Williams Calvin, McGraw Patty, Schneck Elyse E, LaFae Anna, Jacob Jesse T, Moreno Daniela, Reyes Katherine, Cubillos G Fernando, Kett Daniel H, Estrella Ronald, Morgan Daniel J, Harris Anthony D, Drees Marci
1Department of Medicine,Christiana Care Health System,Newark,Delaware.
2Department of Laboratory Medicine,Christiana Care Health System,Newark,Delaware.
Infect Control Hosp Epidemiol. 2015 Apr;36(4):431-7. doi: 10.1017/ice.2014.75.
To determine whether gowning and gloving for all patient care reduces contamination of healthcare worker (HCW) clothing, compared to usual practice.
Cross-sectional surveys.
Five study sites were recruited from intensive care units (ICUs) randomized to the intervention arm of the Benefits of Universal Gown and Glove (BUGG) study.
All HCWs performing direct patient care in the study ICUs were eligible to participate.
Surveys were performed first during the BUGG intervention study period (July-September 2012) with universal gowning/gloving and again after BUGG study conclusion (October-December 2012), with resumption of usual care. During each phase, HCW clothing was sampled at the beginning and near the end of each shift. Cultures were performed using broth enrichment followed by selective media. Acquisition was defined as having a negative clothing culture for samples taken at the beginning of a shift and positive clothing culture at for samples taken at the end of the shift.
A total of 348 HCWs participated (21-92 per site), including 179 (51%) during the universal gowning/gloving phase. Overall, 51 (15%) HCWs acquired commonly pathogenic bacteria on their clothing: 13 (7.1%) HCWs acquired bacteria during universal gowning/gloving, and 38 (23%) HCWs acquired bacteria during usual care (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.2-0.6). Pathogens identified included S. aureus (25 species, including 7 methicillin-resistant S. aureus [MRSA]), Enterococcus spp. (25, including 1 vancomycin-resistant Enterococcus [VRE]), Pseudomonas spp. (4), Acinetobacter spp. (4), and Klebsiella (2).
Nearly 25% of HCWs practicing usual care (gowning and gloving only for patients with known resistant bacteria) contaminate their clothing during their shift. This contamination was reduced by 70% by gowning and gloving for all patient interactions.
与常规做法相比，确定对所有患者护理操作均进行穿 gowning 和戴手套是否能减少医护人员（HCW）衣物的污染。
横断面调查。
从重症监护病房（ICU）招募了五个研究地点，这些 ICU 被随机分配到通用 gowning 和手套益处（BUGG）研究的干预组。
在研究 ICU 中进行直接患者护理的所有医护人员均有资格参与。
在 BUGG 干预研究期间（2012 年 7 月至 9 月）进行通用 gowning/戴手套操作时进行首次调查，在 BUGG 研究结束后（2012 年 10 月至 12 月）恢复常规护理时再次进行调查。在每个阶段，在每个班次开始时和接近结束时对医护人员的衣物进行采样。培养采用肉汤增菌后接选择性培养基的方法。获取定义为在班次开始时衣物培养为阴性，而在班次结束时衣物培养为阳性。
共有 348 名医护人员参与（每个地点 21 - 92 名），其中 179 名（51%）在通用 gowning/戴手套阶段参与。总体而言，51 名（15%）医护人员在其衣物上获取了常见病原菌：13 名（7.1%）医护人员在通用 gowning/戴手套期间获取细菌，38 名（23%）医护人员在常规护理期间获取细菌（优势比[OR]，0.3；95%置信区间[CI]，0.2 - 0.6）。鉴定出的病原体包括金黄色葡萄球菌（25 种，包括 7 种耐甲氧西林金黄色葡萄球菌[MRSA]）、肠球菌属（25 种，包括 1 种耐万古霉素肠球菌[VRE]）、假单胞菌属（4 种）、不动杆菌属（4 种）和克雷伯菌属（2 种）。
近 25%的采用常规护理（仅对已知耐药菌患者进行 gowning 和戴手套）的医护人员在班次期间污染了他们的衣物。通过对所有患者互动均进行 gowning 和戴手套，这种污染减少了 70%。
