Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298-0019, USA.
Infect Control Hosp Epidemiol. 2010 May;31(5):491-7. doi: 10.1086/651671.
To compare the efficacy of universal gloving with emollient-impregnated gloves with standard contact precautions for the control of multidrug-resistant organisms (MDROs) and to measure the effect on healthcare workers' (HCWs') hand skin health.
Prospective before-after trial.
An 18-bed surgical intensive care unit.
During phase 1 (September 2007 through March 2008) standard contact precautions were used. During phase 2 (March 2008 through September 2008) universal gloving with emollient-impregnated gloves was used, and no contact precautions. Patients were screened for vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). HCW hand hygiene compliance and hand skin health and microbial contamination were assessed. The incidences of device-associated infection and Clostridium difficile infection (CDI) were determined.
The rate of compliance with contact precautions (phase 1) was 67%, and the rate of compliance with universal gloving (phase 2) was 78% (P = .01). Hand hygiene compliance was higher during phase 2 than during phase 1 (before patient care, 40% vs 35% of encounters; P = .001; after patient care, 63% vs 51% of encounters; P < .001). No difference was observed in MDRO acquisition. During phases 1 and 2, incidences of device-related infections, in number of infections per 1,000 device-days, were, respectively, 3.7 and 2.6 for bloodstream infection (P = .10), 8.9 and 7.8 for urinary tract infection (P = .10), and 1.0 and 1.1 for ventilator-associated pneumonia (P = .09). The CDI incidence in phase 1 and in phase 2 was, respectively, 2.0 and 1.4 cases per 1,000 patient-days (P = .53). During phase 1, 29% of HCW hand cultures were MRSA positive, compared with 13% during phase 2 (P = .17); during phase 1, 2% of hand cultures were VRE positive, compared with 0 during phase 2 (P = .16). Hand skin health improved during phase 2.
Compared with contact precautions, universal gloving with emollient-impregnated gloves was associated with improved hand hygiene compliance and skin health. No statistically significant change in the rates of device-associated infection, CDI, or patient MDRO acquisition was observed. Universal gloving may be an alternative to contact precautions.
比较通用手套加润肤手套与标准接触预防措施在控制多重耐药菌（MDROs）方面的效果，并测量其对手卫生保健工作者（HCWs）手部皮肤健康的影响。
前瞻性前后对照试验。
18 张床位的外科重症监护病房。
在第一阶段（2007 年 9 月至 2008 年 3 月）采用标准接触预防措施。在第二阶段（2008 年 3 月至 2008 年 9 月）采用通用手套加润肤手套，不采用接触预防措施。对万古霉素耐药肠球菌（VRE）和耐甲氧西林金黄色葡萄球菌（MRSA）进行患者筛查。评估 HCW 的手部卫生依从性和手部皮肤健康及微生物污染情况。确定器械相关感染和艰难梭菌感染（CDI）的发生率。
接触预防措施（第一阶段）的依从率为 67%，通用手套（第二阶段）的依从率为 78%（P=0.01）。第二阶段的手部卫生依从性高于第一阶段（接触患者前，40%比 35%；P=0.001；接触患者后，63%比 51%；P<0.001）。未观察到 MDRO 的获得有差异。在第一阶段和第二阶段，每 1000 个器械日发生的器械相关感染的感染率分别为：血流感染分别为 3.7 和 2.6（P=0.10），尿路感染分别为 8.9 和 7.8（P=0.10），呼吸机相关性肺炎分别为 1.0 和 1.1（P=0.09）。第一阶段和第二阶段的艰难梭菌感染的发生率分别为每 1000 个患者日 2.0 和 1.4 例（P=0.53）。在第一阶段，29%的 HCW 手部培养物呈 MRSA 阳性，而第二阶段为 13%（P=0.17）；在第一阶段，2%的手部培养物呈 VRE 阳性，而第二阶段为 0（P=0.16）。第二阶段手部皮肤健康状况有所改善。
与接触预防措施相比，通用手套加润肤手套与提高手部卫生依从性和皮肤健康有关。未观察到器械相关感染、CDI 或患者 MDRO 获得率的统计学显著变化。通用手套可能是接触预防措施的替代方法。
