Certified nursing assistants often fail to change gloves in long-term care facility
Certified nursing assistants frequently failed to change their gloves when moving between patients or after touching contaminated surfaces, possibly contributing to the spread of infections in a long-term care facility, an observational study found.
“Glove use behavior is as important as hand-washing when it comes to infection prevention,” Deborah Burdsall, PhD, RN-BC, CIC, of the University of Iowa College of Nursing, said in a press release. “These findings indicate that glove use behavior should be monitored alongside hand hygiene. The observations should be shared with staff to improve behaviors and reduce the risk of disease transmission.”
The researchers performed a descriptive structured observational study on a random sample of 74 certified nursing assistants (CNAs) working in a long-term care facility. Observers asked the staff members for permission to watch them as they helped patients with using the toilet or delivered perineal care. To minimize the Hawthorne effect, a psychological phenomenon in which individuals change their behavior when they know they are being watched, observers used a “minor deception,” telling workers that they were searching for possible barriers to health care provider hand hygiene.
CNAs wore gloves for 80.2% of touch points but failed to change gloves at 66.4% of points when glove changing was required, such as immediately after touching a potentially contaminated surface or between caring for different patients, Burdsall and colleagues reported. Staff members changed their gloves a median of 2 times per patient care event, and a median of 1 change occurred at a change point.
However, the researchers wrote, the CNAs failed to change their gloves during the appropriate change points a median of 2.5 times per care event. More than three-quarters of patient care events included more than one contaminated touch point (82.4%). Nearly half (n = 782 of 1,774; 44%) of gloved touch points were defined as contaminated, yielding a median eight contaminated touch points per care event. Burdsall and colleagues noted that workers wore gloves for all contaminated touch points, however (P < .001).
The study was limited by the fact that the sample consisted only of CNAs, as well as the fact that the CNAs all knew the investigator who observed them.
“Based on information from such studies, infection prevention staff and educators must develop training programs using adult learning principles and evidence-based instructional methods to improve [health care personnel (HCP)] glove use,” the researchers wrote. – by Andy Polhamus
Disclosures: The authors report no relevant financial disclosures.