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October 14, 2015

How hospital gowns may lead to patient infections

Daily Briefing

    Hospital workers are often unable to remove their gloves and gowns without contaminating themselves with bacteria, according to a study published this week in JAMA Internal Medicine.

    For the study, researchers recruited health care workers from four Cleveland-area hospitals to participate in 435 simulations. Participants included:

    • Physicians;
    • Nurses; and
    • Other health care professionals, such as dieticians, pharmacists, physician therapists, and radiology technicians.

    During the simulations, participants put on "contact isolation gowns" and nitrile gloves. The participants then rubbed their hands for 15 seconds with fluorescent lotion—which simulated bacteria—and wiped their hands on their gowns. Researchers then gave participants a clean pair of gloves and asked them to remove their gloves and gowns as they usually would. After the gowns and gloves had been removed, researchers used a black light to determine whether the fluorescent lotion remained on the participants' skin and clothing.

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    Key findings

    The average contamination rate in the simulation was 46%. According to the study, hospital workers had lotion remaining on their skin and clothing 38% of the time after they removed their gowns and 53% of the time after they removed their gloves.

    Other types of health care workers who participated in the study were similarly likely to incorrectly remove or put on protective equipment.

    The most commonly made mistakes were:

    • Failure to pull gloves over the wrist;
    • Putting on gloves before putting on the gown;
    • Removing gowns over the head -- rather than pulling them away from the body; and
    • Touching the outside of a dirty glove during removal.

    Where germs hide in the hospital

    Not surprisingly, participants who made mistakes when donning or removing the gowns or gloves were more than twice as likely—at 70%—to be contaminated as participants who followed procedures correctly. The likelihood of contamination was about the same across participants from each of the four hospitals. According to the study, participants of smaller or larger statures had more difficulty removing their gowns safely.

    Reducing contamination

    Following the study, lead researcher Myreen Tomas of the Cleveland Veterans Affairs Medical Center (CVAMC) initiated a training program about CDC-recommended protocols for proper glove and gown removal. The contamination rate fell from 60% to 19% following the training, according to the study.

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    Study co-author Curtis Donskey, also of CVAMC, said the findings demonstrate the urgent need to determine ways to reduce contamination risks.

    The study suggests making personal protective equipment easier to remove without contaminating oneself. In addition, the authors said it is important to identify ways to train health care workers about best practices for gown and glove removal (Preidt, HealthDay/U.S. News & World Report, 10/12; Kaplan, "Science Now," Los Angeles Times, 10/12).

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    More from today's Daily Briefing
    1. Current ArticleHow hospital gowns may lead to patient infections

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