Hostname: page-component-7b7567c8c-2n9c9 Total loading time: 0 Render date: 2026-11-13T20:18:11.271Z Has data issue: false hasContentIssue false
  • English
  • Français

Does one size fit all for contact precautions implementation? Impact of requiring use of gloves and gowns for every room entry on personnel time, personal protective equipment costs, and carbon footprint

Published online by Cambridge University Press:  10 September 2025

Amelia L. Milner,
Elizabeth C. EcksteinOpen the ORCID record for Elizabeth C. Eckstein[Opens in a new window] and
Curtis J. DonskeyOpen the ORCID record for Curtis J. Donskey[Opens in a new window]
Amelia L. Milner
Affiliation:
University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
Elizabeth C. Eckstein
Affiliation:
Infection Control Department, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
Curtis J. Donskey*
Affiliation:
Case Western Reserve University School of Medicine, Cleveland, OH, USAGeriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
*
Corresponding author: Curtis J. Donskey; Email: Curtis.Donskey@va.gov
Rights & Permissions [Opens in a new window]

Abstract

In an observational study, healthcare personnel often entered contact precautions rooms without contacting patients or the environment. An approach requiring gloves and gowns based on actual contacts rather than for all room entries would reduce personal protective equipment donning and doffing time, cost, and carbon footprint by more than half.

Information

Type
Concise Communication
Information
Infection Control & Hospital Epidemiology , Volume 46 , Issue 11 , November 2025, pp. 1161 - 1163
Check for updates
Creative Commons
This is a work of the US Government and is not subject to copyright protection within the United States. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America.
Copyright
© U.S. Department of Veterans Affairs, 2025

Introduction

Contact precautions are commonly used to prevent transmission of healthcare-associated pathogens spread by direct or indirect contact with patients or their environment. Reference Siegel, Rhinehart, Jackson and Chiarello1 Personnel caring for patients on contact precautions must wear a gown and gloves for all interactions that involve contact with the patient or the patient’s environment. Many facilities use a one-size-fits-all approach in which personnel are required to wear gloves and a gown any time they enter a contact precautions room, whereas others allow personnel to base their use of gloves and gowns on anticipated activities. The primary rationale for the one-size-fits-all approach is that contacts sometimes occur even when none are anticipated.

The one-size-fits-all approach for contact precautions has potential disadvantages, including the time for donning and doffing, reduced staff autonomy, and increased carbon and plastic footprints. Reference Gastmeier2–Reference Diekema, Nori, Stevens, Smith, Coffey and Morgan4 Moreover, as the burden of contact precautions increases, there may be a reduction in compliance by personnel. Reference Dhar, Marchaim and Tansek5 One proposed approach to address these concerns is to require contact precautions only for certain high-risk activities and personnel. Reference O’Hara, Calfee and Miller6,Reference Adediran, Robinson and Johnson7 The Department of Veterans Affairs national infectious diseases program recommends that facilities require use of gloves and gowns for all entries into a contact precautions room. Here, we tested the hypothesis that use of gloves and gowns based on contact with patients or their environment would substantially reduce glove and gown use, time for donning and doffing, costs, and carbon footprint.

Methods

The study was approved by the Cleveland VA Medical Center’s Research and Development committee as a quality improvement project. During the study, the hospital policy for contact precautions required personnel to wear gloves and a single-use disposable gown for any room entry. An observer (A.L.M.) was stationed at contact precautions rooms in the medical intensive care unit (ICU) and on 2 medical/surgical units for periods of 1 to 4 hours between 8 AM and 5 PM on weekdays. The observer was trained by an infection prevention nurse and used a standardized data collection form. For all personnel entering the room, the observer asked if they could enter the room to observe their activities. The observer recorded all contacts that the hands and clothing and/or cover gown of personnel made with the patient and environment. Personnel were classified as physicians, nurses, or other staff. The number of entrances to the room was recorded and the time required for donning and doffing gloves and gowns was measured. We did not record compliance with glove and/or gown use or information that would identify personnel or patients.

The percentage of room entries in which the hands or clothing/cover gown of personnel contacted the patient or environmental surfaces was calculated for the ICU and the medical-surgical units. We compared glove and gown use, cost of gloves and gowns, and time required for donning and doffing for approaches requiring gloves and gowns for any entry into the room versus use based on contact with patients or their environment (ie, hand contact required gloves; a gown was also required if clothing/cover gowns contacted the patient or environment). The carbon footprint of gloves and gowns in carbon dioxide (CO2) equivalents was calculated as described by Rizan et al. Reference Rizan, Reed and Bhutta8

Results

Observations were conducted between May 14, 2024, and June 13, 2024, for 30 hours, including 12 hours in the ICU and 18 hours on medical/surgical units. One hundred-forty-six personnel (92 nurses, 57 physicians, and 7 other staff) were observed, including 68 in the ICU (45 room entries per 8 hours of observation) and 78 on the medical/surgical units (35 room entries per 8 hours of observation). Hands and clothing and/or cover gowns of personnel contacted patients and/or environmental surfaces during 60% and 42% of room entries, respectively. The frequency of contacts was similar for the ICU and the medical/surgical units (Figure 1), and for physicians, nurses, and other staff (supplementary material). Contact with surfaces occurred more often than contact with patients. The items touched most frequently included the bed rail, intravenous infusion stand, and bedside table (supplemental material). The average time required for donning and doffing gloves and gowns was 77 seconds, including 65 seconds donning and 12 seconds doffing; for gloves only, the average time was 10 seconds, with 7 seconds donning and 3 seconds doffing.

Figure 1.

Percentage of entries into contact precautions rooms in the intensive care unit (A) and on medical/surgical units (B) in which the hands or clothing of personnel contacted environmental surfaces or the patient.

Table 1 shows the impact of the 2 approaches for contact precautions on glove and gown use, cost of gloves and gowns, time required for donning and doffing, and carbon footprint in 1 contact precautions room based on 8 hours of observation. For both the ICU and the medical/surgical units, the number of gowns, time required for donning and doffing, cost of gloves and gowns, and the carbon footprint were reduced by more than half when glove and gown use was based on contacts.

Table 1.

Impact of 2 approaches for contact precautions implementation on glove and gown use, cost of gloves and gowns, time required for donning and doffing, and carbon footprint during 8 hours of observationFootnote *

* calculated for a single contact precautions room based on observations conducted over 30 hours in multiple contact precautions rooms between 8 AM and 5 PM on weekdays

Discussion

In our facility, personnel entering contact precautions rooms touched surfaces and/or patients with their hands only about two-thirds of the time. Others have demonstrated that personnel entering non-isolation rooms often do not touch anything inside the room. Reference Cohen, Hyman, Rosenberg and Larson9 Clothing and/or cover gowns of personnel contacted surfaces and/or patients even less frequently (40% in the ICU; 44% on medical/surgical units). These results suggest that allowing personnel to base their use of personal protective equipment on actual contacts with patients and surfaces could substantially reduce use of gloves and gowns.

Requiring gloves and gowns for every contact precautions room entry places a substantial burden on personnel (ICU: 45 room entries per 8 hours requiring 58 minutes for donning and doffing); medical/surgical units: 35 room entries per 8 hours requiring 45 minutes for donning and doffing). The requirement for use of protective equipment for each room entry reduces staff autonomy and may lead to reduced compliance due to isolation fatigue. Reference Dhar, Marchaim and Tansek5

The healthcare system contributes substantially to greenhouse gas emissions and plastic waste. Reference Diekema, Nori, Stevens, Smith, Coffey and Morgan4 It has been argued that the potential benefits of contact precautions should be balanced against the potential for harm due to their carbon and plastic footprint. Reference Diekema, Nori, Stevens, Smith, Coffey and Morgan4,Reference Rizan, Reed and Bhutta8 Single-use polypropylene gowns are particularly problematic, but reusable gowns also have a large carbon footprint. Reference Vozzola, Overcash and Griffing10 Our findings suggest if contact precautions are used, the carbon and plastic footprint could be markedly reduced if personnel use gloves and gowns based contacts with patients or the environment.

Our study has some limitations. Only 3 wards in one healthcare facility were included. Observations were conducted only between 8 AM and 5 PM on weekdays. Personnel may have modified their usual activities because they were observed. Our findings may underestimate the potential to reduce use of gowns because personnel wearing gloves and gowns often had incidental contact with surfaces that could have been easily avoided if they were trying to minimize contacts (eg, touching or leaning against the bedrail while talking to a patient). Finally, we did not assess how often personnel had unanticipated contact with patients or the environment.

Supplementary material

To view supplementary material for this article, please visit https://doi.org/10.1017/ice.2025.10257

Acknowledgments

We would like to thank the personnel at the Louis Stokes Cleveland VA Medical Center who participated in the study.

Financial support

None.

Competing interests

C.J.D has received research support from Clorox and Ushio America.

References

Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L, and the Healthcare Infection Control Practices Advisory Committee. Guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. Available at: https://www.cdc.gov/infection-control/hcp/isolation/isolation-precautions/index.html. Accessed May 1, 2025.Google Scholar
Gastmeier, P. From ‘one size fits all’ to personalized infection prevention. J Hosp Infect 2020;104:256–260.10.1016/j.jhin.2019.12.010CrossRefGoogle ScholarPubMed
Bearman, GM, Harris, AD, Tacconelli, E. Contact precautions for the control of endemic pathogens: Finding the middle path. Antimicrob Steward Healthc Epidemiol 2023;3:e57.10.1017/ash.2023.145CrossRefGoogle ScholarPubMed
Diekema, DJ, Nori, P, Stevens, MP, Smith, MW, Coffey, KC, Morgan, DJ. Are contact precautions “essential” for the prevention of healthcare-associated methicillin-resistant Staphylococcus aureus? Clin Infect Dis 2024;78:1289–1294.10.1093/cid/ciad571CrossRefGoogle ScholarPubMed
Dhar, S, Marchaim, D, Tansek, R, et al. Contact precautions: More is not necessarily better. Infect Control Hosp Epidemiol 2014;35:213–21.CrossRefGoogle Scholar
O’Hara, LM, Calfee, DP, Miller, LG, et al. Optimizing contact precautions to curb the spread of antibiotic-resistant bacteria in hospitals: A multicenter cohort study to identify patient characteristics and healthcare personnel interactions associated with transmission of methicillin-resistant Staphylococcus aureus . Clin Infect Dis 2019;69:S171–S177.10.1093/cid/ciz621CrossRefGoogle ScholarPubMed
Adediran, TY, Robinson, GL, Johnson, JK, et al. Factors associated with patient-to-healthcare personnel (HCP) and HCP-to-subsequent patient transmission of methicillin-resistant Staphylococcus aureus . Infect Control Hosp Epidemiol 2024;45:583–589.10.1017/ice.2023.269CrossRefGoogle ScholarPubMed
Rizan, C, Reed, M, Bhutta, MF. Environmental impact of personal protective equipment distributed for use by health and social care services in England in the first six months of the COVID-19 pandemic. J R Soc Med 2021;114:250–263.10.1177/01410768211001583CrossRefGoogle ScholarPubMed
Cohen, B, Hyman, S, Rosenberg, L, Larson, E. Frequency of patient contact with health care personnel and visitors: Implications for infection prevention. Jt Comm J Qual Patient Saf 2012;38:560–5.Google ScholarPubMed
Vozzola, E, Overcash, M, Griffing, E. Environmental considerations in the selection of isolation gowns: A life cycle assessment of reusable and disposable alternatives. Am J Infect Control 2018;46:881–886.10.1016/j.ajic.2018.02.002CrossRefGoogle ScholarPubMed
Figure 0

Figure 1.Percentage of entries into contact precautions rooms in the intensive care unit (A) and on medical/surgical units (B) in which the hands or clothing of personnel contacted environmental surfaces or the patient.

Figure 1

Table 1.Impact of 2 approaches for contact precautions implementation on glove and gown use, cost of gloves and gowns, time required for donning and doffing, and carbon footprint during 8 hours of observation*

Supplementary material: File

Milner et al. supplementary material

Milner et al. supplementary material
Download Milner et al. supplementary material(File)
File 42.3 KB