Deconstructing the relative benefits of a universal glove and gown intervention on MRSA acquisition

Authored by A D Harris, D J Morgan, L Pineles, E N Perencevich, S L Barnes

Date Published: 2017

DOI: 10.1016/j.jhin.2017.03.011

Sponsors: United States National Institutes of Health (NIH)

Platforms: No platforms listed

Model Documentation: Other Narrative Flow charts

Model Code URLs: Model code not found

Abstract

Background: The 20-site Benefits of Universal Glove and Gown (BUGG) study found that wearing gloves and gowns for all patient contacts in the intensive care unit (ICU) reduced acquisition rates of meticillin-resistant Staphylococcus aureus (MRSA). The relative importance of gloves and gowns as a barrier, improved hand hygiene, and reduced healthcare worker (HCW) epatient contact rates is unknown. Aim: To determine what proportion of the reduction in acquisition rates observed in the BUGG study was due to improved hand hygiene, reduced contact rates, and universal glove and gown use using agent-based simulation modelling. Methods: An existing agent-based model to simulate MRSA transmission dynamics in an ICU was modified, and the model was calibrated using site-specific data. Model validation was completed using data collected in the BUGG study. A full 2k factorial design was conducted to quantify the relative benefits of improving each of the aforementioned factors with respect to MRSA acquisition rates. Findings: Across 40 simulated replications for each factorial design point and intervention site, approximately 44\% of the decrease in MRSA acquisition rates was due to universal glove and gown use, 38.1\% of the decrease was due to improvement in hand hygiene compliance on exiting patient rooms, and 14.5\% of the decrease was due to the reduction in HCWepatient contact rates. Conclusion: Using mathematical modelling, the decrease in MRSA acquisition in the BUGG study was found to be due primarily to the barrier effects of gowns and gloves, followed by improved hand hygiene and lower HCWepatient contact rates. (C) 2017 Published by Elsevier Ltd on behalf of The Healthcare Infection Society.

Tags

mathematical modelling Infections Hand hygiene Contact rates Contact precautions Multi-drug-resistant organisms Randomized controlled trial Icu