Gown and Glove Can Give Some HAIs the Shove

Doffing protocols for treating patients with infections caused by methicillin-resistant Staphylococcus aureus (MRSA) appear to help ward off other healthcare-associated infections (HAIs), but how potent that effect might be remains uncertain. That’s one of the preliminary results of a study by Anthony Harris, MD, an epidemiologist at the University of Maryland and a former president of the Society for Healthcare Epidemiology of America (SHEA). Harris wanted to see whether the universal use of gloves and gowns could also reduce transmission of antibiotic-resistant gram-negative bacteria, including Acinetobacter, Pseudomonas, Escherichia coli, and Klebsiella. The protocol “seems to have an effect for most, but not all organisms. And the effect size depends on the type of organism,” Harris said in a press release by the Agency for Healthcare Research and Quality (AHRQ), which is funding the study. 

The findings build on a 2013 investigation by Harris published in JAMA that found that universal glove and gown use in intensive care units (ICUs) reduced MRSA infection by 40%. The use of gloves and gowns did not affect vancomycin-resistant enterococcus (VRE) rates in that study, however. 

The preliminary results from Harris’ new study, however, show that the universal gown and glove protocol did, in fact, lower infection rates for antibiotic-resistant gram-negative bacteria.  

Harris is also studying which pre-existing conditions make patients more susceptible for developing HAIs. According to diagnostic codes submitted to the US Centers for Disease Control and Prevention from about 550 hospitals, patients with diabetes, obesity, and kidney disease have a higher risk of developing a central line-associated bloodstream infection (CLABSI) or surgical site infection (SSI).

“Establishing this connection has important policy implications, because current pay-for-performance efforts reduce payments to hospitals if patients develop an HAI as a result of their care and do not currently adjust for many chronic conditions,” according to the AHRQ press release. 

Hospitals who take care of more patients with such chronic conditions might be unfairly ranked. 

“We want hospitals to be striving to improve performance, but we want them to strive based on rankings of outcome measures that are sound,” Harris said in the press release.

Better outcome measures will help adjust rankings for hospitals that treat more patients who are more vulnerable to HAIs.