416. Universal Glove and Gown Use is Associated with a Significant Reduction in the Central Line-Associated Bloodstream Infection Rate in the MICU at an Academic Medical Center: 5 Years of Evaluation
Session: Poster Abstract Session: HAI: Preventing Device-Associated Infections
Thursday, October 27, 2016
Room: Poster Hall
Background: Wearing gloves and gowns for all patient contact has been evaluated as a means of preventing health care-associated infections (HAIs).  The medical intensive care unit (MICU) at University Hospital participated in a multicenter national study and was randomized to the intervention arm requiring health care workers (HCWs) to wear gloves and gowns for all patient contact.  During the 9 month study time period, a significant reduction in the central line-associated bloodstream infection (CLABSI) rate was observed.  After the study, the intervention was discontinued and the CLABSI rate increased.  In response, universal gloving and gowning was re-started in the MICU 13 months later.   Methods: During intervention time periods, all HCWs wore gloves and gowns for all patient contact and on patient room entry.  No other interventions were launched.  The CLABSI rate and catheter-associated urinary tract infection (CAUTI) rate were monitored using CDC National Healthcare Safety Network definitions.  Rate differences were calculated by Fisher’s exact using mid-P value.   Results: CLABSI rates are reported as per 1000 central line days (Figure 1).  Baseline time period 1 (January – December 2011) had a CLABSI rate of 3.93.  Intervention time period 2 (January – October 4, 2012) had a CLABSI rate of 0.395.  Washout time period 3 (October 5, 2012 – October 31, 2013) had a CLABSI rate of 2.06.  Intervention time period 4 (November 1, 2013 – Feb 28, 2016) had a CLABSI rate of 0.659.  The difference between CLABSI rates in time periods 1 and 2 was statistically significant (p-value 0.004).  The difference between time periods 3 and 4 was also statistically significant (p-value 0.0325).  Using the rate difference between time periods 3 and 4, the number of CLABSIs avoided during time period 4 is calculated to be 15.  Based on Agency for Healthcare Research and Quality estimates, 2.7 deaths, 195 hospital days, and $678,810 in extra costs were avoided.  The CAUTI rate was not significantly impacted by this intervention.   Conclusion: Universal glove and gown use for all patient contact in the MICU was associated with a significant decrease in the CLABSI rate.  These reduced rates were observed during 2 distinct intervention time periods of 9 and 28 months, separated by a 13 month washout time period, and showed reductions of 90% and 68% from their respective preceding time periods.  
Jason E. Bowling, MD1,2, Anthony D. Harris, MD, MPH, FIDSA, FSHEA3, Daniel Morgan, MD, MS, FIDSA, FSHEA4, Ronald Estrella, BSN, CCRN5, Stephanie Levine, MD1,6 and Jan E. Patterson, MD, FIDSA, FSHEA7, (1)University Health System, San Antonio, TX, (2)University of Texas Health Science Center at San Antonio, San Antonio, TX, (3)Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, (4)Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, (5)University Health System, San Antonio, San Antonio, TX, (6)Medicine/Pulmonary, University of Texas Health Science Center San Antonio, San Antonio, TX, (7)University of Texas Health Sciences Center, San Antonio, TX

Disclosures:

J. E. Bowling, None

A. D. Harris, None

D. Morgan, None

R. Estrella, None

S. Levine, None

J. E. Patterson, Young Living Essential Oils: Distributor , Salary

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.