Universal Glove and Gown Use for the Prevention of Methicillin-Resistant Staphylococcus aureus (MRSA) or Vancomycin-Resistant Enterococcus (VRE)

Abstract

Over one hundred thousand healthcare-associated infections (HAIs) occur in the United States annually. Many are caused by multidrug-resistant organisms (MDROs) like methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). Infections with MRSA and VRE are associated with worse outcomes than antibiotic-sensitive counterparts, and the estimated cost of antibiotic resistance in the United States is more than $4 billion per year. Transmission of MRSA and VRE in healthcare settings is believed to occur from patient to patient through the hands or attire of healthcare workers (HCWs) and contamination of the environment. Patients who are colonized with MRSA or VRE commonly contaminate the room environment, and HCWs leaving the rooms of these patients are contaminated 10-25% of the time. The use of gloves and gowns as a barrier to contamination is a commonly employed method for preventing transmission of MRSA, VRE, and other pathogens. Theoretically, this barrier will become contaminated during care but will be removed at room exit, reducing burden of HCW contamination. By reducing transient carriage of pathogens by the HCW, gloves and gowns should decrease the likelihood of contaminating subsequent patients. Gloves and gowns are recommended as a part of standard precautions for any patient with uncontrolled secretions and as a part of contact precautions for MDROs of importance, such as MRSA or VRE. Evidence for effectiveness of contact precautions (gloves, gowns, and a private or cohorted room) is limited, leading to various interpretations of CDC guidance. Gloves and gowns can also be used in a universal fashion in which all HCWs use gloves and gowns for every patient contact or room entry regardless of colonization or infection with an MDRO. Universal glove and gown (UGG) use has been employed in relatively limited fashion in response to outbreaks or in specific hospital units with high risk of spread for MDROs. A recent cluster randomized trial found that universal glove and gown use in intensive care units had no impact on the primary outcome of MRSA or VRE acquisition but appeared to decrease MRSA in secondary analysis.