To gown or not to gown: the effect on acquisition of vancomycin-resistant enterococci

Area of Science:

• Infectious Diseases
• Hospital Epidemiology
• Microbiology

Background:

• Vancomycin-resistant enterococci (VRE) pose a significant threat in healthcare settings.
• Horizontal transmission of VRE is a major concern in intensive care units (ICUs).
• Current infection control guidelines recommend gowns and gloves to mitigate VRE spread.

Purpose of the Study:

• To evaluate the effectiveness of combined gown and glove use versus glove use alone in preventing VRE transmission.
• To determine the impact of enhanced personal protective equipment on VRE acquisition rates in a medical intensive care unit (MICU).

Main Methods:

• A quasi-experimental study design was employed, comparing two periods with different personal protective equipment (PPE) protocols.
• The study involved monitoring VRE acquisition among patients in an MICU over two distinct intervention periods.
• Period 1 (gown and gloves): July 1997–June 1998 and July 1999–December 1999.
• Period 2 (gloves only): July 1998–June 1999.

Main Results:

• VRE acquisition was significantly lower during the period when gowns and gloves were used (9.1 cases/1000 MICU-days) compared to the period with gloves only (19.6 cases/1000 MICU-days).
• Statistical analysis indicated a protective effect of gowns in reducing VRE acquisition.
• The findings were particularly relevant in an MICU setting with high VRE colonization pressure.

Conclusions:

• The use of gowns in conjunction with gloves provides superior protection against VRE transmission in MICUs compared to gloves alone.
• Implementing enhanced PPE protocols, including gowns, is crucial for controlling VRE spread in high-risk healthcare environments.
• These findings reinforce the importance of adhering to comprehensive infection control strategies to combat antimicrobial resistance.