Study Name: “Glove: Use for safety or over-use?”*

HISTORY HAND HYGIENE & GLOVE USE: THE FUTURE

Today, the aim of glove use is for the protection of both the care provider and the patient.

Occupational exposure to blood and body fluids presents a major safety risk for bloodborne viruses to all health care workers (HCW).

The elimination of routine glove use from contact precautions

would reduce wastage and improve cost savings without a concomitant increase in infections.

A modified glove use approach with a cultural shift would improve

the safety of patient-centred care.

Refresh WHO 5 Moments with explicit reminders to change gloves between Moments.

RECOMMENDATION:

Requirements:Compliance with WHO 5 Moments including before donning PPE and after removing PPERemoval of all PPE on exiting room/ward followed by immediate hand hygiene

Identification of:Non-sterile glove boxes have been reported to be contaminated with bacteria HCWs to evaluate risk of exposure to blood and body fluids before donning glovesIncreased hand hygiene by eliminating gloves for ‘dry’ contacts with patient under contact precautions to reduce cross-contamination by gloved hands.

Contaminated gloves should be changed during an episode of care that had the HCW’s hands been ungloved would have involved several hand hygiene events.

HCWs have become accustomed to feeling safe with gloves, and this feeling may have averted their need for hand hygiene.

Feedback of hand hygiene is complicated by falsely enhanced compliance rates produced by the Hawthorne Effect.

HCWs find integrating changes of gloves into the principles of the 5 Moments notoriously difficult.

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1758

1899

Gloves were made from sheep caecum in an attempt to protect the surgeon’s hands during surgery, vaginal examination, and autopsies.

Glove use moved out of the operating theatre onto the ward. Gloves on the ward were used in conjunction with handwashing after every patient but only for “grossly contaminated hands with pathogens”.

The American Hospital Association published the first hospital infection

control manual. This recommendation suggested that the target of the

equipment was the safety of the HCWs.

The consequence of multiple changes to guidelines raised

concerns about poor compliance with hand hygiene

associated with glove use.

Gloves specified for anticipated contact with blood and specified body fluids, and hands were to be washed immediately after glove removal An over-reliance on glove use produced an increased risk of the transmission of pathogens.

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The Lancet supported the use of thin, sterile, rubber gloves for possible exposures to body fluids.

The disposable glove emerged.

The pre-packaging of gloves transformed gloves into an essential accessible protective item.

William Halsted, a surgeon, advocated gloves for the protection of patients from surgical

infections during hernia operations.

1957

1958

1960

1966

1968

1980s

1990

2018

High hand hygiene compliance is accepted as the most cost-effective infection prevention activity.

With the current emphasis on gloves as a protective barrier, hand hygiene compliance remains low.

There remains an overreliance on gloves in absence of integrating hand hygiene in to the WHO 5 Moments.

The role of HCWs’ hands in the transmission of pathogens to patients is undisputed.

AFTER BODYDDFLU

ID

EXPOSURE RISK3 AFTER CONTACT

WITH PATIENT SURROUNDINGS5

2BEFORE A

PROCEDURECLEAN / ASEPTIC

AFTERPATIENT CONTACT4

BEFOREPATIENTCONTACT1

Gloves are part of personal protective equipment (PPE)

for all potential or expected exposures to blood and body fluid.

*Jain S, Clezy K, McLaws ML. | https://doi.org/10.1016/j.ajic.2017.08.029

AFTER CONTACTWITH PATIENT SURROUNDINGS5

AFTERPATIENT CONTACT4

2BEFORE A

PROCEDURECLEAN / ASEPTIC

BEFOREPATIENTCONTACT1

AFTER BODYDDFLU

ID

EXPOSURE RISK3

GLOVES: USED FOR SAFETY OR OVER-USED?