Gowns and Gloves Reduced Resistant Germs, Infections at University Hospital’s MICU

October 07, 2013

National study found little improvement, but University Hospital’s results were promising enough to continue their use.

Making healthcare workers put on gowns and gloves before entering the rooms of all patients in intensive care units didn’t make much of a dent in whether those patients tested positive for two common, drug-resistant bacteria, according to results of a major national study at University Hospital and 19 other hospitals across the country.

Still, the benefits at University Hospital were significant enough that it will recontinue the practice beginning next month, now that the results are known. University Hospital’s own data showed the presence of both those dangerous forms of bacteria were slashed by more than half after the gowns-and-gloves requirement was put in place in the hospital’s Medical ICU.

And actual healthcare-associated infections from central lines and urinary catheters were also reduced — something the entire study failed to show.

One reason may be that at University Hospital, everyone — including family members and visitors — had to put on gowns and gloves, not just healthcare workers, as was the case in some other hospitals. And University Hospital’s compliance rate for people putting on those gowns and gloves was considerably higher than at the other hospitals.

“You can’t just say, ‘Well, gowns and gloves for everybody don’t work,’” said Dr. Jason Bowling, a UT Medicine infectious disease specialist and staff epidemiologist at University Hospital. “It didn’t seem to have a large benefit in general, but every hospital should take a look at its own practices. It seems for our site there was benefit.”

The study was published online Friday by the Journal of the American Medical Association. It was released early to coincide with the presentation of its findings at a scientific conference of infectious disease professionals.

The $5.7 million study, funded by the Agency for Healthcare Research and Quality, was the largest and most rigorous study to date to look at whether putting on gowns and gloves when entering an ICU room would reduce the risk of patients acquiring the two common drug-resistant bacteria. Most hospitals only require them when a particular patient is known to be already infected.

The two bacteria were methicillin-resistant Staphylococcus aureus, or MRSA; and vancomycin-resistant Enterococci, or VRE. MRSA and VRE are important causes of healthcare-associated infections, which are the most common medical complication in hospitals, affecting as many as one patient in 20.

Over a nine-month period in 2012, 10 hospitals, including University Hospital, required gowns and gloves before entering all patient rooms on the unit, while 10 others followed the current standard practice. The study included more than 26,000 patients. All patients were tested for the bacteria when they were admitted, and again on discharge.

Looking at MRSA and VRE together, the entire study found no statistically significant difference between universal gowns and gloves, and standard practice. There was a small reduction in MRSA alone in the gowns-and-gloves group.

Bowling said another important finding came out of the study: it disproved one concern that universal gowns and gloves might actually be harmful to patients. Some had speculated that healthcare workers would be less likely to check on patients because of the hassle factor. In fact, there were fewer patient visits per hour when gowns and gloves were required, but no increase in adverse medical complications when that occurred.

“It definitely adds to our general medical knowledge of how we reduce these infections and what do we do,” Bowling said. “I think it’s really important that UHS participated in it.”