JAMA Pediatrics Journal Club Slides:
Glove Use to Prevent Infections in
Preterm Infants
Kaufman DA, Blackman A, Conaway MR, Sinkin RA. Nonsterile glove
use in addition to hand hygiene to prevent late-onset infection in
preterm infants: randomized clinical trial. JAMA Pediatr. Published
online August 11, 2014. doi:10.1001/jamapediatrics.2014.953.
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Introduction
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Background
– Late-onset infections commonly occur in extremely preterm infants and
are associated with high rates of mortality and neurodevelopmental
impairment.
– Hand hygiene alone does not always achieve the desired clean hands,
as microorganisms are still present >50% of the time.
– Remaining colony-forming units on hands after hand hygiene may be a
significant exposure to preterm infants.
– Some retrospective studies have shown that glove use after hand
hygiene may further decrease infections compared with hand hygiene
alone.
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Study Objective
– To determine if nonsterile glove use after hand hygiene before all
patient and intravenous catheter contact, compared with hand hygiene
alone, prevents late-onset infections in preterm infants.
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Methods
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Study Design
– Prospective, single-center, randomized clinical trial.
– Duration of ≥4 weeks until patient no longer has venous access (central
or peripheral).
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Setting
– Neonatal intensive care unit.
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Participants
– Birth weight <1000 g and/or gestational age <29 weeks.
– <8 days old.
– 175 eligible infants, of whom 120 were enrolled.
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Methods
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Outcomes
– Primary: ≥1 episode of late-onset (>72 hours of age) infection in the
bloodstream, urinary tract, or cerebrospinal fluid or necrotizing
enterocolitis.
– Secondary: Infection-related data, mortality, other neonatal
morbidities.
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Methods
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Limitations
– Single-center study and may be affected by local infection control
practices.
– Sample size was based on a higher incidence of infections than
were observed in the control group, so it was underpowered for
the primary outcome.
– Aim of study was to have >90% compliance with hand hygiene
rates.
– Parents had the choice to use gloves or not use gloves if their
child was randomized to group A (group with nonsterile glove use
after hand hygiene).
– There is a possibility that if hand hygiene, glove use by parents,
and study protocol compliance were higher, infection rates may
have been lower in 1 or both groups.
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Results
Primary and Secondary
Infection-Related
Outcomes
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Results
Difference in
Proportions Between
Groups With 95% CIs
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Comment
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Nonsterile glove use after hand hygiene prior to patient and catheter contact
is associated with fewer gram-positive bloodstream infections (BSIs) and
central line–associated bloodstream infections (CLABSIs) in this group of
preterm infants.
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Number needed to treat:
– To prevent 1 gram-positive BSI is 6.
– To prevent 1 possible CLABSI is 7.
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Comment
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In addition to the Centers for Disease Control and Prevention definition
of CLABSI, we also evaluated possible CLABSIs defined as detection of
growth from ≥1 blood culture of any organism, including coagulasenegative Staphylococcus, and the presence of a central catheter in the
absence of another source.
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We included this definition because asymptomatic BSIs, defined as
growth in ≥1 blood culture and treated, even when caused by
coagulase-negative Staphylococcus organisms, are associated with
increased neurodevelopmental impairment and white matter injury in
preterm infants.
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Comment
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Retrospective studies have demonstrated an association with the addition of
glove use after hand hygiene in preterm infants and other patient
populations.
– Very low-birth weight infants: Decreased BSIs and necrotizing
enterocolitis in preterm infants with birth weight <1500 g; this study had
an additional step of applying alcohol hand rub to the gloves.1
– Intensive Care Units: Glove use after hand hygiene during respiratory
syncytial virus season compared with the other months during an 8-year
period in a children’s hospital was associated with fewer BSIs and
CLABSIs in the neonatal intensive care unit, pediatric intensive care
unit, and pediatric bone marrow transplant unit.2
1.
Ng PC, Wong HL, Lyon DJ, et al. Combined use of alcohol hand rub and gloves reduces the incidence of late
onset infection in very low birthweight infants. Arch Dis Child Fetal Neonatal Ed. 2004;89(4):F336-F340.
Yin J, Schweizer ML, Herwaldt LA. Pottinger JM, Perencevich EN. Benefits of universal gloving on hospitalacquired infections in acute care pediatric units. Pediatrics. 2013;131(5):e1515-e1520.
2.
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Comment
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This readily implementable infection control measure may result in
decreased infections in high-risk preterm infants.
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Contact Information
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If you have questions, please contact the corresponding author:
– David A. Kaufman, MD, Division of Neonatology, Department of
Pediatrics, University of Virginia School of Medicine, 3768 OMS
Hospital Dr, Charlottesville, VA 22908 (dak4r@virginia.edu).
Funding/Support
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The study was funded in part by grants from the University of
Virginia Institute of Quality and Patient Safety, Cardinal Health
Foundation, and University of Virginia Children’s Hospital Grant’s
Program (Dr Kaufman).
Conflict of Interest Disclosures
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None reported.
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