Department of Epidemiology and Public Health, University of Maryland School of Medicine and VA Maryland Healthcare System, Baltimore, Maryland, USA.
Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.
Clin Infect Dis. 2023 Feb 8;76(3):e1202-e1207. doi: 10.1093/cid/ciac519.
Clostridioides difficile is the most common cause of healthcare-associated infections in the United States. It is unknown whether universal gown and glove use in intensive care units (ICUs) decreases acquisition of C. difficile.
This was a secondary analysis of a cluster-randomized trial in 20 medical and surgical ICUs in 20 US hospitals from 4 January 2012 to 4 October 2012. After a baseline period, ICUs were randomized to standard practice for glove and gown use versus the intervention of all healthcare workers being required to wear gloves and gowns for all patient contact and when entering any patient room (contact precautions). The primary outcome was acquisition of toxigenic C. difficile determined by surveillance cultures collected on admission and discharge from the ICU.
A total of 21 845 patients had both admission and discharge perianal swabs cultured for toxigenic C. difficile. On admission, 9.43% (2060/21 845) of patients were colonized with toxigenic C. difficile. No significant difference was observed in the rate of toxigenic C. difficile acquisition with universal gown and glove use. Differences in acquisition rates in the study period compared with the baseline period in control ICUs were 1.49 per 100 patient-days versus 1.68 per 100 patient-days in universal gown and glove ICUs (rate difference, -0.28; generalized linear mixed model, P = .091).
Glove and gown use for all patient contact in medical and surgical ICUs did not result in a reduction in the acquisition of C. difficile compared with usual care.
NCT01318213.
艰难梭菌是美国最常见的医疗保健相关感染病原体。目前尚不清楚重症监护病房（ICU）内普遍使用长袍和手套是否会减少艰难梭菌的感染。
这是一项在美国 20 家医院的 20 个内科和外科 ICU 中进行的集群随机试验的二次分析。在基线期之后，将 ICU 随机分为标准手套和长袍使用组与干预组，干预组要求所有医护人员在接触患者和进入任何患者病房时（接触预防措施）均需戴手套和长袍。主要结局是通过在 ICU 入院和出院时采集的监测培养物确定的产毒艰难梭菌感染。
共有 21845 名患者入院和出院时进行了肛拭子艰难梭菌产毒培养。入院时，21845 名患者中有 9.43%（2060/21845）定植有产毒艰难梭菌。普遍使用长袍和手套并未显著降低产毒艰难梭菌的感染率。与对照组 ICU 相比，研究期间的感染率差异在控制 ICU 中分别为每 100 患者日 1.49 例与每 100 患者日 1.68 例（差异率，-0.28；广义线性混合模型，P =.091）。
与常规护理相比，在普通内科和外科 ICU 中对所有患者接触均使用长袍和手套并不能减少艰难梭菌的感染。
NCT01318213。
