Donning gloves may protect preemies from infection in the NICU

By Megan Brooks

NEW YORK (Reuters Health) - Extremely premature infants in a neonatal intensive care unit (NICU) had fewer infections when medical staff donned gloves after washing their hands compared with hand washing alone in a randomized controlled trial.

"Gloving after hand hygiene prior to all patient and line contact should become part of our care of preterm infants," Dr. David A. Kaufman of the University of Virginia School of Medicine in Charlottesville, told Reuters Health by email.

"Many NICUs already practice nonsterile gloving with any patient contact. Some bacteria still remain on health care worker's hands after excellent hand hygiene, which can be a significant exposure to certain patients who may be immunocompromised, have a central catheter, or in an intensive care unit," he explained.

"While much attention has focused on reducing central line associated bloodstream infections (CLABSIs) in NICU and other hospitalized patients, many bloodstream infections with other sources still occur in preterm infants with significant mortality and associated neurodevelopmental impairment in survivors," Dr. Kaufman said.

He and his colleagues designed their study to see whether wearing nonsterile gloves after hand washing and before all direct patient care, compared with hand washing alone, would prevent late-onset infections or necrotizing enterocolitis (NEC) in preterm babies who weighed less than 1000 g and/or had a gestational age of < 29 weeks and were less than eight days old.

The study enrolled 120 infants at the University of Virginia NICU over a 30-month period from December 2008 to June 2011.

Late-onset invasive infection or NEC occurred in 32% of infants (19 of 60) in the gloving group compared with 45% of infants (27 of 60) in the hand washing only group, according to a report online August 11 in JAMA Pediatrics.

There were also 53% fewer gram-positive bloodstream infections and 64% fewer central line-associated bloodstream infections in the gloving group than the hand washing only group.

"Decreasing gram-positive infections by 53%, which are the most common cause of bloodstream infections in the NICU, can make a big difference for our patients," Dr. Kaufman told Reuters Health.

He added, "For staff during the study, it was an adjustment to gloving after hand hygiene, so we had signage and gloves at the bedside to facilitate compliance. After the study, educating all the health care workers who come in contact with our patients (e.g., clinicians, nurses, respiratory and other therapists, radiology technicians) on the benefits was critical for compliance."

"We hope other centers will continue to study this further and a multicenter study would continue to add to ours and others findings of decreased infections with nonsterile gloving after hand hygiene for preterm infants and other patient populations," Dr. Kaufman said.

In an editorial published with the study, Dr. Susan Coffin from University of Pennsylvania says further study is needed.

"At this point, we should applaud Kaufman and colleagues for tackling a challenging and important problem, lobby funding institutions to support additional well-designed infection prevention trials, and await additional data before donning these gloves," Dr. Coffin writes.

"It is important to recognize that universal glove use might lead to several unintended consequences. Glove use has been found by many investigators to be one of the key barriers to appropriate hand hygiene," she adds.

Dr. Coffin also notes that while planning their study, the investigators used current data from their institution on the incidence of late-onset infection among premature infants to calculate a sample size that would allow them to detect a clinically relevant difference in outcome.

"Unfortunately for the investigators - but fortunately for their patients - the background rate of late-onset infections appears to have dropped significantly from the time they performed their sample size calculations to the study period (from 60% to 45%), thus rendering their study underpowered," Dr. Coffin notes.

SOURCE: http://bit.ly/1r5W01e and http://bit.ly/XdGV0z

JAMA Pediatr 2014.

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