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Gloves are a potential barrier to hand hygiene, especially among nurses

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November 25, 2018

Glove use in health care settings is a potential barrier to hand hygiene, especially among nurses, according to study findings published in Infection Control & Hospital Epidemiology.

Hand hygiene and the use of examination gloves in health care is critical. WHO highlights that health care personnel should perform hand hygiene, either using alcohol-based hand-rub or soap and water, before and after donning gloves and that gloves should only be worn in certain scenarios,” Richard A. Martinello, MD, associate professor of medicine and pediatrics at the Yale School of Medicine and medical director of infection prevention at Yale New Haven Hospital and Yale New Haven Health, and colleagues wrote.

“Evidence has suggested that inappropriate use of examination gloves was a significant cause of missed [hand hygiene] opportunities at our and other institutions.”

To investigate glove use as a potential barrier to hand hygiene, Martinello and colleagues conducted a prospective quantitative and qualitative study in adult and pediatric medical-surgical wards and ICUs between Aug. 11, 2016, and Dec. 30, 2016.

“Hand hygiene performance of [health care professionals] providing hands-on inpatient care was measured by a validated observer using a ‘secret-shopper’ method focused on wash-in and wash-out [hand hygiene] opportunities and instances where gloves were worn in lieu of [hand hygiene],” they wrote.

According to the study findings, compliance with hand hygiene was 74.5% for both wash-in and wash-out opportunities during the 4-month period. The highest percentage of hand hygiene opportunities (41%) were performed by registered nurses, followed by licensed independent practitioners (16%) such as physicians, physician assistants and advanced practice registered nurses, and nursing assistants (16%).

The study showed that 45% of wash-in episodes lacking compliance with hand hygiene protocol were performed by registered nurses, and that 44% of all wash-in episodes lacking such compliance were performed by staff who wore gloves. These episodes were observed more frequently among registered nurses (47%), according to Martinello and colleagues.

Interviews performed during the study identified four major drivers of glove use: protection and safety of staff and patients, availability of gloves, previous medical training guidance and barriers to hand hygiene, the researchers reported. Other lesser mentioned barriers included workload, distance to hand-washing sinks and growing use of hospital-supported cell phones. Martinello and colleagues said it may be useful to re-educate health care professionals about proper glove use and hand hygiene.

“Overall, compliance with [hand hygiene] was high among [health care professionals],” they concluded. “Gloves were found to be a potential barrier to [hand hygiene] and use in lieu of [hand hygiene] was greatest among nursing staff. Glove use was shown to be driven by staff desire for personal safety and potentially learned during professional training.” – by Caitlyn Stulpin

Disclosures: Martinello reports receiving nonfinancial research support from GOJO Industries. Please see the study for a list of all other authors’ relevant financial disclosures.