541. Gown Use Does Not Decrease Transmission of Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococci (VRE) if Hand Hygiene Compliance is Suboptimal
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Gowns are recommended for patients in contact isolation to prevent transmission of MRSA and VRE, but their effectiveness in addition to hand hygiene (HH) is debated. In most institutions HH compliance remains suboptimal.
Methods: In a crossover study in 2 ICUs, admission, discharge and twice-weekly patient cultures for MRSA and VRE were obtained. The study included a 6-month gown use and a 6-month no-gown phase in each ICU. Glove use for patients in contact isolation, and HH for all patients, were required throughout the study. Gown, glove and HH compliance was monitored. MRSA or VRE acquisition was defined as a positive culture >48 hours after admission. To determine whether gown use decreased risk for MRSA and VRE acquisition, multivariable Cox proportional hazards models were used.
Results: Of 1330 admissions during the study period, 125 (9%) were already colonized with MRSA or VRE. Of 746 at risk for MRSA and/or VRE acquisition, 413 (55%) stayed during a gown use phase. During a gown use phase, 47 patients (11%) acquired VRE, MRSA or both, compared to 28 patients (8%) during a no-gown phase (HR 1.3, 95% CI 0.8 - 2.0). More patients acquired VRE (30 [7%] in gown use phase vs. 16 [5%] in no-gown phase) than acquired MRSA (15 [4%] vs. 10 [3%]) or both (2 [<1%] each). Average compliance by ICU and study phase varied from 28 - 40% for HH, 56 - 77% for glove use, and 55 - 77% for gown use. Average HH compliance did not vary significantly by gown use (37%) vs. no-gown (34%) phase. In multivariable analysis, gown use remained unassociated with decreased MRSA/VRE acquisition.
Conclusion: With suboptimal HH compliance, we found no difference in MRSA/VRE acquisition between ICUs with and without a gown use requirement, despite reasonable compliance with gown and glove use. Without frequent and effective HH, institutions that require gowns and gloves as part of their contact isolation protocol will not obtain maximal benefit.
Marci Drees, MD, MS1, Eldad Elnekave, MD2, Scott Epstein, MD2, Yoav Golan, MD MS3, John Griffith, PhD2, Stanley Nasraway, MD2, David Snydman, MD, FIDSA4, Padade Vue, MD2 and  M. Drees, None..
D. R. Snydman, None..
J. Griffith, None..
P. M. Vue, None..
E. Elnekave, None..
S. Epstein, None..
S. A. Nasraway, None..
Y. Golan, None., (1)Christiana Care Health System, Newark, DE, (2)Tufts Med. Ctr., Boston, MA, (3)Tufts-New England Medical Center, Boston, MA, (4)Tufts New England Medical Center, Boston, MA