Healthcare-associated infections (HAIs) are unacceptably high, and proper glove use has been fingered (get it?) as key to reducing HAIs.
Earlier this year, the Society for Healthcare Epidemiology of America (SHEA), Infectious Diseases Society of America (IDSA), and Association for Professionals in Infection Control and Epidemiology (APIC), in collaboration with the American Hospital Association and The Joint Commission, published the SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update. This document includes two new essential practices, one of which is “Ensure appropriate glove use to reduce hand and environmental contamination.”
How Glove Use Affects Hand Hygiene
Researchers have long known that hand hygiene rates are almost universally lower when healthcare providers use gloves than when they do not. According to a 2021 study, hand hygiene compliance in Indian pediatric intensive care units was lower (41.3%) during glove-wearing episodes as compared to those with no glove use (68.2%). A study from Norway reported similar findings: nearly 2/3 of nursing home employees failed to follow hand hygiene guidelines when using gloves.
Both of those studies were conducted during the COVID-19 pandemic. Perhaps not coincidentally, the risk of three common HAIs – methicillin-resistant Staphylococcus aureus (MRSA), central-line associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI), “spiked to a 5-year high in hospitals” during the pandemic, according to The Leapfrog Group.
The U.S. Centers for Disease Control and Prevention (CDC) also noted a significant uptick in HAIs and has said, “more needs to be done to prevent healthcare-associated infections.”
Misconceptions About Glove Use Increase Risk of HAIs
Hand hygiene and glove-wearing are two strategies commonly used to decrease the risk of transmitting pathogens (and subsequently, infection) from healthcare providers to patients. Yet common misconceptions about glove use and hand hygiene can lead to improper practice and increase the risk of infection.
Misconception #1: Hand hygiene isn’t necessary before donning gloves
Many healthcare providers do not routinely perform hand hygiene before putting gloves on. (One 2019 study found that hand hygiene compliance before gloving was just 42%.)
The CDC recommends hand hygiene prior to any patient contact, so healthcare providers should perform hand hygiene before donning gloves and interacting with patients. As the CDC states, “Gloves are not a substitute for hand hygiene.”
Misconception #2: One pair of gloves can be worn through a patient encounter
The CDC says that gloves should be changed (and hand hygiene performed) if gloves become damaged or visibly soiled with blood or body fluids, and when moving from work on a soiled body site to a clean body site. Yet a 2020 study noted continued wearing of gloves in about half of observed episodes of patient care on an internal medicine ward. Researchers counted more than 215 opportunities for a risk of organism transmission over 66 episodes of patient care when gloves should have been removed or changed.
To decrease the risk of HAIs, healthcare providers should remove gloves and perform hand hygiene as recommended by the CDC, even if doing so means using multiple pairs of gloves (and performing hand hygiene multiple times) while working with the same patient.
Misconception #3: Glove removal procedure is a matter of personal preference
Improper glove removal can inadvertently contaminate healthcare providers’ hands and increase the risk of pathogen transmission. The 2022 strategies to prevent HAIs through hand hygiene recommendations emphasize the need to “teach proper glove removal” and recommends that hospitals “validate that HCP can remove gloves in a way that prevents contamination.”
Staff should assume that the outside surface of gloves is contaminated, even if no visible soiling is apparent. To properly remove gloves, healthcare providers should use one gloved hand to grasp the palm of the other gloved hand, peel off the first glove, and hold the removed glove in the still-gloved hand. The provider should then slip a couple fingers of the ungloved hand under the wrist of the remaining glove and peel the second glove off over the first. Used gloves should be promptly discarded in an appropriate waste container.
Misconception #4: There’s no need to clean hands after glove removal
Proper removal of gloves decreases, but does not fully eliminate, the potential of hand contamination. To effectively prevent HAIs, healthcare providers must immediately perform hand hygiene after glove removal. If a sink is not readily available, providers should clean their hands with alcohol-based hand sanitizer and then wash hands as soon as possible.
To effectively decrease HAIs, hospitals must correct misconceptions about glove use and hand hygiene. Educating staff about proper glove use is essential. Proper donning and removal of gloves should also be assessed on a regular basis. SwipeSense is committed to helping hospitals and healthcare providers establish and sustain excellent hand hygiene practices.