S Huang; Kim F Wong; Rachel B Slayton; James A McKinnell; Daniel F Sahm; Krystyna Kazmierczak; Leslie E Mueller; John A Jernigan; Bruce Y Lee Journal: J Clin Microbiol Date: 2016-08-31 Impact factor: 5.948
Authors: Courtney A Gidengil; Charlene Gay; Susan S Huang; Richard Platt; Deborah Yokoe; Grace M Lee Journal: Infect Control Hosp Epidemiol Date: 2015-01 Impact factor: 3.254
Authors: Bruce Y Lee; Sarah M Bartsch; Kim F Wong; Diane S Kim; Chenghua Cao; Leslie E Mueller; Gabrielle M Gussin; James A McKinnell; Loren G Miller; Susan S Huang Journal: Infect Control Hosp Epidemiol Date: 2019-03-28 Impact factor: 3.254
Authors: Sarah M Bartsch; Kim F Wong; Owen J Stokes-Cawley; James A McKinnell; Chenghua Cao; Gabrielle M Gussin; Leslie E Mueller; Diane S Kim; Loren G Miller; Susan S Huang; Bruce Y Lee Journal: J Infect Dis Date: 2020-05-11 Impact factor: 7.759
Authors: Bruce Y Lee; Sarah M Bartsch; Michael Y Lin; Lindsey Asti; Joel Welling; Leslie E Mueller; Jim Leonard; Shawn T Brown; Kruti Doshi; Sarah K Kemble; Elizabeth A Mitgang; Robert A Weinstein; William E Trick; Mary K Hayden Journal: Am J Epidemiol Date: 2021-02-01 Impact factor: 4.897