Study Ties Use of Gloves After Washing Hand to Fewer Infections in Preemies

Premature babies kept in neonatal intensive care units have reduced risk of infection when medical staff members wear gloves after washing hands as compared to washing hands alone.

The extremely premature babies face a high risk of death in case of late-onset infections (that occurs 72 hours after birth) and necrotizing enterocolitis (NEC, tissue death in intestine). Medical staff, even after washing their hands, can carry microorganisms that are dangerous for the health of extremely preterm newborns. This is because of their underdeveloped skin, mucosal barriers and immature immune system.

In this study, the researchers looked at whether the use of non-sterile gloves after washing hands and before all direct patient, bed and catheter contact (as compared to only washing hands) was sufficient to prevent the late-onset infections or NEC in preterm babies who weighed less than 1,000 grams and whose gestational age was less than 29 weeks and who were less than 8 days old.

This study was conducted at a single hospital NICU with 120 infants who were enrolled during the 30-month study from 2008-2011. The infants were randomly divided into two groups. Group A had 60 infants where medical staff wore non-sterile gloves after washing hands and Group B where the staff just washed hands.

The researchers noticed that nearly 32 percent of infants from Group A had NEC as compared to 45 percent infants of Group B. On comparing the two groups, there were 53 percent fewer gram-positive bloodstream infections and 64 percent less central line-associated blood stream infection in Group A infants.

"This readily implementable control measure to reduce infections in preterm infants while they have central or peripheral venous access warrants further study in this and other patient populations," said David A. Kaufman, M.D., of the University of Virginia School of Medicine.

In a related editorial, Susan E. Coffin of the University of Pennsylvanis said that while planning the study the researchers used present data from the institution on the rate of late-onset infections on extremely-low-birth weight infants in order to calculate the sample size that would help them to detect the relevant difference in outcome.

"Unfortunately for the investigators -- but fortunately for their patients -- the background rate of late-onset infections appears to have dropped significantly from the time they performed their sample size calculations to the study period (from 60 percent to 45 percent), thus rendering their study underpowered," Coffin notes. "It is important to recognize that universal glove use might lead to several unintended consequences. Glove use has been found by many investigators to be one of the key barriers to appropriate hand hygiene."

The finding was documented in JAMA Pediatrics.