Using gowns and gloves during high-risk transmission activities for all nursing home residents rather than only those colonized with MRSA or with chronic skin breakdown increased costs by 123% compared to usual care, according to recent data.
“This increase can be ameliorated if specific clinically relevant subsets (eg, those with chronic skin breakdown or MRSA colonization) are targeted for gown and glove use for high-risk activities,” Mary-Claire Roghmann, MD, MS, of the department of epidemiology and public health at the University of Maryland School of Medicine, and colleagues wrote.
Researchers estimate costs of glove, gown use
Roghmann and colleagues used data from their prospective, observational study to estimate the costs of using gloves and gowns during high-risk activities, including dressing, transferring, providing hygiene, changing linens and toileting residents over a 28-day period. The costs included the price of the equipment as well as time to don and doff gown and gloves. The researchers then compared costs when using gloves and gowns to treat all residents, residents with MRSA colonization and residents with chronic skin breakdown.
More than 400 residents from 13 community-based nursing homes and their health care workers (HCWs) were included in the analysis. Twenty-eight percent of residents were colonized with MRSA, and 17% had chronic skin breakdown.
The overall cost of gowns and gloves for usual care was $100 per resident. The overall cost of gowns and gloves for high-risk care limited to residents with chronic skin care was $125 per resident, and for MRSA colonization, it was $137 per resident. When gowns and gloves were used for all residents, the costs per resident increased up to $223.
“Most of this cost is due to the cost of the gowns,” Roghmann and colleagues wrote.
MRSA transmission to gowns, gloves common
In a previous analysis conducted by the same research team, Roghmann and colleagues demonstrated how frequent MRSA is transmitted to HCWs’ gowns and gloves during high-contact activities.
According to the researchers, 24% of gloves and 14% of gowns were contaminated with MRSA after 954 worker interactions with a MRSA-infected resident. In addition, residents with chronic skin breakdown were more likely to transmit MRSA during risky interactions with HCWs than those without chronic skin breakdown (P = .02).
The most common interactions that led to transmission of MRSA to workers’ gowns included dressing (OR = 2.33; 95% CI, 1.5-1.61), transferring (OR = 2.13; 95% CI, 1.44-3.13) and assisting patients with hygiene (OR = 1.98; 95% CI, 1.2-3.28). The most common causes of MRSA transfer to workers’ gloves were dressing (OR = 1.81; 95% CI, 1.33-2.45), changing linens (OR = 1.77; 95% CI, 1.13-2.78) and assisting with hygiene (OR = 1.58; 95% CI, 1.09-2.3).
“In our study, high-risk care activities were all high-contact activities of daily living and often did not involve overt contact with body fluids, skin breakdown, or mucous membranes,” Roghmann and colleagues wrote. “This finding indicates the need to modify current CDC standards of care involving use of gowns and gloves in this setting because under standard precautions, gowns and gloves are not recommended to be worn for what we define here as high-risk care.” – by Stephanie Viguers
Disclosure: Roghmann reports no relevant financial disclosures. Please see the full studies for a list of all other authors’ relevant financial disclosures.