Mandatory gloving in acute care paediatric units associated with decreased risk of hospital-acquired infections
- Department of Medicine, Division of Infectious Diseases, VCU Medical Center, Richmond, Virginia, USA
- Correspondence to: Dr Gonzalo Bearman, Department of Medicine, Division of Infectious Diseases, VCU Medical Center, 1300 East Marshall Street, PO Box 980019, Richmond, VA 23298-0019, USA;
Implications for practice and research
The benefits of universal gloving for all patient contact in paediatric settings during respiratory syncytial virus (RSV) season has a secondary outcome of reducing hospital-acquired infections.
Prospective studies are needed to assess the impact of universal gloving on hospital-acquired infections.
In an institution where health professionals were required to comply with mandatory gloving for all patient contact during RSV season, Yin and colleagues assessed the impact of the gloving policy on healthcare-acquired infections (HAI).
Using a quasi-experimental design, the investigators undertook a retrospective cohort study in paediatric intensive care units in a tertiary care medical centre between 2002 and 2010. Robust statistical methods were utilised, including Poisson regression models, to measure the association between mandatory gloving and HAI incidence. The outcomes included all HAIs; bloodstream infections (BSIs), central line-associated bloodstream infections (CLABSIs), healthcare-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP) and Clostridium difficile infections.
During the study period, 686 HAIs occurred during 363 782 patient-days. After adjusting for trends and seasonal effect, the risk of HAI for all causes was 25% lower during mandatory gloving periods compared with non-gloving periods. Mandatory gloving was associated with lower risks of BSIs (RR=0.63, 95% CI 0.49 to 0.81, p<0.001), and CLABSIs (RR=0.61, 95% CI 0.44 to 0.84, p=0.003). The reduction was significant in the PICUs (RR=0.63, 95% CI 0.42 to 0.93, p=0.02), the neonatal intensive care units (RR=0.62, 95% CI 0.39 to 0.98, p=0.04) and the paediatric bone marrow transplant units (RR=0.52, 95% CI 0.29 to 0.91, p=0.02). No significant reductions were seen in the rates of HAP, VAP and C difficile.
This study suggests that mandatory gloving resulted in reduced healthcare-acquired infection (HAI) risk. Limitations of the quasi-experimental design related to the range of data collected which did not include hand hygiene (HH) and gloving compliance. HH may have significantly fluctuated during mandatory gloving, possibly impacting on infection rates. Gloving compliance may have been affected by heightened infection prevention practices during respiratory syncytial virus season. Glove use may not be sustainable during non-seasonal infection periods. The study was a single-centre design and the results may not be generalisable to other settings.
Recent studies highlight the negative impact of universal gloving on HH adherence.1 ,2 In one study, glove use was referred to as the ‘worst enemy of hand hygiene’.3 However, the potential benefits of mandatory gloving should not be underestimated particularly as an alternative to usual contact precautions. Huskins and colleagues evaluated a range of infection prevention interventions across ICUs for the control of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE).4 Patients were assigned to contact precautions (gown and glove use) for MRSA or VRE infection or colonisation; all the other patients were assigned to care with universal gloving. No difference in either infection or colonisation with MRSA or VRE was observed between the two strategies suggesting that mandatory gloving was a suitable alternative strategy.4 Excellent adherence to HH with glove use has also been observed in a prospective trial of universal gloving.5 A universal gloving strategy with suspension of contact precautions was equivalent to the standard of care for HAI prevention. Universal gloving was preferred over usual contact precautions.5
A horizontal infection control strategy employs multiple interventions aimed at reducing risk from all pathogens transmitted by the same mechanism. Examples include HH, chlorhexidine patient bathing, central line insertion bundles, ventilator bundles and head of bed elevation.6 The employment of universal gloving may be a sensible component of a horizontal infection prevention strategy provided that sustained compliance with HH and glove use is ensured.
There is a small yet growing body of evidence to suggest that universal gloving provides an infection prevention benefit that is at least as effective as the employment of contact precautions. Yin and colleagues’ findings suggest that universal gloving may be a useful infection prevention adjunct. In future, if high-quality studies can replicate these results, universal gloving should be considered.