When a patient is on standard contact precautions, the healthcare worker caring for that patient should be wearing the appropriate personal protective equipment (PPE), including gloves, a gown, and a mask.
The problem with contact precautions is ensuring that staff members are complying with proper PPE protocol.
A study published in the May issue of Infection Control and Hospital Epidemiology found that a universal gloving policy could be equally as effective as placing patients under contact precautions for a multidrug-resistant organism (MDRO) infection.
The 12-month prospective study in an 18-bed surgical ICU at Virginia Commonwealth University Medical Center in Richmond included two phases. The first phase (first six months) measured the rate of compliance with contact precautions, and the second phase (second six months) measured the rate of compliance with universal gloving. Results showed that policy compliance was higher in phase two (78%) than phase one (67%), and hand hygiene compliance was higher in phase two before patient care (40% vs. 35%) and after patient care (63% vs. 51%).
"Throughout the entire study, both the first and second phases, we did active surveillance cultures twice a week on all patients to see if they were carrying MRSA or VRE, and we also did concurrent or real-time surveillance for hospital-acquired infections like we do here with the hospital infection prevention unit," says Gonzalo Bearman, MD, MPH, lead author of the study and associate hospital epidemiologist at Virginia Commonwealth.
Infection rates stayed the same or decreased with universal gloving. Bloodstream and urinary tract infections decreased, while ventilator-associated pneumonia increased only slightly. Additionally, hand cultures of healthcare workers showed fewer positive MRSA cultures during phase two of the study.
"Research shows in outbreak situations, heightened infection prevention—which includes hand hygiene, the use of gloves, and the use of gowns—is probably what is preferred," Bearman says. "However, using those measures for standard care in endemic settings may not be necessary; it may be too aggressive. So what we're saying is that maybe a less restrictive option—just issuing universal gloves—appears to work for the control of multidrug-resistant organisms and should be considered."
Improved compliance rates
One of the major positive results from the study was the increased compliance with the universal glove policy and hand hygiene.
Bearman believes that compliance with the policy increased because it was well received by staff members.
A survey given to healthcare workers at the conclusion of the study indicated that the majority of workers welcomed the idea of universal gloving and believed it was not too cumbersome, says Bearman. Only 15% said they thought that universal gloving was impractical.
"Generally, healthcare workers don't like having to put on gowns and gloves to go see patients," Bearman says. "It's much easier to don gloves than put on the gown for patient care. So I think that twist on isolation precautions was well received by the healthcare workers."
Improved skin health
The study also indicated improved skin health among healthcare workers at Virginia Commonwealth, largely due to the fact that staff used emollient-impregnated gloves. The gloves themselves were not a new product, but the fact that staff members wore them so consistently led to an improvement in skin health.
This may have contributed to increased hand hygiene compliance rates as well, since healthcare workers most often complain that dry, irritated skin deters them from washing their hands.
"It's believed that if you wear the gloves long enough and intensely enough or frequently enough, then they do have a benefit on the health of the skin—in other words, decreased redness or dermatitis or flakiness," Bearman says. "A lot of times I'm seeing patients and I constantly have to put cream on my hands because the alcohol rubs are so caustic."
Is it a viable option?
Unfortunately, probably not enough information can be gleaned from the study to make general recommendations, but it's possible to see the potential translation of this study to other units or hospitals, depending on the risks that are present, Bearman says. "I think the results of the study are certainly unique to this unit," he adds. "Whether you can actually generalize that to other units is a bit of a stretch. However, I will say the mechanisms of disease transmission, whether it's medical intensive care or surgical intensive care, are going to be largely the same, although the patient populations might be a little bit different.
"As such, since the mechanisms of disease cross-transmission are the same, it's reasonable to think that this may work in a nonsurgical ICU, whether it's medicine, neurosurgery, pediatrics, cardiothoracic, etc."
Bearman also notes that during the study's 12-month duration, there were no outbreaks of infectious disease. During possible outbreaks, universal gloving alone may not be as effective.
However, this method could be particularly helpful for smaller facilities such as ambulatory surgery centers, clinics, or physician offices that may not have the space for isolation rooms or single-occupancy rooms.
"If there aren't enough single-occupancy rooms, it may be helpful to do universal gloving for multiple or dual-occupancy rooms," Bearman says. "The important thing, however, is clearly the gloves need to be changed between patients, and hand hygiene must occur before and after patient care, even in between patients in the same room. If there is a breakdown in that, there is going to be a breakdown in the effectiveness.
This article was adapted from one that originally appeared in the July 2010 issue of Briefings on Infection Control, an HCPro publication.