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Use of simulations to evaluate the effectiveness of barrier precautions to prevent patient-to-patient transfer of healthcare-associated pathogens

Published online by Cambridge University Press:  12 October 2020

Heba Alhmidi
Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
Daniel F. Li
Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio Case Western Reserve University School of Medicine, Cleveland, Ohio
Jennifer L. Cadnum
Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
Muhammed F. Haq
Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
Natalia C. Pinto-Herrera
Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
Brigid M. Wilson
Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH
Curtis J. Donskey*
Case Western Reserve University School of Medicine, Cleveland, Ohio Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH
Author for correspondence: Curtis J. Donskey, E-mail:



There is controversy regarding whether the addition of cover gowns offers a substantial benefit over gloves alone in reducing personnel contamination and preventing pathogen transmission.


Simulated patient care interactions.


To evaluate the efficacy of different types of barrier precautions and to identify routes of transmission.


In randomly ordered sequence, 30 personnel each performed 3 standardized examinations of mannequins contaminated with pathogen surrogate markers (cauliflower mosaic virus DNA, bacteriophage MS2, nontoxigenic Clostridioides difficile spores, and fluorescent tracer) while wearing no barriers, gloves, or gloves plus gowns followed by examination of a noncontaminated mannequin. We compared the frequency and routes of transfer of the surrogate markers to the second mannequin or the environment.


For a composite of all surrogate markers, transfer by hands occurred at significantly lower rates in the gloves-alone group (OR, 0.02; P < .001) and the gloves-plus-gown group (OR, 0.06; P = .002). Transfer by stethoscope diaphragms was common in all groups and was reduced by wiping the stethoscope between simulations (OR, 0.06; P < .001). Compared to the no-barriers group, wearing a cover gown and gloves resulted in reduced contamination of clothing (OR, 0.15; P < .001), but wearing gloves alone did not.


Wearing gloves alone or gloves plus gowns reduces hand transfer of pathogens but may not address transfer by devices such as stethoscopes. Cover gowns reduce the risk of contaminating the clothing of personnel.

Original Article
Creative Commons
This work is classified, for copyright purposes, as a work of the U.S. Government and is not subject to copyright protection within the United States.
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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