一项关于通用戴手套与接触预防措施预防多重耐药菌传播的对照试验。

A controlled trial of universal gloving versus contact precautions for preventing the transmission of multidrug-resistant organisms.

作者信息

Bearman Gonzalo M L, Marra Alexandre R, Sessler Curtis N, Smith Wally R, Rosato Adriana, Laplante Justin K, Wenzel Richard P, Edmond Michael B

机构信息

Department of Internal Medicine, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, VA, USA.

出版信息

Am J Infect Control. 2007 Dec;35(10):650-5. doi: 10.1016/j.ajic.2007.02.011.

DOI:10.1016/j.ajic.2007.02.011

PMID:18063129

Abstract

BACKGROUND

Contact precautions are recommended to reduce the transmission of multidrug-resistant organisms. However, the optimal method for control of multidrug-resistant organisms remains unclear.

METHODS

A controlled trial was conducted in a medical intensive care unit. Phase 1 was a 3-month period of standard practice in which patients were placed in contact precautions per Centers for Disease Control and Prevention guidelines. In the second 3 months, phase 2, gloves were required for all patient contact, and no patients were placed in contact precautions.

RESULTS

Compliance with contact precautions in phase 1 versus universal gloving in phase 2 was 75.7% versus 87.0%, respectively (P < .001). Hand hygiene compliance before patient care was significantly higher in phase 1 when compared with phase 2 (18.7% vs 11.4%, respectively, P < .001). Hand hygiene compliance after patient care was 57.7% in phase 1 versus 52.5% in phase 2 (P = .011). Nosocomial infection rates per 1000 device-days in phase 1 versus phase 2 were as follows: bloodstream infection, 6.2 versus 14.1, respectively (P < .001); urinary tract infection, 4.3 versus 7.4, respectively (P < .001); and ventilator-associated pneumonia, 0 versus 2.3, respectively (P < .001). There were no differences in vancomycin-resistant enterococci or methicillin-resistant Staphylococcus aureus acquisition in the 2 study phases; however, in both phases, the majority of vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus conversions were clonal.

CONCLUSION

Compliance with universal gloving was significantly greater than compliance with contact precautions. However, greater compliance with hand hygiene was observed in the contact precautions phase. Measures must be in place to both increase and sustain hand hygiene compliance so as to minimize the risk of nosocomial cross transmission before reevaluating the concept of replacing contact precautions with universal gloving.

摘要

背景

建议采取接触预防措施以减少多重耐药菌的传播。然而，控制多重耐药菌的最佳方法仍不明确。

方法

在一个医疗重症监护病房进行了一项对照试验。第一阶段为期3个月，采用标准做法，即根据疾病控制与预防中心的指南对患者采取接触预防措施。在接下来的3个月，即第二阶段，所有患者接触时均需戴手套，且不对任何患者采取接触预防措施。

结果

第一阶段接触预防措施的依从率与第二阶段普遍戴手套的依从率分别为75.7%和87.0%（P <.001）。与第二阶段相比，第一阶段患者护理前的手卫生依从率显著更高（分别为18.7%和11.4%，P <.001）。第一阶段患者护理后的手卫生依从率为57.7%，第二阶段为52.5%（P =.011）。第一阶段与第二阶段每1000个设备日的医院感染率如下：血流感染分别为6.2和14.1（P <.001）；尿路感染分别为4.3和7.4（P <.001）；呼吸机相关性肺炎分别为0和2.3（P <.001）。两个研究阶段中耐万古霉素肠球菌或耐甲氧西林金黄色葡萄球菌的获得情况无差异；然而，在两个阶段中，大多数耐万古霉素肠球菌和耐甲氧西林金黄色葡萄球菌的转换都是克隆性的。