It may sounds counterintuitive, but a study just published online by JAMA concludes that the use of gloves and gowns by health care workers in intensive care units (ICU) failed to materially reduce the incidence of infection of two common hospital-acquired drug resistant bacterial infections methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE).
A randomized 10-month trial conducted by Anthony D. Harris, M.D., and colleagues at the University of Maryland School of Medicine, Baltimore was conducted in 20 ICUs in 20 U.S. hospitals. During this time, all health care workers in the ICUs were required to wear gloves and gowns for all patient contact and when entering any patient room.
After obtaining more than 90 thousand swabs collected from about 26 thousand patients, the researchers found no statistically significant change in the rate of MRSA or VRE infection.They observed a small and barely statistically significant decrease in MRSA infections alone, but the actual effect was little or none.
ACSH s Dr. Josh Bloom who has written repeatedly about the coming antibiotic crisis says, This is quite disappointing: in the absence of a robust pipeline of new antibiotics to treat infections caused by resistant bacteria, preventing the infection becomes crucial.
Although the Centers for Disease Control and Prevention (CDC) has recommend use of gloves and gowns when caring for ICU patients, this alone is clearly not sufficient.
How to explain this surprising report? Betsy McCaughey, the former lieutenant governor of New York State, and now chairman of RID (Committee to Reduce Infection Deaths), offers this: Research also shows that particularly in regard to VRE, the highest risk factor for colonization is who occupied the room and bedside area before the current patient. It is the VRE on the bedrail, computer keyboard, call button etc waiting to colonize or infect the next patient. For that reason, rigorous cleaning of high touch surfaces around the bedside is likely the best single intervention to reduce colonization risk.
In other words, the use of gloves and gowns, despite being good practices, cannot make up for the real culprit the presence of the bacterial in the room. Dr. Bloom again: Of course, this is not an either/or situation. Both stringent hygienic practices and gloving and gowning can and should be used synergistically to most effectively lower infection rates.
We encourage you to visit Dr. McCaughey s RID website.
