A prospective study to determine whether cover gowns in addition to gloves decrease nosocomial transmission of vancomycin-resistant enterococci in an intensive care unit

BACKGROUND: Vancomycin-resistant enterococci (VRE) remain a significant nosocomial pathogen. Current guidelines of the Hospital Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) recommend the use of gowns and gloves for some interactions with VRE-infected or -colonized patients to prevent nosocomial transmission of VRE. OBJECTIVE: To assess the effect of disposable cover gowns on preventing nosocomial transmission of VRE. DESIGN AND SETTING: Prospective study in a 16-bed medical intensive care unit of a university teaching hospital. PATIENTS: All patients who were at risk to acquire VRE, were admitted to the intensive care unit from August 1998 to January 1999, and had at least two perirectal cultures were included in the analysis of VRE acquisition. INTERVENTION: VRE isolation precautions were changed from gowns and gloves to gloves alone. MAIN OUTCOME MEASURE: VRE acquisition rates and risk factors for VRE acquisition. RESULTS: The VRE acquisition rate was 1.80 cases per 100 days at risk in the gown and gloves period compared with 3.78 in the gloves only period (P = .04). In a proportional hazards model adjusted for length of stay, gloves only precautions with a hazard ratio of 2.5 (P = .02; 95% confidence interval, 1.2 to 5.3) were the only independent risk factor for VRE acquisition. CONCLUSION: Our data lend support to current HICPAC recommendations for the use of cover gowns to decrease nosocomial transmission of VRE.