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Meta-Analysis
. 2003;2003(3):CD003670.
doi: 10.1002/14651858.CD003670.

Gowning by attendants and visitors in newborn nurseries for prevention of neonatal morbidity and mortality

J Webster  1 , M A Pritchard
Affiliations
Meta-Analysis

Gowning by attendants and visitors in newborn nurseries for prevention of neonatal morbidity and mortality

J Webster et al. Cochrane Database Syst Rev. 2003.

Abstract

Background: Overgowns are widely used in newborn nurseries and neonatal intensive care units. It was thought that they may help to prevent the spread of nosocomial infection and serve as a reminder to staff and visitors to wash their hands before contacts with the infant.

Objectives: The objective of this review was to assess the effects of the wearing of an overgown by attendants and visitors for the prevention of infection and death in infants in newborn nurseries.

Search strategy: The standard methods of the Cochrane Collaboration and its Neonatal Review Group were used. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2002), MEDLINE (1966-January 2003) and CINAHL (1982-January 2003).

Selection criteria: All published trials using random or quasi-random patient allocation, in which overgowns worn by attendants or visitors were compared with no overgowns worn by attendants or visitors.

Data collection and analysis: The standard methods of the Cochrane Collaboration and its Neonatal Review Group were used. Data extraction and study quality were independently assessed by the two authors. Missing information was sought from three authors but only one responded. Results are expressed as relative risk or mean difference with 95% confidence intervals.

Main results: Eight trials were included, reporting outcomes for 3,811 infants. Trial quality varied; two were of good quality. Not wearing overgowns was associated with a trend to reduction in the death rate, typical RR 0.84 (95% CI 0.70, 1.02) compared to wearing overgowns, but these results did not reach statistical significance. There was no statistically significant effect of gowning policy on incidence of systemic nosocomial infection, typical RR 1.24 (CI 0.90,1.71). The overall analysis showed no significant effects of gowning policy on the incidence of colonisation, length of stay or handwashing frequency. No trials of visitor gowning were found.

Reviewer's conclusions: The evidence from this systematic review and meta analysis does not demonstrate that overgowns are effective in limiting death, infection or bacterial colonisation in infants admitted to newborn nurseries.

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Conflict of interest statement

None

Figures

1.1
1.1. Analysis
Comparison 1 No Gowns vs Gowns, Outcome 1 Death before discharge.
1.2
1.2. Analysis
Comparison 1 No Gowns vs Gowns, Outcome 2 Systemic nosocomial infection.
1.3
1.3. Analysis
Comparison 1 No Gowns vs Gowns, Outcome 3 Localised nosocomial infection.
1.4
1.4. Analysis
Comparison 1 No Gowns vs Gowns, Outcome 4 Nasal colonisation.
1.5
1.5. Analysis
Comparison 1 No Gowns vs Gowns, Outcome 5 Umbilical colonisation.
1.6
1.6. Analysis
Comparison 1 No Gowns vs Gowns, Outcome 6 Eye colonisation.
1.7
1.7. Analysis
Comparison 1 No Gowns vs Gowns, Outcome 7 Groin colonisation.
1.8
1.8. Analysis
Comparison 1 No Gowns vs Gowns, Outcome 8 Length of hospital stay.
1.9
1.9. Analysis
Comparison 1 No Gowns vs Gowns, Outcome 9 Duration of mechanical ventilation.
See this image and copyright information in PMC

References

References to studies included in this review

Agbayani 1981 {published data only}
    1. Agbayani M, Rosenfeld W, Evans H, Salazar D, Jhaveri R, Braun J. Evaluation of modified gowning procedures in a neonatal intensive care unit. American Journal of Diseases of Children 1981;135:650‐2. - PubMed
Birenbaum 1990 {published data only}
    1. Birenbaum HJ, Glorioso L, Rosenberger C, Arshad C, Edwards K. Gowning on a postpartum ward fails to decrease colonization in the newborn infant. American Journal of Diseases of Children 1990;144:1031‐3. - PubMed
Evans 1971 {published data only}
    1. Evans HE, Akpata SO, Baki A. Bacteriologic and clinical evaluation of gowning in a premature nursery. Journal of Pediatrics 1971;78:883‐6. - PubMed
Forfar 1958 {published data only}
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Pelke 1994 {published data only}
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Rush 1990 {published data only}
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References to studies excluded from this review

Altimier 1996 {published data only}
    1. Altimier LB, Lott JW, McCain G. Research utilization: evaluating the use of cover gowns in a neonatal intensive care unit. Neonatal Intensive Care 1996;Nov/Dec:52‐8.
Haque 1989 {published data only}
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References to other published versions of this review

Webster 2003
    1. Webster J, Pritchard MA. Gowning by attendants and visitors in newborn nurseries for prevention of neonatal morbidity and mortality. Cochrane Database of Systematic Reviews 2003, Issue 3. [DOI: 10.1002/14651858.CD003670] - DOI - PMC - PubMed
Webster 2006
    1. Webster J, Pritchard MA. Gowning by attendants and visitors in newborn nurseries for prevention of neonatal morbidity and mortality. Cochrane Database of Systematic Reviews 2006, Issue 3. [DOI: 10.1002/14651858.CD003670] - DOI - PMC - PubMed
Webster 2009
    1. Webster J, Pritchard MA. Gowning by attendants and visitors in newborn nurseries for prevention of neonatal morbidity and mortality. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD003670] - DOI - PMC - PubMed

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