Glove and Hand Hygiene Compliance for Healthcare Workers

Infection Risk

When a patient enters a hospital for medical treatment or surgery, they face the risk of contracting an infection during their stay. These healthcare-associated infections (HAIs) remain a common occurrence in healthcare facilities (e.g. hospitals). According to the World Health Organization (WHO), hundreds of millions of patients are affected by HAIs worldwide each year (WHO, 2020).  HAIs come at a high cost for patients, their families and the healthcare system.

Current evidence indicates that COVID-19 is transmitted through respiratory droplets or contact (WHO, 2020). Contact transmission occurs when contaminated hands touch the mouth, nose, or eyes, allowing the virus to enter the body. The virus can also be transferred from one surface to another by contaminated hands, which facilitates indirect contact transmission (WHO, 2020). It is by no surprise that hand hygiene remains the most important method at preventing the spread of COVID-19.

Antimicrobial-resistant pathogens such as Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant enterococci (VRE), and multidrug-resistant Gram-negative bacilli can survive for weeks, even months, on environmental surfaces (Pittet et al, 1999). Contaminated and high-touch surfaces, such as patient bedsides, patient curtains, healthcare nursing uniforms, medical equipment, sinks, computer keyboards, can serve as reservoirs of healthcare pathogens and vectors for cross-contamination to patients (Dancer, 2014). Studies have shown that healthcare workers may contaminate their hands by touching these contaminated surfaces, with a high chance of pathogens being then passed onto other patients and areas in the healthcare facility (Dancer, 2014).

Glove Use and Hand Hygiene

According to the Centers for Disease Control and Prevention (CDC) and the WHO, hand hygiene is the undisputed, single most effective infection control measure in the prevention of HAIs. It is also the least expensive means of reducing the spread of antimicrobial resistance (Mathur, 2011). Several studies have demonstrated that handwashing virtually eradicates the carriage of MRSA which invariably occurs on the hands of healthcare workers working in ICUs (Peacock et al, 1980). An increase in handwashing compliance has been found to be accompanied by a fall in MRSA rates (Pittet et al, 2000).

Recently, hand hygiene compliance rates in healthcare facilities in Australia were reported to be around 84.5% (HHA, 2018). Healthcare workers are normally under a lot of stress and may sometimes forget to perform correct hand hygiene techniques. It is therefore important to remind healthcare workers of the 5 Moments of Hand Hygiene to reinforce best hand hygiene practice: before touching a patient; before clean/aseptic procedures; after a body fluid exposure risk; after touching a patient; and after touching a patient’s surroundings.

Medical gloves protect healthcare workers from contamination while caring for their patients and potentially prevent transmitting pathogens between patients and the environment when used and disposed of correctly. Wearing gloves significantly reduces the probability of cross-contamination and hence should be worn during all patient care activities that may involve exposure to splashes of bodily fluids or exposure to non-intact skin (Heath Victoria Government, 2020)

The most common medical gloves are disposable single-use gloves, which should be removed after each use and safely discarded into a bin, followed by proper handwashing. Disposable examination gloves should be changed with a new pair as soon as possible when contaminated and should not be used when torn or punctured.

Unfortunately, the misuse of medical gloves is still present in healthcare facilities today. Medical staff often fail to follow best glove practices and thus facilitate the spread of pathogens in their environment. One study reported that gloves worn by healthcare workers were donned too early or removed too late. The study also found glove use was associated with a high risk of cross-contamination outside the patient zone (Loveday et al, 2014). Furthermore, when a healthcare worker uses medical gloves, the surface of the glove may become heavily contaminated, making cross-contamination from touching other surfaces or patients with those contaminated gloves highly likely.

Fuller et al. (2011) observed the rate of hand hygiene compliance of healthcare workers wearing medical gloves was much worse than when medical gloves were not worn. They also found that wearing gloves correlated with lower hand washing before and after patient contact. These findings reinforce the need for continuing education on the importance of hand hygiene while wearing gloves and when it should be practised. Hand hygiene should be performed:

• Before patient contact
• After patient contact
• During glove use, should the integrity of the glove become compromised, gloves should be removed, hands cleaned, and a new pair of gloves donned.

Wearing examination gloves does not remove the need to comply with hand hygiene. Improving the rate of hand hygiene compliance in association with wearing gloves could be critical in raising compliance levels and reducing HAIs.

References

1. Dancer, S., 2014. Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination. Clinical Microbiology Reviews, 27(4), pp.665-690.
2. Fuller, C., Savage, J., Besser, S., Hayward, A., Cookson, B., Cooper, B. and Stone, S., 2011. “The Dirty Hand in the Latex Glove”: A Study of Hand Hygiene Compliance When Gloves Are
3. Worn. Infection Control & Hospital Epidemiology, 32(12), pp.1194-1199.
4. Health Victoria Government 2020. Blue Book: Managing Exposures To Blood And Body Fluids/Substances. [online] Available at: <https://www2.health.vic.gov.au/public-health/infectious-diseases/infection-control-guidelines/manage-exposure-blood-body-fluids-substances> [Accessed 18 August 2020].
5. Loveday, H., Lynam, S., Singleton, J. and Wilson, J., 2014. Clinical glove use: healthcare workers’ actions and perceptions. Journal of Hospital Infection, 86(2), pp.110-116.
6. Mathur, P., 2011. Hand hygiene: Back to the basics of infection control. The Indian Journal of Medical Research, 134(5), p.611.