Skip to main content
×
Home
    • Aa
    • Aa

A Prospective Study to Determine Whether Cover Gowns in Addition to Gloves Decrease Nosocomial Transmission of Vancomycin-Resistant Enterococci in an Intensive Care Unit

  • Arjun Srinivasan (a1) (a2), Xiaoyan Song (a2), Tracy Ross (a3), William Merz (a3), Roy Brower (a4) and Trish M. Perl (a1) (a2)...
Abstract
Background:

Vancomycin-resistant enterococci (VRE) remain a significant nosocomial pathogen. Current guidelines of the Hospital Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) recommend the use of gowns and gloves for some interactions with VRE-infected or -colonized patients to prevent nosocomial transmission of VRE.

Objective:

To assess the effect of disposable cover gowns on preventing nosocomial transmission of VRE.

Design and Setting:

Prospective study in a 16-bed medical intensive care unit of a university teaching hospital.

Patients:

All patients who were at risk to acquire VRE, were admitted to the intensive care unit from August 1998 to January 1999, and had at least two perirectal cultures were included in the analysis of VRE acquisition.

Intervention:

VRE isolation precautions were changed from gowns and gloves to gloves alone.

Main Outcome Measure:

VRE acquisition rates and risk factors for VRE acquisition.

Results:

The VRE acquisition rate was 1.80 cases per 100 days at risk in the gown and gloves period compared with 3.78 in the gloves only period (P= .04). In a proportional hazards model adjusted for length of stay, gloves only precautions with a hazard ratio of 2.5 (P = .02; 95% confidence interval, 1.2 to 5.3) were the only independent risk factor for VRE acquisition.

Conclusion:

Our data lend support to current HICPAC recommendations for the use of cover gowns to decrease nosocomial transmission of VRE.

Copyright
Corresponding author
Carnegie Building, Room 284, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287-5425
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1.National Nosocomial Infections Surveillance (NNIS) System report, data summary from January 1990-May 1999, issued June 1999. Am J Infect Control 1999;27:520532.

2. PK Linden , AW Pasculle , R Manez , et al. Differences in outcomes for patients with bacteremia due to vancomycin-resistant Enterococcus faecium or vancomycin-susceptible E. faecium. Clin Infect Dis 1996;22:663670.

3. GM Lucas , N Lechtzin , DW Puryear , et al. Vancomycin-resistant and vancomycin-susceptible enterococcal bacteremia: comparison of clinical features and outcomes. Clin Infect Dis 1998;26:11271133.

5. E Rhinehart , NE Smith , C Wennersten , et al. Rapid dissemination of beta-lactamase-producing, aminoglycoside-resistant Enterococcus faecalis among patients and staff on an infant-toddler surgical ward. N Engl J Med 1990;323:18141818.

7. LL Livornese , S Dias , C Samel , et al. Hospital-acquired infection with vancomycin-resistant Enterococcus faecium transmitted by electronic thermometers. Ann Intern Med 1992;117:112116.

8. GA Noskin , V Stosor , I Cooper , et al. Recovery of vancomycin-resistant enterococci on fingertips and environmental surfaces. Infect Control Hosp Epidemiol 1995;16:577581.

9. DJ Weber , WA Rutala . Role of environmental contamination in the transmission of vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 1997;18:306309.

, , , . . ;:–.11. JM Boyce IA Mermel MJ Zervos et alControlling vancomycin-resistant enterococci Infect Control Hosp Epidemiol 1995 16 634637

12. S Slaughter , MK Hayden , C Nathan , et al. A comparison of the effect of universal use of gloves and gowns with that of glove use alone on acquisition of vancomycin-resistant enterococci in a medical intensive care unit. Ann Intern Med 1996;125:448456.

14. BD Kirkpatrick , SM Harrington , D Smith , et al. An outbreak of vancomycin-dependent Enterococcus faecium in a bone marrow transplant unit. Clin Infect Dis 1999;29:12681273.

15. RV Goering . Molecular epidemiology of nosocomial infection: analysis of chromosomal restriction fragment patterns by pulsed-field gel electrophoresis. Infect Control Hosp Epidemiol 1993;14:595600.

17. SM Bhavnani , JA Drake , A Forrest , et al. A nationwide, multicenter, case-control study comparing risk factors, treatment, and outcome for vancomycin-resistant and -susceptible enterococcal bacteremia. Diagn Microbiol Infect Dis 2000;36:145158.

18. JZ Jordens , J Bates , DT Griffiths . Faecal carriage and nosocomial spread of vancomycin-resistant Enterococcus faecium. J Antimicrob Chemother 1994;34:515528.

21. H de Lencastre , AE Brown , M Chung , et al. Role of transposon Tn5482 in the epidemiology of vancomycin-resistant Enterococcus faecium in the pediatric oncology unit of a New York City Hospital. Microb Drug Resist 1999;5:113129.

22. TR Frieden , SS Munsiff , DE Low , et al. Emergence of vancomycin-resistant enterococci in New York City. Lancet 1993;342:7679.

23. Y Carmeli , MH Samore , C Huskins . The association between antecedent vancomycin treatment and hospital-acquired vancomycin-resistant enterococci: a meta-analysis. Arch Intern Med 1999;159:24612468.

24. MB Edmond , JF Ober , DL Weinbaum , et al. Vancomycin-resistant Enterococcus faecium bacteremia: risk factors for infection. Clin Infect Dis 1995;20:11261133.

25. S Handwerger , B Raucher , D Altarac , et al. Nosocomial outbreak due to Enterococcus faecium highly resistant to vancomycin, penicillin, and gentamicin. Clin Infect Dis 1993;16:750755.

26. MA Montecalvo , H Horowitz , C Gedris , et al. Outbreak of vancomycin-, ampicillin-, and aminoglycoside-resistant Enterococcus faecium bacteremia in an adult oncology unit. Antimicrob Agents Chemother 1994;38:13631367.

27. J Quale , D Landman , G Saurina , et al. Manipulation of a hospital antimicrobial formulary to control an outbreak of vancomycin-resistant enterococci. Clin Infect Dis 1996;23:10201025.

28. MJ Bonten , S Slaughter , AW Ambergen , et al. The role of “colonization pressure” in the spread of vancomycin-resistant enterococci: an important infection control variable. Arch Intern Med 1998;158:11271132.

29. LA Puzniak , T Leet , J Mayfield , M Kollef , LM Mundy . To gown or not to gown: the effect on acquisition of vancomycin-resistant enterococci. Clin Infect Dis 2002;35:1825.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 6 *
Loading metrics...

Abstract views

Total abstract views: 75 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd June 2017. This data will be updated every 24 hours.