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Impact of Universal Gowning and Gloving on Health Care Worker Clothing Contamination

Published online by Cambridge University Press:  02 January 2015

Calvin Williams
Department of Medicine, Christiana Care Health System, Newark, Delaware
Patty McGraw
Department of Medicine, Christiana Care Health System, Newark, Delaware
Elyse E. Schneck
Department of Laboratory Medicine, Christiana Care Health System, Newark, Delaware
Anna LaFae
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Jesse T. Jacob
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Daniela Moreno
Department of Medicine, Henry Ford Hospital, Detroit, Michigan
Katherine Reyes
Department of Medicine, Henry Ford Hospital, Detroit, Michigan
G. Fernando Cubillos
Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
Daniel H. Kett
Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
Ronald Estrella
Department of Medicine, University Health System, San Antonio, Texas
Daniel J. Morgan
Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, Maryland Baltimore VA Medical Center, Baltimore, Maryland
Anthony D. Harris
Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Marci Drees*
Department of Medicine, Christiana Care Health System, Newark, Delaware Value Institute, Christiana Care Health System, Newark, Delaware Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
Address correspondence to Marci Drees, MD, MS, Christiana Care Health System, Department of Medicine, Ammon Suite 2E70, 4755 Ogletown-Stanton Road, Newark DE 19718 (



To determine whether gowning and gloving for all patient care reduces contamination of healthcare worker (HCW) clothing, compared to usual practice.


Cross-sectional surveys.


Five study sites were recruited from intensive care units (ICUs) randomized to the intervention arm of the Benefits of Universal Gown and Glove (BUGG) study.


All HCWs performing direct patient care in the study ICUs were eligible to participate.


Surveys were performed first during the BUGG intervention study period (July–September 2012) with universal gowning/gloving and again after BUGG study conclusion (October–December 2012), with resumption of usual care. During each phase, HCW clothing was sampled at the beginning and near the end of each shift. Cultures were performed using broth enrichment followed by selective media. Acquisition was defined as having a negative clothing culture for samples taken at the beginning of a shift and positive clothing culture at for samples taken at the end of the shift.


A total of 348 HCWs participated (21–92 per site), including 179 (51%) during the universal gowning/gloving phase. Overall, 51 (15%) HCWs acquired commonly pathogenic bacteria on their clothing: 13 (7.1%) HCWs acquired bacteria during universal gowning/gloving, and 38 (23%) HCWs acquired bacteria during usual care (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.2–0.6). Pathogens identified included S. aureus (25 species, including 7 methicillin-resistant S. aureus [MRSA]), Enterococcus spp. (25, including 1 vancomycin-resistant Enterococcus [VRE]), Pseudomonas spp. (4), Acinetobacter spp. (4), and Klebsiella (2).


Nearly 25% of HCWs practicing usual care (gowning and gloving only for patients with known resistant bacteria) contaminate their clothing during their shift. This contamination was reduced by 70% by gowning and gloving for all patient interactions.

Infect Control Hosp Epidemiol 2014;00(0): 1–7

Original Articles
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved 

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The results discussed in this manuscript were presented in part at the ID Week conference, San Diego, CA, October 5, 2013.



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