1145. The Benefits of Universal Glove and Gown (BUGG) use on the acquisition of antibiotic-resistant bacteria: A cluster randomized trial
Session: Oral Abstract Session: Featured Oral Abstract
Friday, October 4, 2013: 4:15 PM
Room: The Moscone Center: Esplanade Ballroom 301-310

Background: Antibiotic-resistant bacteria increase patient morbidity and mortality.  It is unknown whether wearing gloves and gowns for all patient contact in the intensive care unit decreases acquisition of antibiotic-resistant bacteria.

Methods: To assess whether wearing gloves and gowns for all patient contact in the intensive care unit (ICU) decreases acquisition of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) we conducted a cluster-randomized trial of 20 medical and surgical ICUs in 20 US hospitals. In the intervention arm all healthcare workers were required to wear gloves and gowns for all patient contact and when entering any patient room and compared to usual care in the control arm. The primary outcome was acquisition of MRSA or VRE based on surveillance cultures collected on admission and discharge from the ICUSecondary outcomes included individual VRE acquisition, MRSA acquisition, frequency of healthcare-worker visits, hand hygiene compliance, healthcare-associated infections and adverse events. 

Results: 26,180 patients were included and 92,241 swabs collected for the primary outcome.  The primary outcome of MRSA or VRE acquisition did not significantly differ between control and intervention ICUs (20.8% vs. 14.4% relative reduction from baseline, p=0.57). For key secondary outcomes, intervention ICUs had a 40.2% relative reduction from baseline in MRSA acquisition compared with 15.0% in control ICUs (p=0.046) and no statistically significant difference in VRE acquisition (10.5% vs. 17.3% relative reduction, p=0.70). (See Figure)  Universal glove and gown also decreased healthcare worker room entry (4.28 vs. 5.24 entries per hour, p=0.022), increased room exit hand hygiene compliance (78.9% vs. 62.9%, p=0.015) and had no statistically significant impact on rates of adverse event (57.1 events/1000 patient days vs. 76.4 events/1000 patient days, p=0.24).

Conclusion: Healthcare workers wearing gloves and gowns for all patient contact in the ICU setting reduced MRSA acquisition with no increase in adverse events. Figure. Effect of universal glove and gown use on acquisition rates for VRE or MRSA.

 

Anthony D. Harris, MD, MPH1, Lisa Pineles, MA2, Beverly Belton, RN, MSN, NE-BC3, J. Kristie Johnson, PhD4, Michelle Shardell, PhD5, Mark Loeb, MD, MSc6, Allan Donner, MSc, PhD7, Robin Newhouse, PhD, RN, NEA-BC, FAAN8, Louise Dembry, MD, MS, MBA9, Barbara Braun, PhD10, Eli Perencevich, MD, MS, FIDSA, FSHEA11, Kendall Hall, MD, MS12, Daniel Morgan, MD, MS2 and Benefits of Universal Glove and Gown (BUGG) primary investigators, (1)Departmetn of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, (2)Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, (3)Yale New Haven Health System, New Haven, CT, (4)University of Maryland School of Medicine, Baltimore, MD, (5)Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD, (6)McMaster University, Hamilton, ON, Canada, (7)University of Western Ontario, London, ON, Canada, (8)University of Maryland School of Nursing, Baltimore, MD, (9)Yale University School of Medicine/YNHH, New Haven, CT, (10)The Joint Commission, Oakbrook Terrace, IL, (11)Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, (12)Agency for Healthcare Research and Quality, Rockville, MD

Disclosures:

A. D. Harris, Premier: Consultant, Consulting fee
Cubist: Consultant, Consulting fee
Sanogiene: Consultant, Consulting fee
UpToDate, Online: Consultant, Consulting fee

L. Pineles, None

B. Belton, None

J. K. Johnson, BioMed Protect: Investigator, Research grant

M. Shardell, None

M. Loeb, None

A. Donner, None

R. Newhouse, None

L. Dembry, None

B. Braun, None

E. Perencevich, None

K. Hall, None

D. Morgan, Welch Allyn : Consultant, Consulting fee
Sanogiene : Consultant, Consulting fee

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