Glove Use Requires Extra Attention to Hand Hygiene

By Madison Pittman

Wearing gloves – an intervention designed to protect patients and providers from pathogen exposure – is counter-intuitively associated with poor hand hygiene. 

Hand hygiene rates are almost universally lower when healthcare providers use gloves than when they do not. In early 2021, nearly 2/3 of nursing home employees in Norway failed to follow the World Health Organization’s guidelines for hand hygiene when using gloves, according to a study published in BMC Infectious Diseases. (When not using gloves, the numbers were almost reversed: only 34.7% of employees did not perform hand hygiene as recommended.) A 2021 study of hand hygiene in Indian pediatric intensive care units reported similar findings: hand hygiene compliance was lower (41.3%) during glove-wearing episodes as compared to those with no glove use (68.2%). 

Studies in the United Kingdom and United States reveal similarly troubling statistics, with researchers already fretting about “the dirty hand in the glove” at least a decade ago.  A 2011 editorial in Future Microbiology openly questioned if glove wearing could rightly be called “the worst enemy of hand hygiene” and the evidence to date suggests a persistent and problematic relationship between hand hygiene and glove use.

Breaking this unhealthy link requires targeted effort.

Emphasize Goals of Gloving and Hand Hygiene: Patient and Provider Safety

A 2019 study that examined the perceptions and beliefs of healthcare workers regarding glove use and hand hygiene found that most healthcare workers glove primarily to protect themselves from exposure to pathogens. Patient safety is a secondary concern.

That finding helps explain why some providers skip hand hygiene prior to donning gloves. After all, if a worker believes that the primary purpose of gloving is to prevent personal exposure to germs, sanitizing their hands before gloving seems unnecessary. But gloving is also intended to prevent the unintentional spread of germs from healthcare providers to patients, and when healthcare workers don’t perform hand hygiene prior to donning gloves, they may unwittingly contaminate the entire box of gloves – which means that the gloves they put on may be covered with germs that can cause healthcare-associated infections (HAIs).

According to the U.S. Centers for Disease Control and Prevention (CDC), HAIs affect 1 in 31 hospital patients on any given day and can cause significant morbidity and mortality. 

Stress Necessity of Hand Hygiene to Prevent Contamination

Healthcare workers need to know (and be reminded) that wearing gloves does not eliminate the risk of exposure to pathogens. A 2015 study found that glove removal results in contamination of either skin or clothing more than half of the time. So, wearing gloves is not sufficient to protect either healthcare workers or patients. Hand hygiene is a must to prevent contamination. 

When glove use is indicated, hand hygiene must be performed:

  • Before donning gloves
  • Immediately after glove removal

If gloves become damaged or visibly soiled during healthcare, the provider must

  • Remove the gloves
  • Perform hand hygiene
  • Don a new pair of gloves before resuming care
  • Remove the gloves when the task is complete
  • Perform hand hygiene immediately after glove removal

Performing hand hygiene both before donning and after removing gloves is the best practice to protect both patients and providers. 

Provide Just-in-Time Hand Hygiene Reminders

Healthcare workers who are in a rush may forget to perform hand hygiene. Just-in-time reminders, such as Clean Hands-Safe Hands Natural Language Voice Reminder, can improve hand hygiene by alerting workers to instances when hand hygiene is required. Research has found that when the voice reminder is turned on, hand hygiene performance dramatically improves – and, perhaps unsurprisingly, given the link between hand hygiene and HAIs, healthcare-associated infections decrease by as much as 65%. 

Simply reminding your staff of the need to perform hand hygiene before and after glove use is unlikely to effectively change behavior (or decrease HAIs). Busy healthcare workers often don’t even realize they’ve missed a hand hygiene opportunity until that opportunity has passed. Consistent verbal reminders can help staff develop a regular practice of hand hygiene before and after glove use.

Want to significantly improve hand hygiene and decrease HAIs? Target hand hygiene and glove use practices. Extra attention plus targeted reminders can help you instill excellent habits.

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