| Methods |
Controlled before and after study conducted in a neonatal intensive care unit (NICU) of Kapiolani medical centre, Honolulu, Hawaii, to assess the effect of gowning on RSV and other infections, on traffic and handwashing patterns. Alternate 2‐month gowning and no‐gowning cycles were established in a 24‐bed NICU for 8 months. One entire 4‐month cycle was repeated to eliminate the potential for seasonal variables and outbreaks. All the people entering into the NICU (physicians, nursing staff, ward clerks, families and visitors) wore gowns. During the no‐gowning periods nursing staff wore hospital‐issued pantsuit, washed at home through ordinary methods and worn from home. Ward clerks, physicians, hospital staff, families and visitors wore street clothes without gowns. Throughout the entire 8‐month period, there was the recommendation for all staff and visitors to enforce initial 2‐minute hand‐scrub. Nails were cleaned before scrubbing, and a minimum 15‐second handwash between infants or equipment was expected. Surveillance cultures were done weekly on all patients. Without the knowledge of the NICU staff, a neonatal research nurse scheduled observations of traffic patterns, while ostensibly reviewing charts, to determine if a lack of gowning procedures encourage more traffic. Handwashing compliance was studied, again without staff awareness, by 30 minutes direct observation. Follow up of infection rates was planned through standard infection control surveillance |
| Participants |
230 infants, aged 22 to 42 weeks, with birth a weight of 464 to 6195 grams. Overall there were 330 infants admitted to NICU during the study period. Thus 17% of participants had no RSV cultures taken. The reasons given are vague (transfer or death) |
| Interventions |
Use of gowns and standard procedures (handwashing) versus standard procedures |
| Outcomes |
Laboratory: serological evidence: yes
Effectiveness: RSV infection
Safety: N/A |
| Notes |
Risk of bias: medium (17% loss to follow up)
Notes: the authors conclude that gowning did not protect NICU infants from any type of infection or affect mortality (1.21 versus 1.38/100 patient‐days of gowning and no‐gowning periods respectively). Gowning procedures did not deter staff or visitors from entering the unit, since traffic was also unchanged between periods. Finally the results showed no change in handwashing patterns between periods. Besides the advantage of eliminating a potentially unnecessary ritual that may be perceived as a psychological barrier to families visiting their infants, other benefits to discontinuing gowning include saving staff time involved in various gowning procedures and costs. If gowns are eliminated, it is recommended to perform careful follow up. The study conclusions must be taken with caution given the likely selection bias introduced by the missing 17% of children |
| Risk of bias |
| Bias |
Authors' judgement |
Support for judgement |
| Random sequence generation (selection bias) |
Unclear risk |
N/A |
| Allocation concealment (selection bias) |
Unclear risk |
N/A |
| Blinding (performance bias and detection bias)
All outcomes |
Unclear risk |
N/A |
| Incomplete outcome data (attrition bias)
All outcomes |
Unclear risk |
N/A |
| Selective reporting (reporting bias) |
Unclear risk |
N/A |
