Jumat, 30 April 2010

Benefits of Universal Gloving

Last but not least in the May issue of ICHE, Gonzalo Bearman and our very own Mike Edmond from VCU in Richmond, completed a nice quasi-experimental study looking at the benefits of universal gloving for all patient contact vs. standard contact precautions in their 18-bed surgical ICU. In phase 1 from September '07 to March '08, only standard contact precautions based on passive (clinical culture-directed) surveillance were used while in phase 2 from March '08 to Sept '08 universal gloving with emollient-impregnated gloves was used without contact precautions. During both phases, admission and every 4 day surveillance cultures were performed for MRSA and VRE but for study purposes only and not shared with the clinical teams.

So what happened? Only good things. Universal gloving compliance was 78% in phase 2 and was associated with higher hand hygiene compliance on entry (5% higher) and exit (12% higher). It also appears that universal gloving was associated with reduced CLABSI and catheter-UTIs, but with p-values = 0.1 for both outcomes. C. difficile was also lower (2.0/1,000 patient-days down to 1.4/1,000) but this finding was not statistically significant, p=0.53. VAP rates were the same (1.0 vs 1.1/1000 device days) The most important finding, in my opinion, was that HCW were less likely to have MRSA and VRE contaminating their hands during the universal glove phase. Despite what the authors state (Mike don't be mad!), the study was not likely powered sufficiently to find reduced acquisition, given that MRSA acquisition was reduced by 50% with universal glove (2.9/1000 patient-days vs. 1.4/1000 patient days) but this had a p=0.2.

I think overall, that these findings suggest that universal gloving shows promise warranting further study. I wonder if they stopped universal gloving after the study period? If they did, this would make for a very epidemiologically sound quasi-study (roll-in and roll-out) which could be analyzed using more powerful segmented Poisson regression,which can detect a change in slope and intercept associated with starting or stopping the intervention.

The June ICHE just appeared online 5 minutes ago...more exciting evidence for us to review!

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