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Impact of Universal Gowning and Gloving on Health Care Worker Clothing Contamination

Published online by Cambridge University Press:  02 January 2015

Calvin Williams ,
Patty McGraw ,
Elyse E. Schneck ,
Anna LaFae ,
Jesse T. Jacob ,
Daniela Moreno ,
Katherine Reyes ,
G. Fernando Cubillos ,
Daniel H. Kett  and
Ronald Estrella
...Show all authors
Calvin Williams
Affiliation:
Department of Medicine, Christiana Care Health System, Newark, Delaware
Patty McGraw
Affiliation:
Department of Medicine, Christiana Care Health System, Newark, Delaware
Elyse E. Schneck
Affiliation:
Department of Laboratory Medicine, Christiana Care Health System, Newark, Delaware
Anna LaFae
Affiliation:
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Jesse T. Jacob
Affiliation:
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Daniela Moreno
Affiliation:
Department of Medicine, Henry Ford Hospital, Detroit, Michigan
Katherine Reyes
Affiliation:
Department of Medicine, Henry Ford Hospital, Detroit, Michigan
G. Fernando Cubillos
Affiliation:
Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
Daniel H. Kett
Affiliation:
Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
Ronald Estrella
Affiliation:
Department of Medicine, University Health System, San Antonio, Texas
Daniel J. Morgan
Affiliation:
Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, Maryland Baltimore VA Medical Center, Baltimore, Maryland
Anthony D. Harris
Affiliation:
Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Marci Drees*
Affiliation:
Department of Medicine, Christiana Care Health System, Newark, Delaware Value Institute, Christiana Care Health System, Newark, Delaware Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
*
Address correspondence to Marci Drees, MD, MS, Christiana Care Health System, Department of Medicine, Ammon Suite 2E70, 4755 Ogletown-Stanton Road, Newark DE 19718 (mdrees@christianacare.org).
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Abstract

OBJECTIVE

To determine whether gowning and gloving for all patient care reduces contamination of healthcare worker (HCW) clothing, compared to usual practice.

DESIGN

Cross-sectional surveys.

SETTING

Five study sites were recruited from intensive care units (ICUs) randomized to the intervention arm of the Benefits of Universal Gown and Glove (BUGG) study.

PARTICIPANTS

All HCWs performing direct patient care in the study ICUs were eligible to participate.

METHODS

Surveys were performed first during the BUGG intervention study period (July–September 2012) with universal gowning/gloving and again after BUGG study conclusion (October–December 2012), with resumption of usual care. During each phase, HCW clothing was sampled at the beginning and near the end of each shift. Cultures were performed using broth enrichment followed by selective media. Acquisition was defined as having a negative clothing culture for samples taken at the beginning of a shift and positive clothing culture at for samples taken at the end of the shift.

RESULTS

A total of 348 HCWs participated (21–92 per site), including 179 (51%) during the universal gowning/gloving phase. Overall, 51 (15%) HCWs acquired commonly pathogenic bacteria on their clothing: 13 (7.1%) HCWs acquired bacteria during universal gowning/gloving, and 38 (23%) HCWs acquired bacteria during usual care (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.2–0.6). Pathogens identified included S. aureus (25 species, including 7 methicillin-resistant S. aureus [MRSA]), Enterococcus spp. (25, including 1 vancomycin-resistant Enterococcus [VRE]), Pseudomonas spp. (4), Acinetobacter spp. (4), and Klebsiella (2).

CONCLUSION

Nearly 25% of HCWs practicing usual care (gowning and gloving only for patients with known resistant bacteria) contaminate their clothing during their shift. This contamination was reduced by 70% by gowning and gloving for all patient interactions.

Infect Control Hosp Epidemiol 2014;00(0): 1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 4 , April 2015 , pp. 431 - 437
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

The results discussed in this manuscript were presented in part at the ID Week conference, San Diego, CA, October 5, 2013.

References

REFERENCES

1. Klevens, RM, Edwards, JR, Richards, CL, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007;122:160–166.CrossRefGoogle ScholarPubMed
2. Talbot, GH, Bradley, J, Edwards, JE, Gilbert, D, Scheld, M, Bartlett, JG. Bad bugs need drugs: an update on the development pipeline from the Antimicrobial Availability Task Force of the Infectious Diseases Society of America. Clin Infect Dis 2006;42:657–668.Google Scholar
3. Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370:1198–1208.Google Scholar
4. Arias, CA, Murray, BE. The rise of the Enterococcus: beyond vancomycin resistance. Nat Rev Microbiol 2012;10:266–278.CrossRefGoogle ScholarPubMed
5. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L. Committee the HICA. Management of multi-drug resistant organisms in healthcare settings, 2006. Am J Infect Control 2007;35:S165–S193.Google Scholar
6. Siegel, JD, 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:S65–S164. doi:10.1016/j.ajic.2007.10.007.CrossRefGoogle ScholarPubMed
7. Slota, M, Green, M, Farley, A, Janosky, J, Carcillo, J. The role of gown and glove isolation and strict handwashing in the reduction of nosocomial infection in children with solid organ transplantation. Crit Care Med 2001;29:405–412.Google Scholar
8. Johnson, S, Gerding, DN, Olson, MM, et al. Prospective, controlled study of vinyl glove use to interrupt Clostridium difficile nosocomial transmission. Am J Med 1990;88:137–140.Google Scholar
9. Olsen, RJ, Lynch, P, Coyle, MB, Cummings, J, Bokete, T, Stamm, WE. Examination gloves as barriers to hand contamination in clinical practice. JAMA 1993;270:350–353.Google Scholar
10. Tenorio, AR, Badri, SM, Sahgal, NB, et al. Effectiveness of gloves in the prevention of hand carriage of vancomycin-resistant Enterococcus species by health care workers after patient care. Clin Infect Dis 2001;32:826–829.CrossRefGoogle ScholarPubMed
11. Srinivasan, A, Song, X, Ross, T, Merz, W, Brower, R, Perl, TM. A prospective study to determine whether cover gowns in addition to gloves decrease nosocomial transmission of vancomycin-resistant enterococci in an intensive care unit. Infect Control Hosp Epidemiol 2002;23:424–428.Google Scholar
12. Puzniak, LA, Leet, T, Mayfield, J, Kollef, M, Mundy, LM. To gown or not to gown: the effect on acquisition of vancomycin-resistant enterococci. Clin Infect Dis 2002;35:18–25.Google Scholar
13. Montecalvo, MA, Jarvis, WR, Uman, J, et al. Infection-control measures reduce transmission of vancomycin-resistant enterococci in an endemic setting. Ann Intern Med 1999;131:269–272.Google Scholar
14. Boyce, JM, Opal, SM, Chow, JW, et al. Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol 1994;32:1148–1153.Google Scholar
15. 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;125:448–456.Google Scholar
16. Webster, J, Pritchard, MA. Gowning by attendants and visitors in newborn nurseries for prevention of neonatal morbidity and mortality. Cochrane Database Syst Rev 2003;3:CD003670.Google Scholar
17. Kenny, H, Lawson, E. The efficacy of cotton cover gowns in reducing infection in nursing neutropenic patients: an evidence-based study. Int J Nurs Pract 2000;6:135–139.CrossRefGoogle ScholarPubMed
18. Bessesen, MT, Lopez, K, Guerin, K, et al. Comparison of control strategies for methicillin-resistant Staphylococcus aureus . Am J Infect Control 2013;41:1048–1052.Google Scholar
19. Renaud, MT. Effects of discontinuing cover gowns on a postpartal ward upon cord colonization of the newborn. JOGN Nurs 1983;12:399–401.Google Scholar
20. Grant, J, Ramman-Haddad, L, Dendukuri, N, Libman, MD. The role of gowns in preventing nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA): gown use in MRSA control. Infect Control Hosp Epidemiol 2006;27:191–194.Google Scholar
21. Beer, D, Vandermeer, B, Brosnikoff, C, Shokoples, S, Rennie, R, Forgie, S. Bacterial contamination of health care workers’ pagers and the efficacy of various disinfecting agents. Pediatr Infect Dis J 2006;25:1074–1075.Google Scholar
22. Braddy, CM, Blair, JE. Colonization of personal digital assistants used in a health care setting. Am J Infect Control 2005;33:230–232.Google Scholar
23. Callaghan, I. Bacterial contamination of nurses’ uniforms: a study. Nurs Stand 1998;13:37–42.Google Scholar
24. Datta, P, Rani, H, Chander, J, Gupta, V. Bacterial contamination of mobile phones of health care workers. Indian J Med Microbiol 2009;27:279–281.Google Scholar
25. Morgan, DJ, Rogawski, E, Thom, KA, et al. Transfer of multidrug-resistant bacteria to healthcare workers’ gloves and gowns after patient contact increases with environmental contamination. Crit Care Med 2012;40:1045–1051.Google Scholar
26. Perry, C, Marshall, R, Jones, E. Bacterial contamination of uniforms. J Hosp Infect 2001;48:238–241.Google Scholar
27. Uneke, CJ, Ogbonna, A, Oyibo, PG, Onu, CM. Bacterial contamination of stethoscopes used by health workers: public health implications. J Infect Dev Ctries 2010;4:436–441.Google Scholar
28. Treakle, AM, Thom, KA, Furuno, JP, Strauss, SM, Harris, AD, Perencevich, EN. Bacterial contamination of health care workers’ white coats. Am J Infect Control 2009;37:101–105. doi:10.1016/j.ajic.2008.03.009.CrossRefGoogle ScholarPubMed
29. Harris, AD, Pineles, L, Belton, B, et al. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA 2013;310:1571–1580. doi:10.1001/jama.2013.277815.Google Scholar
30. Robinson, GL, Harris, AD, Morgan, DJ, Pineles, L, Belton, BM, Johnson, JK. Survival of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus spp. for an extended period of transport. J Clin Microbiol 2012;50:2466–2468. doi:10.1128/JCM.00911-12.Google Scholar
31. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial disk susceptibility tests; approved standard, 11th ed. Wayne, Pennsylvania: Clinical and Laboratory Standards Institute, 2012.Google Scholar
32. Munoz-Price, LS, Arheart, KL, Lubarsky, D a, Birnbach, DJ. Differential laundering practices of white coats and scrubs among health care professionals. Am J Infect Control 2013;41:565–567.Google Scholar
33. Bearman, G, Bryant, K, Leekha, S, et al. Healthcare personnel attire in non-operating-room settings. Infect Control Hosp Epidemiol 2014;35:107–121.Google Scholar
34. Bearman, GML, Rosato, A, Elam, K, et al. A crossover trial of antimicrobial scrubs to reduce methicillin-resistant Staphylococcus aureus burden on healthcare worker apparel. Infect Control Hosp Epidemiol 2012;33:268–275.Google Scholar
35. Burden, M, Keniston, A, Frank, MG, et al. Bacterial contamination of healthcare workers’ uniforms: a randomized controlled trial of antimicrobial scrubs. J Hosp Med 2013;8:380–385.Google Scholar
36. Morgan, DJ, Liang, SY, Smith, CL, et al. Frequent multidrug-resistant Acinetobacter baumannii contamination of gloves, gowns, and hands of healthcare workers. Infect Control Hosp Epidemiol 2010;31:716–721.Google Scholar