Blog | Thursday, September 21, 2017

Universal gloving (+/-gowning) is a horizontal intervention

Years ago, Wenzel and Edmond described horizontal vs. vertical infection control interventions. Horizontal interventions were defined as those where “all infections at any site are reduced” and vertical interventions were where “only specific organisms are targeted.” It always seemed to me that universal gloving and universal gowning/gloving interventions were horizontal interventions, just like hand hygiene.

Thus, why is it that when we analyze and make a case against the universal gowns and gloves intervention (or trial) we only include outcomes on methicillin-resistant Staphylococcus aureus (MRSA)? Put another way, why was it designed and critiqued as a vertical intervention and not a horizontal intervention? Shouldn't we also explore potential reductions in methicillin-susceptable S. aureus, gram-negative rods, multidrug-resistant gram-negative rods, and Clostridium difficle infections? Of course, a critique of this approach would be that the BUGG study didn't look at pathogens beyond MRSA and vancomycin-resistant enterococci (yet), so we can't. My response is then we shouldn't do studies of horizontal interventions unless they are properly funded to collect data on all pathogens possibly reduced through the intervention. These studies should also have high construct validity including tracking of post-discharge infections. Look what happens when hand hygiene's impact is limited to just health care-associated S. aureus bacteremia.

If we complete underpowered and underfunded studies with poor construct validity, they might come back to haunt us. And they could harm our field of infection control. More importantly, they might even harm our patients.

Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands). This post originally appeared at the blog Controversies in Hospital Infection Prevention.