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The Effect of Universal Glove and Gown Use on Adverse Events in the Benefits of Universal Glove and Gown (BUGG) Cluster Randomized Trial

Session: Oral Abstract Session: Epidemiology of MRSA and Impact of Control Interventions
Friday, October 10, 2014: 11:45 AM
Room: The Pennsylvania Convention Center: 111-AB

Background: Few studies have examined whether Contact Precautions are associated with patient adverse events (unintended physical injury resulting from or contributed to by medical care). Findings from observational studies on effects of Contact Precautions vary from large increases in adverse events, to increased risk for subsets of events, to no overall difference.  No randomized trials have examined the effect of glove and gown use on adverse events.

Methods: We analyzed 1800 patient charts from 20 intensive care units (ICUs) participating in the Benefits of Universal Gloving and Gowning cluster randomized trial, conducted from January to October 2010. Eligible patients were not colonized with antibiotic resistant bacteria (and thus were not on Contact Precautions in control ICUs). Nine hundred patients from ICUs randomized to universal glove and gown use and 900 patients from usual care ICUs were randomly selected for chart review for adverse events using the Institute for Healthcare Improvement Global Trigger Tool. Preventability and severity of each adverse event were recorded. Mixed effects Poisson regression was used to model rates of adverse events and account for clustering by ICU.

Results : Of 1800 patients, 447 (24.8%) had at least one adverse event in the ICU. Universal glove and gown use was not associated with noninfectious adverse events (incidence rate ratio [IRR] 0.89, 95% confidence interval [CI] 0.54-1.46, p=0.64) after adjustment for ICU type (IRR 0.98 in medical-surgical [MICU-SICU] ICUs, 95% CI 0.55-1.73; IRR 1.17 in SICUs, 95% CI 0.66-2.06), case-mix index below 1.83 (IRR 0.88, 95% CI 0.58-1.34), non-academic hospital setting (IRR 1.01, 95% CI 0.59-1.71), and ICU bed size  (IRR 1.03, 95% CI 1.00-1.06). The adjusted infectious adverse event rate also was not associated with universal glove and gown use (IRR 0.75, 95% CI 0.47-1.18, p=0.21). Universal glove and gown use was not significantly associated with noninfectious preventable adverse events or severe noninfectious adverse events when adjusted for the same covariates (Figure).

Conclusion: Patients in ICUs where healthcare workers donned gloves and gowns for all patient contact were no more likely to experience noninfectious or infectious adverse events.

 

Lindsay Croft, MS1, Anthony D. Harris, MD, MPH1, Lisa Pineles, MA1, Patricia Langenberg, PhD1, Michelle Shardell, PhD1, Linda Simoni-Wastila, BSPharm, MSPH, PhD2, Daniel Morgan, MD, MS3 and Benefits of Universal Glove and Gown (BUGG) primary investigators, (1)Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, (2)Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, (3)Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD

Disclosures:

L. Croft, None

A. D. Harris, None

L. Pineles, None

P. Langenberg, None

M. Shardell, None

L. Simoni-Wastila, None

D. Morgan, None

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