Wearing gloves and gown in ICU may protect against MRSA superbug, but not VRE

A close look at methicillin-resistant Staphylococcus aureus (MRSA) bacteria.
Janice Carr Public Health Image Library

Current Centers for Disease Control and Prevention (CDC) guidelines urge medical professionals to wear gowns and gloves when they are working with patients who are infected with antibiotic-resistant bacteria. Now, a new study shows that if these simple requirements were spread to all patient's rooms in an intensive care unit (ICU), they may be able to provide some protection against at least one deadly superbug.

About one out of every 20 patients acquire an infection from a hospital that they didn't have when they were first admitted, according to the CDC. The health agency's director Dr. Tom Frieden previously said to during a press conference that the most acute sources of antibiotic-resistant germs are hospitals.

One antibiotic-resistant bacteria that is often found in health care settings is methicillin-resistant Staphylococcus aureus (MRSA). It can live harmlessly on the skin or in the nose, but if it infects a person's bloodstream, it can be deadly.

Hospital-linked invasive MRSA in particular infected more than 90,000 people across the U.S. and killed 20,000 people each year about a decade ago, the CDC reports. Since then, hospitals have made a bigger push to improve cleanliness. In 2011, there were just 60,000 people who were sickened, and only 10,000 died because of the bacteria resistant to methicillin antibiotics.

The new study, published on Oct. 4 in JAMA, found that wearing disposable gowns and gloves may help fight against MRSA's spread. The study looked at 20 medical and surgical ICUs in 15 states, where the researchers took 92,000 cultures from more than 26,000 patients from January to October 2012.

MRSA infection was 40 percent less likely in hospitals where all health care workers were required to use disposable gowns and gloves in the ICU, compared to establishments where they were only required to wear protective clothing during a standard isolation routine. The researchers added that workers were more likely to wash their hands after leaving the room if the entire ICU required the protective clothing.

Wearing the gowns and gloves were not shown to change the care the patient received; previous studies have found wearing gowns and gloves might increase likelihood of pressure sores, falls or other unintended physical injuries resulting from medical care. But, the new research showed there was a slight decrease in the amount of adverse events that happened to the patients when hospital workers suited up.

"We set out to find whether having healthcare workers wear gowns and gloves for all ICU patient contact could decrease the acquisition of antibiotic-resistant bacteria such as MRSA without causing any harm to the patient - and the answer was yes," lead study investigator Dr. Anthony D. Harris, professor of epidemiology and public health at the University of Maryland School of Medicine, said in a press release.

"From a public health perspective, it's important that we evaluate interventions that may continue to drive these infection rates down, especially as concerns persist about antibiotic-resistant bacteria," he added.

However, the protective gear was not shown to reduce the rates of vancomycin-resistant Enterococcus (VRE), another bacteria that's a culprit for hospital acquired infections. VRE typically live in the human intestines and female genital tract, but it can sometimes cause infections of the urinary tract and bloodstream. It can also cause an infection if it gets in wounds caused by catheters or surgical procedures.

Because of the VRE results, the researchers determined that requiring gloves and gowns in all ICU scenarios did not decrease overall MRSA and VRE infection rates significantly. However, they argued that it didn't mean gowns and gloves weren't worth wearing at all.

"Infection control studies such as this are important to advance the science and lead to important discoveries that can decrease health care-associated infections," senior author Dr. Daniel J. Morgan, assistant professor of epidemiology and public health at the University of Maryland School of Medicine, said in a press release. "In conjunction with the evolution of hospital cleaning practices, increased handwashing frequency and other measures, patients in hospitals can be safer than they've ever been from HAIs."

In an accompanying editorial, Dr. Preeti N. Malani, an associate editor of JAMA and clinical associate professor of internal medicine at the University of Michigan Health System, said that the study's results didn't provide evidence that glove and gowns could help against MRSA and VRE. She pointed out that the overall MRSA and VRE acquisition decreased from 21.4 infections per 1000 patient-days to 16.9 among the ICU centers, but it also went down in the ICU centers that served as a control that didn't require the garb.

However, Malani agreed that wearing gowns and gloves may help prevent bacterial transmission in some scenarios.

"Even though the results of Harris et al failed to demonstrate an overall benefit of universal use of gloves and gowns to reduce acquisition of MRSA or VRE, this approach may be worth considering in some instances," she wrote. "For example, if MRSA transmission is prevalent in a high-risk setting such as a surgical ICU with a large number of patients with newly implanted medical devices. If implemented, gloving and gowning should be just part of an overall strategy that includes efforts to optimize hand hygiene and prudent use of antimicrobials."

Other studies have shown that taking extra steps to ensure cleanliness can help stop MRSA transmission. A New England Journal of Medicine study showed that ICU patients at centers where all were subjected to a universal decontamination routine were 40 percent less likely to get a bloodstream infection of any type compared to centers who just isolated people who tested positive for MRSA. Universal decontamination involved getting a nose swap with bacteria-fighting ointment twice a day plus a once-daily antiseptic wipe bath.

The CDC has more on superbugs and health care-associated infections.