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Randomized Controlled Trial
. 2023 Feb 8;76(3):e1202-e1207.
doi: 10.1093/cid/ciac519.

The Impact of Universal Glove and Gown Use on Clostridioides Difficile Acquisition: A Cluster-Randomized Trial

Daniel J Morgan  1 , Erik R Dubberke  2 , Tiffany Hink  2 , Gwen Paszkiewicz  3 , Carey-Ann D Burnham  4 , Lisa Pineles  5 , Larry Magder  5 , J Kristie Johnson  3 , Surbhi Leekha  5 , Anthony D Harris  5
Affiliations
Randomized Controlled Trial

The Impact of Universal Glove and Gown Use on Clostridioides Difficile Acquisition: A Cluster-Randomized Trial

Daniel J Morgan et al. Clin Infect Dis. .

Abstract

Background: Clostridioides difficile is the most common cause of healthcare-associated infections in the United States. It is unknown whether universal gown and glove use in intensive care units (ICUs) decreases acquisition of C. difficile.

Methods: This was a secondary analysis of a cluster-randomized trial in 20 medical and surgical ICUs in 20 US hospitals from 4 January 2012 to 4 October 2012. After a baseline period, ICUs were randomized to standard practice for glove and gown use versus 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). The primary outcome was acquisition of toxigenic C. difficile determined by surveillance cultures collected on admission and discharge from the ICU.

Results: A total of 21 845 patients had both admission and discharge perianal swabs cultured for toxigenic C. difficile. On admission, 9.43% (2060/21 845) 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 with the baseline period in control ICUs were 1.49 per 100 patient-days versus 1.68 per 100 patient-days in universal gown and glove ICUs (rate difference, -0.28; generalized linear mixed model, P = .091).

Conclusions: Glove 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.

Clinical trials registration: NCT01318213.

Keywords: Clostridioides difficile; antibiotic-resistance; barrier precautions; contact precautions.

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Conflict of interest statement

Potential conflicts of interest. E. R. D. reports grants or contracts from Synthetic Biologics, Ferring, and Pfizer, outside of the submitted work, and consulting fees from Seres, Merck, Pfizer, Abbott, and Ferring. S. L. reports grants/contracts to their institution under the CDC Prevention Epicenters and Broad Agency Agreement mechanisms in the broad field of infection prevention and healthcare epidemiology from the Centers for Disease Control and Prevention and a contract for Maryland hospital collaboratives on C. difficile and COVID-19 prevention from the Maryland Department of Health, all outside of the submitted work. T. H. reports grants or contracts paid to their institution from Synthetic Biologics, Inc, and CDC Epicenters, both outside of the submitted work. D. J. M. reports grants or contracts unrelated to this work from the National Institutes of Health, CDC, and Veterans Affairs Health Services Research and Development; reimbursement for travel from IDWeek and the Society for Healthcare Epidemiology of America (SHEA); and unpaid positions as Chair of the IDWeek SHEA Committee and as lead of the SHEA Diagnostic Stewardship Taskforce. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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