润肤手套手卫生和预防多重耐药菌效果测试（翻译有奖）

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Trial of Universal Gloving with Emollient-Impregnated Gloves to Promote Skin Health and Prevent the Transmission of Multidrug-Resistant Organisms in a Surgical Intensive Care Unit
Infect Control Hosp Epidemiol 2010;31:491–497
Objective.To compare the efficacy of universal gloving with emollient-impregnated gloves with standard contact precautions for the control of multidrug-resistant organisms (MDROs) and to measure the effect on healthcare workers' (HCWs') hand skin health.

Design.Prospective before-after trial.

Setting.An 18-bed surgical intensive care unit.

Methods.During phase 1 (September 2007 through March 2008) standard contact precautions were used. During phase 2 (March 2008 through September 2008) universal gloving with emollient-impregnated gloves was used, and no contact precautions. Patients were screened for vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). HCW hand hygiene compliance and hand skin health and microbial contamination were assessed. The incidences of device-associated infection and Clostridium difficile infection (CDI) were determined.

Results.The rate of compliance with contact precautions (phase 1) was 67%, and the rate of compliance with universal gloving (phase 2) was 78% ( P=0.01). Hand hygiene compliance was higher during phase 2 than during phase 1 (before patient care, 40% vs 35% of encounters;P=0.001  ; after patient care, 63% vs 51% of encounters; P<0.001 ). No difference was observed in MDRO acquisition. During phases 1 and 2, incidences of device-related infections, in number of infections per 1,000 device-days, were, respectively, 3.7 and 2.6 for bloodstream infection (P=0.10 ), 8.9 and 7.8 for urinary tract infection (P=0.10 ), and 1.0 and 1.1 for ventilator-associated pneumonia (P=0.09 ). The CDI incidence in phase 1 and in phase 2 was, respectively, 2.0 and 1.4 cases per 1,000 patient-days (P=0.53 ). During phase 1, 29% of HCW hand cultures were MRSA positive, compared with 13% during phase 2 ( P=0.17); during phase 1, 2% of hand cultures were VRE positive, compared with 0 during phase 2 ( P=0.16). Hand skin health improved during phase 2.

Conclusions.Compared with contact precautions, universal gloving with emollient-impregnated gloves was associated with improved hand hygiene compliance and skin health. No statistically significant change in the rates of device-associated infection, CDI, or patient MDRO acquisition was observed. Universal gloving may be an alternative to contact precautions.

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