Study Design
infection
INFECTION
We performed a mixed-method study including a cluster randomized trial to evaluate the effectiveness of a direct-gloving strategy in which each participating unit was assigned to either usual care (following the hospital’s policy to perform hand hygiene before donning nonsterile gloves) or the direct-gloving intervention (unit-based policies were updated to allow HCP to don nonsterile gloves without first performing hand hygiene). We stratified the randomization of participating units by unit type with the intention of selecting 1 unit from each unit type at each hospital. In addition, to account for differences in baseline adherence to infection prevention practices, including hand hygiene and glove use, we observed baseline rates for 6 months across all 33 available units at participating health care centers before we selected and randomly assigned the units to the intervention (direct-gloving units) or to usual care (usual care units). When possible, units with similar baseline adherence where selected for randomization. After baseline data collection and final unit selection, we performed a 3-month wash-in period during which HCP were educated to follow the policy to which their units were assigned. We implemented the intervention during the final 12th month of the study.