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

Objective: To determine the efficacy of the use of gloves and gowns co mpared with that of the use of gloves alone for the prevention of noso comial transmission of vancomycin-resistant enterococci. Design: Epide miologic study and controlled, nonrandomized clinical trial. Setting: University-affiliated, 900-bed, urban teaching hospital in which vanco mycin-resistant enterococci are endemic. Patients: 181 consecutive pat ients admitted to the medical intensive care unit for 48 hours or more . Intervention: It was determined that all hospital employees would al ways use gloves and gowns when attending 8 particular beds in the medi cal intensive care unit and would always use gloves alone when attendi ng 8 others. Compliance with precautions was monitored weekly. Rectal surveillance cultures were taken from patients daily. Cultures of envi ronmental surfaces, such as those of bed rails, bedside tables, and ot her frequently touched objects in patient rooms and common areas, were taken monthly. Pulsed-field gel electrophoresis was used for molecula r epidemiologic typing of vancomycin-resistant enterococci. Measuremen ts: The number of patients becoming colonized by vancomycin-resistant enterococci; the number of days to acquisition of vancomycin-resistant enterococci; and other measurements, including nosocomial infections, length of hospital stay, and mortality rates. Results: The 93 patient s in glove-and-gown rooms and the 88 patients in glove-only rooms had similar demographic and clinical characteristics. Fifteen (16.1%) pati ents in the glove-and-gown group and 13 (14.8%) in the glove-only grou p had vancomycin-resistant enterococci on admission to the medical int ensive care unit. Twenty-four (25.8%) patients in the glove-and-gown g roup and 21 (23.9%) in the glove-only group acquired vancomycin-resist ant enterococci in the medical intensive care unit. The mean times to colonization among the patients who became colonized were 8.0 days in the glove-and-gown group and 7.1 days in the glove-only group. None of these comparisons were statistically significant. Risk factors for ac quisition of vancomycin-resistant enterococci included length of stay in the medical intensive care unit, use of enteral feeding, and use of sucralfate. Compliance with precautions was 79% in glove-and-gown roo ms and 62% in glove-only rooms (P < 0.001). Only 25 of 397 (6.3%) envi ronmental cultures were positive for vancomycin-resistant enterococci. Nineteen types of vancomycin-resistant enterococci were documented by pulsed-field gel electrophoresis during the study period. Conclusions : Universal use of gloves and gowns was no better than universal use o f gloves only in preventing rectal colonization by vancomycin-resistan t enterococci in a medical intensive care unit of a hospital in which vancomycin-resistant enterococci are endemic. Because the use of gowns and gloves together may be associated with better compliance and may help prevent transmission of other infectious agents, this finding may not be applicable to outbreaks caused by single strains or hospitals in which the prevalence of vancomycin-resistant enterococci is low.