Lindsay D Croft1, Anthony D Harris2, Lisa Pineles1, Patricia Langenberg1, Michelle Shardell1, Jeffrey C Fink3, Linda Simoni-Wastila4, Daniel J Morgan2. 1. Department of Epidemiology and Public Health, University of Maryland School of Medicine. 2. Department of Epidemiology and Public Health, University of Maryland School of Medicine VA Maryland Healthcare System. 3. Department of Epidemiology and Public Health, University of Maryland School of Medicine VA Maryland Healthcare System Department of Medicine, Division of General Internal Medicine, University of Maryland School of Medicine. 4. Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore.
Abstract
BACKGROUND: No randomized trials have examined the effect of contact precautions or universal glove and gown use on adverse events. We assessed if wearing gloves and gowns during all patient contact in the intensive care unit (ICU) changes adverse event rates. METHODS: From January 2012 to October 2012, intervention ICUs of the 20-site Benefits of Universal Gloving and Gowning cluster randomized trial required that healthcare workers use gloves and gowns for all patient contact. We randomly sampled 1800 medical records of adult patients not colonized with antibiotic-resistant bacteria and reviewed them for adverse events using the Institute for Healthcare Improvement Global Trigger Tool. RESULTS:Four hundred forty-seven patients (24.8%) had 1 or more ICU adverse events. Adverse events were not associated with universal glove and gown use (incidence rate ratio [IRR], 0.81; 95% confidence interval [CI], .48-1.36). This did not change with adjustment for ICU type, severity of illness, academic hospital status, and ICU size, (IRR, 0.91; 95% CI, .59-1.42; P = .68). Rates of infectious adverse events also did not differ after adjusting for the same factors (IRR, 0.75; 95% CI, .47-1.21; P = .24). CONCLUSIONS: In ICUs where healthcare workers donned gloves and gowns for all patient contact, patients were no more likely to experience adverse events than in control ICUs. Concerns of adverse events resulting from universal glove and gown use were not supported. Similar considerations may be appropriate regarding use of contact precautions. CLINICAL TRIALS REGISTRATION: NCT0131821. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.
RCT Entities:
BACKGROUND: No randomized trials have examined the effect of contact precautions or universal glove and gown use on adverse events. We assessed if wearing gloves and gowns during all patient contact in the intensive care unit (ICU) changes adverse event rates. METHODS: From January 2012 to October 2012, intervention ICUs of the 20-site Benefits of Universal Gloving and Gowning cluster randomized trial required that healthcare workers use gloves and gowns for all patient contact. We randomly sampled 1800 medical records of adult patients not colonized with antibiotic-resistant bacteria and reviewed them for adverse events using the Institute for Healthcare Improvement Global Trigger Tool. RESULTS: Four hundred forty-seven patients (24.8%) had 1 or more ICU adverse events. Adverse events were not associated with universal glove and gown use (incidence rate ratio [IRR], 0.81; 95% confidence interval [CI], .48-1.36). This did not change with adjustment for ICU type, severity of illness, academic hospital status, and ICU size, (IRR, 0.91; 95% CI, .59-1.42; P = .68). Rates of infectious adverse events also did not differ after adjusting for the same factors (IRR, 0.75; 95% CI, .47-1.21; P = .24). CONCLUSIONS: In ICUs where healthcare workers donned gloves and gowns for all patient contact, patients were no more likely to experience adverse events than in control ICUs. Concerns of adverse events resulting from universal glove and gown use were not supported. Similar considerations may be appropriate regarding use of contact precautions. CLINICAL TRIALS REGISTRATION: NCT0131821. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.
Authors: Geoffrey Taylor; Denise Gravel; Anne Matlow; Joanne Embree; Nicole LeSaux; Lynn Johnston; Kathryn N Suh; Michael John; John Embil; Elizabeth Henderson; Virginia Roth; Alice Wong Journal: Antimicrob Resist Infect Control Date: 2016-05-21 Impact factor: 4.887