The impact of universal glove and gown use on Clostridioides difficile acquisition, a cluster randomized trial

Abstract

ABSTRACTImportanceClostridioides difficile is the most common cause of healthcare-associated infections (HAI) in the US. It is unknown whether universal gown and glove use in intensive care units (ICUs) decreases acquisition of C. difficile.ObjectiveTo assess whether wearing gloves and gowns for all patient contact in the ICU decreases acquisition of C. difficile compared with usual care.Design, setting, and ParticipantsSecondary analysis of a cluster-randomized trial in 20 medical and surgical ICUs in 20 US hospitals from January 4, 2012, to October 4, 2012.InterventionsAfter a baseline period, ICUs were randomized to standard practice for glove and gown use vs. the intervention of all healthcare workers being required to wear gloves and gowns for all patient contact and when entering any patient room (contact precautions).Main outcomes and measuresThe primary outcome was acquisition of toxigenic C. difficile determined by surveillance cultures collected on admission and discharge from the ICU. Secondary outcomes included ribotype 027-like C. difficile acquisition and the impact of other factors on acquisition.ResultsFrom the 26,749 patients enrolled in the study, a total of 21,845 patients had both admission and discharge perianal swabs cultured for toxigenic C. difficile. On admission, 9.43% (2,060/21,845) of patients were colonized with toxigenic C. difficile. No significant difference was observed in the rate of toxigenic C. difficile acquisition with universal gown and glove use. Differences in acquisition rates in the study period compared to baseline period in control ICUs were 1.49 per 100 patient days vs 1.68 per 100 patient days in universal gown and glove ICUs, (rate difference -0.28, generalized linear mixed model, p=0.091). Similarly, there was no difference in rates of ribotype 027-like C. difficile acquisition: control ICUs 0.13 per 100 patient days vs. 0.16 per 100 patient days in universal gown and glove ICUs during the study period, (rate difference -0.03, generalized linear mixed model, p=0.35). Secondary analyses identified C. difficile colonization was associated with acquisition, p=0.014).Conclusions and relevanceGlove and gown use for all patient contact in medical and surgical ICUs did not result in a reduction in the acquisition of C. difficile compared with usual care.Key PointsQuestionDoes wearing gloves and gowns for all patient contact in the ICU decrease acquisition of C. difficile?FindingsGlove and gown use for all patient contact in medical and surgical ICUs did not result in a difference in the acquisition of C. difficile compared with usual care.MeaningGlove and gown use does not impact acquisition of C. difficile from asymptomatically colonized patients. Universal use of glove and gowns or targeted use based on active surveillance for C. difficile are unlikely to impact transmission.