A Tale of Two Studies

Two studies presented at a national medical conference in Orlando, Florida last month reported findings that suggest its authors might want to talk to one another.

A research team from the Ronald Regan UCLA Medical Center, led by Elise Martin, MD, wanted to know what would happen to hospital infection rates if they stopped using routine contact precautions.

Is the hospital gear doing its job?

Does wearing this gear really prevent the spread of infection?

Precautions are used for patients infected with bad bugs such as MRSA (methicillin-resistant staphylococcus aureus), and VRE (vancomycin-resistant enterococcus). They are placed in isolation and healthcare workers (HCW) wear personal protective equipment (PPE); such things as gowns, gloves, masks, and goggles, for each and every patient contact.

There are, however, downsides to the procedure: It’s time consuming for staff to don and doff the gear; patients report feeling that staff avoid them because of the inconvenience of having to put it on; the gear is expensive, for example, it costs the UCLA hospital over $650,000 every year; and besides, say the researchers, there isn’t a lot of data saying this approach works to begin with.

Dr. Elise Martin: The gear makes no difference

Dr. Elise Martin: The gear makes no difference.

So to find out if the effort is worth it, Dr. Martin and her colleagues simply suspended the contact precautions from July through to December last year, and checked the data to see whether there was any effect on hospital infection rates. The result: No difference; i.e., whether you use the contact precautions or not, the infections rates for MRSA and VRE remained the same!

Oh boy. That’s quite a finding because these precautions are SOP across the country, if not the world. And so her work has become a hot topic in the medical community; for instance, it remains the most read article on Medscape Infectious Disease a week after it was first posted.

But there’s a problem.

At that very same conference in Orlando, a research team from the Cleveland Veterans Affairs Medical Center in Ohio, led by Myreen Tomas, MD, presented their study on PPE, which looked at it from a different angle; namely, whether or not HCW are using the gear properly, and if not, do they become contaminated as a result, thereby increasing the risk of contaminating their patients.

Dr. Myreen Tomas: We're not using the gear properly

Dr. Myreen Tomas: We’re not using the gear properly.

The Tomas team say their results were “very surprising”: The skin and clothing of HCW became very contaminated during the removal of the gear; for example, when the PPE gloves were contaminated the workers themselves became contaminated 80% of the time, especially their hands, thus increasing the risk of spreading disease throughout the hospital.

Overall, gown and glove contamination resulted in HCW contamination 46% of the time. The problem, Dr. Thomas says, is improper use of the gear, especially when taking it off. For example, the gown should be removed away from the body, not over the head.

When the researchers made sure that the correct procedures were followed the contamination rate dropped dramatically – all the way down to 5%.

In other words, according to this study, contact precautions do work – if they’re done right.

And there’s the rub. Because outside of the controlled environment of a study, where researchers are there to tell the HCW if they’re donning and doffing the equipment properly, the real word is very demanding of their time and those pressures lead to mistakes.

Ironically, it’s those very demands on HCW time that makes the UCLA study so appealing. Because it offers the service provider the promise of more time to do their job which translates into happy employees and satisfied patients.

So imagine:

You’re the CEO of the Ronald Reagan UCLA Medical Center. Your budget’s tight, your staff say they’re overworked and underpaid, your patients say they want more attention from their HCW – and remember there’s a lot more patients without drug-resistant infections than there are with.

Dr. Elise Martin walks into your office and says she has a sure-fire way of taking care of these concerns – be a pioneer, she tells you, and dump the traditional practice of contact precautions.

What do you say to her?

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