Division of Neonatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville.
Division of Translational Research and Applied Statistics, Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville.
JAMA Pediatr. 2014 Oct;168(10):909-16. doi: 10.1001/jamapediatrics.2014.953.
Late-onset infections commonly occur in extremely preterm infants and are associated with high rates of mortality and neurodevelopmental impairment. Hand hygiene alone does not always achieve the desired clean hands, as microorganisms are still present more than 50% of the time. We hypothesize that glove use after hand hygiene may further decrease these infections.
To determine if nonsterile glove use after hand hygiene before all patient and intravenous catheter contact, compared with hand hygiene alone, prevents late-onset infections in preterm infants.
DESIGN, SETTINGS, AND PARTICIPANTS: A prospective, single-center, clinical, randomized trial was conducted in infants admitted to the neonatal intensive care unit who weighed less than 1000 g and/or had a gestational age of less than 29 weeks and were less than 8 days old. There were 175 eligible infants, of which 120 were enrolled during a 30-month period from December 8, 2008, to June 20, 2011.
Infants were randomly assigned to receive care with nonsterile gloves after hand hygiene (group A) or care after hand hygiene alone (group B) before all patient and intravenous line (central and peripheral) contact. Study intervention was continued while patients had central or peripheral venous access.
One or more episodes of late-onset (>72 hours of age) infection in the bloodstream, urinary tract, or cerebrospinal fluid or necrotizing enterocolitis.
The 2 groups were similar in baseline demographic characteristics. Late-onset invasive infection or necrotizing enterocolitis occurred in 32% of infants (19 of 60) in group A compared with 45% of infants (27 of 60) in group B (difference, -12%; 95% CI, -28% to 6%; P = .13). In group A compared with group B, there were 53% fewer gram-positive bloodstream infections (15% [9 of 60] vs 32% [19 of 60]; difference, -17%; 95% CI, -31% to -1%; P = .03) and 64% fewer central line-associated bloodstream infections (3.4 vs 9.4 per 1000 central line days; ratio, 0.36; 95% CI, 0.16 to 0.81; P = .01).
Glove use after hand hygiene prior to patient and line contact is associated with fewer gram-positive bloodstream infections and possible central line-associated bloodstream infections in preterm infants. This readily implementable infection control measure may result in decreased infections in high-risk preterm infants.
clinicaltrials.gov Identifier: NCT01729000.
迟发性感染在极早产儿中很常见，与高死亡率和神经发育障碍有关。单独进行手部卫生并不能始终达到清洁双手的目的，因为微生物仍然存在超过 50%的时间。我们假设在接触所有患者和静脉导管之前，在进行手部卫生后使用非无菌手套可以进一步降低这些感染的发生。
确定与单独进行手部卫生相比，在接触所有患者和静脉导管之前，使用非无菌手套是否可以预防极低体重早产儿的迟发性感染。
设计、地点和参与者：这是一项前瞻性、单中心、临床、随机试验，在新生儿重症监护病房入院的体重不足 1000 克和/或胎龄小于 29 周且小于 8 天的婴儿中进行。共有 175 名符合条件的婴儿，其中 120 名在 2008 年 12 月 8 日至 2011 年 6 月 20 日期间的 30 个月内被纳入研究。
婴儿被随机分配接受接触患者和静脉置管（中心和外周）前进行手部卫生+非无菌手套（A 组）或仅手部卫生（B 组）的护理。当患者有中心或外周静脉通路时，研究干预将继续进行。
血液、尿液或脑脊液中出现一次或多次迟发性（>72 小时龄）感染，或发生坏死性小肠结肠炎。
两组在基线人口统计学特征方面相似。A 组中 32%（60 例中的 19 例）的婴儿发生迟发性侵袭性感染或坏死性小肠结肠炎，而 B 组中 45%（60 例中的 27 例）的婴儿发生（差异，-12%；95%CI，-28%至 6%；P=0.13）。与 B 组相比，A 组革兰氏阳性菌血流感染减少 53%（15%[60 例中的 9 例]与 32%[60 例中的 19 例]；差异，-17%；95%CI，-31%至-1%；P=0.03），中心静脉相关血流感染减少 64%（3.4 例与 9.4 例/每 1000 个中心静脉导管天；比值，0.36；95%CI，0.16 至 0.81；P=0.01）。
在接触患者和导管之前，在手卫生后使用手套与早产儿革兰氏阳性菌血流感染和可能的中心静脉相关血流感染减少有关。这种易于实施的感染控制措施可能会降低高危早产儿的感染率。
clinicaltrials.gov 标识符：NCT01729000。
