Gloves Not Enough for Infection Control in Preterm Newborns

BOSTON – Supplementing appropriate hand hygiene with nonsterile gloving can help keep late-onset infections at bay in preterm infants.

In a randomized, controlled trial reported at the annual meeting of the Pediatric Academic Societies, preterm infants in the neonatal intensive care unit of an academic hospital whose caregivers were directed to don nonsterile gloves after standard hand washing and prior to contact with the infants or with their central or peripheral lines were significantly less likely to develop bloodstream infections after 72 hours than those cared for by individuals who practiced appropriate hand hygiene only.

Specifically, the rate of gram-positive bloodstream infections among the 60 newborns randomized to gloved treatment was approximately 40% less than in the 60 newborns randomized to hand hygiene-only care, according to lead investigator David A. Kaufman of the University of Virginia in Charlottesville.

Further, "gloving after hand hygiene with all patient line contact was associated with a 60% decrease in central line associated blood stream infections and a 50% decrease in UTIs [urinary tract infections]," he said.

In previous studies, gloving plus hand hygiene has reduced the transmission of methicillin-resistant Staphylococcus aureus (MRSA) and other infections, "but we haven’t seen many randomized controlled trials in the NICU," said Dr. Kaufman. Such investigations are especially warranted in light of evidence that microorganisms often persist despite appropriate hand hygiene practices as well as the increased risk of infection and consequent morbidity and mortality among preterm infants weighing less than 1,000 g at birth.

For the current study, preterm newborns who weighed less than 1,000 g at birth or who were born at or before 28 weeks’ gestation were randomized to the gloving plus hand hygiene or hand hygiene-only group within 7 days after birth and continuing for 4 weeks or until intravenous access was no longer necessary, Dr. Kaufman said. Hand hygiene was defined as using alcohol hand rub or washing hands with antimicrobial soap. Outcome measures included the incidence of one or more episodes of blood stream infection, urinary tract infection, meningitis, and/or necrotizing enterocolitis after 72 hours.

The baseline characteristics of both groups of infants were similar, Dr. Kaufman reported, noting that gestational age and body weight of infants in the gloved group were 25.7 weeks and 790 g, respectively, compared with 25.9 weeks and 803 g in the hand hygiene-only group. While the rates for one or more episode of blood stream infection, UTI, meningitis, and necrotizing enterocolitis were similar between the groups, the odds ratio for gram-positive bloodstream infections in the gloving group was 0.42, and the odds ratio of possible central line-associated blood stream infection – defined as one or more positive culture and a central line in place – was 0.31 in the gloving group, he said.

The findings suggest that gloving is a simple, effective approach for preventing invasive infections in high-risk infants with lines in place, said Dr. Kaufmann. The resulting reduction in infection rates could improve outcomes while reducing hospital stays and overall health care costs in this population.

Dr. Kaufmann said he had no relevant financial conflicts to disclose.

BOSTON – Supplementing appropriate hand hygiene with nonsterile gloving can help keep late-onset infections at bay in preterm infants.

In a randomized, controlled trial reported at the annual meeting of the Pediatric Academic Societies, preterm infants in the neonatal intensive care unit of an academic hospital whose caregivers were directed to don nonsterile gloves after standard hand washing and prior to contact with the infants or with their central or peripheral lines were significantly less likely to develop bloodstream infections after 72 hours than those cared for by individuals who practiced appropriate hand hygiene only.

Specifically, the rate of gram-positive bloodstream infections among the 60 newborns randomized to gloved treatment was approximately 40% less than in the 60 newborns randomized to hand hygiene-only care, according to lead investigator David A. Kaufman of the University of Virginia in Charlottesville.

Further, "gloving after hand hygiene with all patient line contact was associated with a 60% decrease in central line associated blood stream infections and a 50% decrease in UTIs [urinary tract infections]," he said.

In previous studies, gloving plus hand hygiene has reduced the transmission of methicillin-resistant Staphylococcus aureus (MRSA) and other infections, "but we haven’t seen many randomized controlled trials in the NICU," said Dr. Kaufman. Such investigations are especially warranted in light of evidence that microorganisms often persist despite appropriate hand hygiene practices as well as the increased risk of infection and consequent morbidity and mortality among preterm infants weighing less than 1,000 g at birth.

For the current study, preterm newborns who weighed less than 1,000 g at birth or who were born at or before 28 weeks’ gestation were randomized to the gloving plus hand hygiene or hand hygiene-only group within 7 days after birth and continuing for 4 weeks or until intravenous access was no longer necessary, Dr. Kaufman said. Hand hygiene was defined as using alcohol hand rub or washing hands with antimicrobial soap. Outcome measures included the incidence of one or more episodes of blood stream infection, urinary tract infection, meningitis, and/or necrotizing enterocolitis after 72 hours.

The baseline characteristics of both groups of infants were similar, Dr. Kaufman reported, noting that gestational age and body weight of infants in the gloved group were 25.7 weeks and 790 g, respectively, compared with 25.9 weeks and 803 g in the hand hygiene-only group. While the rates for one or more episode of blood stream infection, UTI, meningitis, and necrotizing enterocolitis were similar between the groups, the odds ratio for gram-positive bloodstream infections in the gloving group was 0.42, and the odds ratio of possible central line-associated blood stream infection – defined as one or more positive culture and a central line in place – was 0.31 in the gloving group, he said.

The findings suggest that gloving is a simple, effective approach for preventing invasive infections in high-risk infants with lines in place, said Dr. Kaufmann. The resulting reduction in infection rates could improve outcomes while reducing hospital stays and overall health care costs in this population.

Dr. Kaufmann said he had no relevant financial conflicts to disclose.

BOSTON – Supplementing appropriate hand hygiene with nonsterile gloving can help keep late-onset infections at bay in preterm infants.

In a randomized, controlled trial reported at the annual meeting of the Pediatric Academic Societies, preterm infants in the neonatal intensive care unit of an academic hospital whose caregivers were directed to don nonsterile gloves after standard hand washing and prior to contact with the infants or with their central or peripheral lines were significantly less likely to develop bloodstream infections after 72 hours than those cared for by individuals who practiced appropriate hand hygiene only.

Specifically, the rate of gram-positive bloodstream infections among the 60 newborns randomized to gloved treatment was approximately 40% less than in the 60 newborns randomized to hand hygiene-only care, according to lead investigator David A. Kaufman of the University of Virginia in Charlottesville.

Further, "gloving after hand hygiene with all patient line contact was associated with a 60% decrease in central line associated blood stream infections and a 50% decrease in UTIs [urinary tract infections]," he said.

In previous studies, gloving plus hand hygiene has reduced the transmission of methicillin-resistant Staphylococcus aureus (MRSA) and other infections, "but we haven’t seen many randomized controlled trials in the NICU," said Dr. Kaufman. Such investigations are especially warranted in light of evidence that microorganisms often persist despite appropriate hand hygiene practices as well as the increased risk of infection and consequent morbidity and mortality among preterm infants weighing less than 1,000 g at birth.

For the current study, preterm newborns who weighed less than 1,000 g at birth or who were born at or before 28 weeks’ gestation were randomized to the gloving plus hand hygiene or hand hygiene-only group within 7 days after birth and continuing for 4 weeks or until intravenous access was no longer necessary, Dr. Kaufman said. Hand hygiene was defined as using alcohol hand rub or washing hands with antimicrobial soap. Outcome measures included the incidence of one or more episodes of blood stream infection, urinary tract infection, meningitis, and/or necrotizing enterocolitis after 72 hours.

The baseline characteristics of both groups of infants were similar, Dr. Kaufman reported, noting that gestational age and body weight of infants in the gloved group were 25.7 weeks and 790 g, respectively, compared with 25.9 weeks and 803 g in the hand hygiene-only group. While the rates for one or more episode of blood stream infection, UTI, meningitis, and necrotizing enterocolitis were similar between the groups, the odds ratio for gram-positive bloodstream infections in the gloving group was 0.42, and the odds ratio of possible central line-associated blood stream infection – defined as one or more positive culture and a central line in place – was 0.31 in the gloving group, he said.

The findings suggest that gloving is a simple, effective approach for preventing invasive infections in high-risk infants with lines in place, said Dr. Kaufmann. The resulting reduction in infection rates could improve outcomes while reducing hospital stays and overall health care costs in this population.

Dr. Kaufmann said he had no relevant financial conflicts to disclose.