Johnson S, Gerding D N, Olson M M, Weiler M D, Hughes R A, Clabots C R, Peterson L R
Department of Medicine, Veterans Administration Medical Center, Minneapolis, Minnesota 55417.
Am J Med. 1990 Feb;88(2):137-40. doi: 10.1016/0002-9343(90)90462-m.
Despite recognition that Clostridium difficile diarrhea/colitis is a nosocomial infection, the manner in which this organism is transmitted is still not clear. Hands of health care workers have been shown to be contaminated with C. difficile and suggested as a vehicle of transmission. Therefore, we conducted a controlled trial of the use of disposable vinyl gloves by hospital personnel for all body substance contact (prior to the institution of universal body substance precautions) to study its effect on the incidence of C. difficile disease.
The incidence of nosocomial C. difficile diarrhea was monitored by active surveillance for six months before and after an intensive education program regarding glove use on two hospital wards. The interventions included initial and periodic in-services, posters, and placement of boxes of gloves at every patient's bedside. Two comparable wards where no special intervention was instituted served as controls.
A decrease in the incidence of C. difficile diarrhea from 7.7 cases/1,000 patient discharges during the six months before intervention to 1.5/1,000 during the six months of intervention on the glove wards was observed (p = 0.015). No significant change in incidence was observed on the two control wards during the same period (5.7/1,000 versus 4.2/1,000). Point prevalence of asymptomatic C. difficile carriage was also reduced significantly on the glove wards but not on the control wards after the intervention period (glove wards, 10 of 37 to four of 43, p = 0.029; control wards, five of 30 to five of 49, p = 0.19). The cost of 61,500 gloves (4,505 gloves/100 patients) used was $2,768 on the glove wards, compared with $1,895 (42,100 gloves; 3,532 gloves/100 patients) on the control wards.
Vinyl glove use was associated with a reduced incidence of C. difficile diarrhea and is indirect evidence for hand carriage as a means of nosocomial C. difficile spread.
尽管已认识到艰难梭菌腹泻/结肠炎是一种医院感染，但该病原体的传播方式仍不明确。医护人员的手部已被证明被艰难梭菌污染，并被认为是传播媒介。因此，我们进行了一项对照试验，让医院工作人员在接触所有体液时（在实施普遍的体液防护措施之前）使用一次性乙烯基手套，以研究其对艰难梭菌疾病发病率的影响。
在两个医院病房就手套使用开展强化教育项目前后，通过主动监测对医院获得性艰难梭菌腹泻的发病率进行了为期六个月的监测。干预措施包括初始和定期在职培训、张贴海报以及在每个患者床边放置手套盒。两个未采取特殊干预措施的可比病房作为对照。
在使用手套的病房，观察到艰难梭菌腹泻的发病率从干预前六个月的每1000例出院患者7.7例降至干预期间六个月的每1000例1.5例（p = 0.015）。同期，两个对照病房的发病率没有显著变化（分别为每1000例5.7例和4.2例）。干预期后，使用手套的病房无症状艰难梭菌携带的点患病率也显著降低，但对照病房未降低（使用手套的病房，37例中有10例降至43例中有4例，p = 0.029；对照病房，30例中有5例降至49例中有5例，p = 0.19）。使用手套的病房使用的61500只手套（每100名患者4505只手套）成本为2768美元，而对照病房为1895美元（42100只手套；每100名患者3532只手套）。
使用乙烯基手套与艰难梭菌腹泻发病率降低相关，这间接证明手部携带是医院内艰难梭菌传播的一种方式。
