Control of Vancomycin-Resistant Enterococcus

TO THE EDITOR:

The recent article by Slaughter and colleagues [1] comparing the effect of universal use of gloves and gowns with that of universal glove use alone in a medical intensive care unit showed that the use of gloves and gowns was no better than the use of gloves only in preventing rectal colonization by vancomycin-resistant enterococci. We compared the cost of our glove and gown use before and after an outbreak of vancomycin-resistant enterococci in our institution. The annual cost of glove use was $28 602 before the outbreak and $31 483 after the start of the outbreak, for a difference of $2881 per year. The annual cost of gown use was $1868 before the outbreak and $10 291 after the outbreak, for a difference of $8423 per year (an increase threefold greater than that of glove use). Our annual expenses for gloves and gowns have thus increased by $11 304 since the outbreak began. If we were to switch from strict contact isolation to the use of gloves only for our patients with vancomycin-resistant enterococci, we could potentially save our institution approximately $8000 a year. However, as Slaughter and colleagues reiterate, other investigators have shown that improved compliance is associated with the requirement of a greater level of precautions [2, 3]. We compared compliance with handwashing after contact with patients under strict contact isolation with compliance after contact with patients not under isolation; compliance was 100% in the former situation and 51% in the latter. We also found that only 70% of staff members who donned gloves for patient contact washed their hands after removing their gloves.