Gowning by attendants and visitors in newborn nurseries for prevention of neonatal morbidity and mortality

Abstract

Overgowns are widely used in newborn nurseries and neonatal intensive care units. It was thought that they may help to prevent the spread of nosocomial infection and serve as a reminder to staff and visitors to wash their hands before contacts with the infant. The objective of this review was to assess the effects of the wearing of an overgown by attendants and visitors for the prevention of infection and death in infants in newborn nurseries. The standard methods of the Cochrane Collaboration and its Neonatal Review Group were used. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2002), MEDLINE (1966-January 2003) and CINAHL (1982-January 2003). All published trials using random or quasi-random patient allocation, in which overgowns worn by attendants or visitors were compared with no overgowns worn by attendants or visitors. The standard methods of the Cochrane Collaboration and its Neonatal Review Group were used. Data extraction and study quality were independently assessed by the two authors. Missing information was sought from three authors but only one responded. Results are expressed as relative risk or mean difference with 95% confidence intervals. Eight trials were included, reporting outcomes for 3,811 infants. Trial quality varied; two were of good quality. Not wearing overgowns was associated with a trend to reduction in the death rate, typical RR 0.84 (95% CI 0.70, 1.02) compared to wearing overgowns, but these results did not reach statistical significance. There was no statistically significant effect of gowning policy on incidence of systemic nosocomial infection, typical RR 1.24 (CI 0.90,1.71). The overall analysis showed no significant effects of gowning policy on the incidence of colonisation, length of stay or handwashing frequency. No trials of visitor gowning were found. The evidence from this systematic review and meta analysis does not demonstrate that overgowns are effective in limiting death, infection or bacterial colonisation in infants admitted to newborn nurseries.