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Association between Universal Glove Use, MDRO Acquisition and Healthcare-Associated Infections: a Meta-Analysis
Chang NN, Kates AE, Ward MA, Kiscaden E, Reisinger HS, Perencevich EN, Kiscaden M, Schweizer ML. Association between Universal Glove Use, MDRO Acquisition and Healthcare-Associated Infections: a Meta-Analysis. Paper presented at: European Congress of Clinical Microbiology and Infectious Diseases; 2016 Apr 11; Amsterdam, Netherlands.
Background: Multi-drug resistant organisms (MDROs) can be transmitted from patient-to-patient via the hands of healthcare workers. Universal glove use with or without universal gown use, is a horizontal intervention that aims to prevent the spread of all pathogens including MDROs. The objective of this meta-analysis was to evaluate whether implementation of universal glove use (+/- universal gown use) was associated with reduced incidence of MDRO acquisition or healthcare-associated infection (HAI) in clinical settings.
Materials/methods: A systematic literature review was conducted using MEDLINE, Cochrane Library, CINAHL (the Cumulative Index of Nursing and Allied Health Literature), EMBASE, PsychInfo, and ClinicalTrials.gov. A backward search using reference lists was also conducted. The Downs and Black checklist was used to assess study quality. Pooled incidence rate ratios (IRR) and 95% confidence intervals (CI) were calculated using random effects models. The I2 test was used to evaluate heterogeneity. Data were stratified by study design and outcome, and pooled if there were at least 3 studies in the same category. Publication bias was assessed by creating a funnel plot.
Results: Of the 535 studies evaluated, 5 were included in the meta-analysis. Studies were of moderate quality (mean Downs and Black score: 21 out of 34). These studies had conflicting results, but all findings were close to the null. When pooled, there were no significant associations between universal glove use and transmission of MDROs/HAIs, although results were heterogeneous (pooled IRR: 0.87, 95% CI: 0.69, 1.09; I2 = 71%). When the four studies that evaluated MRSA were pooled, universal gloving did not significantly reduce MRSA acquisition (IRR = 0.95; 95% CI: 0.79, 1.14; I2 = 12%). Results were similar when the three studies that evaluated VRE acquisition were pooled (IRR = 1.10; 95% CI: 0.69, 1.75; I2 = 60%). There was a statistically significant association when only the three quasi-experimental studies were pooled (IRR = 0.78; 95% CI: 0.68-0.89; I2 = 0%), but the randomized controlled trials did not see a statistically significant association (Table). Results that could not be pooled are described in the Table. There was no evidence of publication bias.
Conclusion: Implementation of universal glove use is not associated with a statistically significant decrease in MDRO acquisition or HAI compared with standard care. However, more large, high-quality studies should be conducted.