Authors of a recent study cite previous research showing that even when health care workers wash their hands, they don't do it thoroughly enough to eliminate bacteria transmitted to patients through central or peripheral IV lines. This is especially dangerous for extremely preterm infants, whose developing immune systems make them particularly vulnerable to hospital-acquired infections.

Hypothesizing that wearing gloves in addition to performing standard hand hygiene would help reduce such infections, the researchers conducted a prospective, randomized clinical trial of 120 preterm infants. Sixty were assigned to an intervention group in which they were cared for by staff who wore nonsterile gloves in addition to washing their hands with antimicrobial soap or an alcohol rub. The 60 controls-similar to the intervention group in demographics and infection risk factors such as iv access-were cared for by staff practicing only hand hygiene.

In the intervention group, 32% developed late-onset (occurring more than 72 hours after birth) infection compared with 45% in the control group. That result wasn't statistically significant, however, unlike the finding that the rate of gram-positive infections in the control group (32%) was more than twice that in the intervention group (15%).

In an e-mail to AJN, leading infection control expert Elaine Larson, associate dean for nursing research and professor of epidemiology at the Columbia University School of Nursing in New York City, commented that "despite the fact that this was a single-site, relatively small study, it was well done and the results are impressive and certainly consistent with the fact that hands are most likely to be 'involved' in gram-positive bloodstream infections and [central line-associated bloodstream infections], both of which were significantly reduced when gloves were worn.

"Even clean, 'nonsterile' gloves have many times fewer organisms than do the hands," wrote Larson. "This seems to be a cost-effective intervention worth considering in such high-risk settings."-Sibyl Shalo Wilmont, BSN, RN

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