Compliance with routine use of gowns by healthcare workers (HCWs) and non-HCW visitors on entry into the rooms of patients under contact precautions

BACKGROUND. Modified contact precautions ( MCP), defined as routine donning of isolation gowns ( along with routine gloving) on entry into the rooms of patients under contact precautions, regardless of the likelihood of direct exposure to the patient or their immediate environment, were instituted at our medical center to reduce nosocomial transmission of common hospital pathogens. OBJECTIVES. To study compliance with MCP policy regarding routine gowning in intensive care units ( ICUs) and general wards and to determine the relationship between gown and glove use in the care of patients under MCP in ICUs. DESIGN. Prospective observational study from February 20, 2004, through January 8, 2005, involving 2,110 persons ( 1,504 healthcare workers [ HCWs] and 606 non- HCW visitors). SETTING. A 900- bed tertiary care teaching community hospital. RESULTS. Overall compliance with routine gown use was observed for 1,542 persons ( 73%), including 1,150 HCWs ( 76%) and 392 visitors ( 65%) ( odds ratio [ OR], 1.8 [ 95% confidence interval {CI}, 1.4- 2.2]; P<.001). Visitors in the ICUs ( 186 [ 91%] of 204) were more likely than visitors in the general wards ( 202 [ 51%] of 398) to comply with gown use ( OR, 10 [ 95% CI, 6.0- 17.0]; P<.001). In logistic regression analysis, independent predictors of gown compliance among HCWs were female sex ( OR, 2.3 [ 95% CI, 1.8- 3.0]; P<.001) and ICU setting ( OR, 2.2 [ 95% CI, 1.7- 2.9]; P<.001). In the ICUs, gown use was highly predictive of glove use among HCWs ( positive predictive value, 95%). CONCLUSION. Improvement in compliance with gown use at our medical center will require more- intensive educational efforts targeted at male HCWs and at HCWs and visitors on general wards. In the care of ICU patients under MCP, HCW compliance with gown use may be used as a proxy for their compliance with glove use.