The results of a new study appear to cast doubt on the widely-held belief that infection rates can be reduced significantly if healthcare staff wear gloves and gowns as a matter of course.
Confusion abounds following the publication of the research by the University of Maryland School of Medicine and the Yale New Haven Health System Center for Healthcare Solutions.
In conjunction with the evolution of hospital cleaning practices, increased handwashing frequency and other measures, patients in hospitals can be safer than they've ever been
The analysis covered 20 intensive care units across 15 US states, each of which took part in a 10-month study analysing more than 92,000 bacterial cultures from around 26,000 patients. Rates of MRSA and VRE were then recorded.
To make a comparison, one group of healthcare workers wore gloves and gowns every time they were in a patient’s room. The other group wore the barrier clothing only when dealing with those already infected with antibiotic-resistant bacteria - the current standard isolation protocol.
But the results failed to provide a definitive answer, leaving healthcare providers to decide whether the high cost of barrier nursing in this way is worth it.
The findings showed that cases of MRSA or VRE among the group wearing gloves and gowns fell from 21.35 acquisitions per 1,000 patient days during the baseline period to 16.91 per 1,000 patient days over the study period. While this appears to suggest a link, the control group of staff not wearing protective clothing all the time also saw a drop from 19.02 to 16.29. The two groups therefore recorded more or less the same results.
However, when broken down by the bacteria present, it did appear that wearing gloves and gowns had a positive impact on MRSA rates. Where gowns were worn a decrease of 40% was observed compared to just a 14% reduction among the other group. There was so significant different in VRE rates.
Although it is appealing to believe there is a simple approach to what should and should not be done to prevent infection in ICUs, best practices are more nuanced and unfortunately one size does not fit all
The study’s principal investigator, Anthony D Harris, a professor of epidemiology and public health at the University of Maryland School of Medicine, claimed the results were a breakthrough in research into how infections spread in healthcare environments.
He said: “We set out to find whether having healthcare workers wear gowns and gloves for all ICU patient contact could decrease the acquisition of antibiotic-resistant bacteria such as MRSA without causing any harm to the patient – and the answer was ‘yes’.
His colleague and co-author, Daniel J Morgan, added: "Infection control studies such as this are important to advance the science and lead to important discoveries that can decrease healthcare-associated infections.
“In conjunction with the evolution of hospital cleaning practices, increased handwashing frequency and other measures, patients in hospitals can be safer than they've ever been."
But come academics have been more cautious in welcoming the results.
Although it is appealing to believe there is a simple approach to what should and should not be done to prevent infection in ICUs, best practices are more nuanced and unfortunately one size does not fit all
Preeti Malani of the University of Michigan Health System called the study ‘a meaningful addition to a growing cadre of high-quality infection prevention trials’, but added: “Although it is appealing to believe there is a simple approach to what should and should not be done to prevent infection in ICUs, best practices are more nuanced and unfortunately one size does not fit all. The final approach must be adapted to fit the epidemiology of specific ICUs and should also consider the type of resources available."
Others noted the high cost of wearing gowns and gloves for every patient contact.
Mary Hayden of Rush University Medical Center in Chicago said: “There are some possible drawbacks. The cost would be a downside, as well as the trash that you would generate, because the gowns and gloves are all disposable."