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Use of gloves vs contact restriction to prevent the transmission of multidrug-resistant bacteria in hospitals for the maintenance of chronic patients

In recent years, both in the United States and in USA, there has been a general trend towards an aging population. Many older people become residents of nursing homes, including specialized treatment facilities designed to contain patients with various chronic conditions. In these institutions, antibiotic resistant microorganisms often circulate: strains of Staphylococcus aureus resistant to methicillin (MRSA), enterococci resistant to vancomycin (VRE), Gram negative bacilli producing beta- extended spectrum lactamases, etc. which can lead to infection by these pathogens of the people they contain. It is not possible to achieve the recommended complete isolation of patients already infected with resistant strains and is not economically viable.

Study by W.E. Trick et al. (United States), the objective was to determine the most effective and economically viable method to prevent the spread of antibiotic resistant bacteria in hospitals for the maintenance of chronic patients. During the study, a comparative evaluation of two modes of infection control was carried out: traditional use of gloves (PI) vs restriction of contact with patients (OK), which involved the use of disposable gowns and gloves, placing patients in boxes or separate rooms, where individuals are colonized by the above microorganisms.

The study involved 156 patients: the PI scheme - 74 patients (average age 55 years) and the OK scheme - 82 patients (average age 59 years) who were at the Illinois State Hospital for the period June 1, 1998 to December 7, 1999. All patients underwent bacteriological studies to detect infection by 4 microorganisms resistant to antibiotics (MRSA, VRE, Klebsiella pneumoniae or Escherichia coli , producing extended spectrum beta-lactamases). All isolates isolated were typed.

According to the results, the frequency of infection by antibiotic-resistant microorganisms did not differ when using the PI and OK modes - 31 episodes (1.5 per 1000 bed-days) vs 38 episodes (1.6 per 1,000 bed-days), accordingly. Infection with one of the two common strains of K. pneumoniae was observed more often (p = 0.06) when using the OK regimen. At the same time, the expected cost of using OK mode was 40% higher than that of IP.

Thus, the traditional use of gloves can effectively prevent the spread of pathogenic flora and is economically justified, which allows us to recommend its use in most medical institutions for the maintenance of chronic patients.

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