Healthcare workers who wear gloves while treating patients are much less likely to clean their hands before and after patient contact, according to a study published in the December issue of Infection Control and Hospital Epidemiology. This failure of basic hand hygiene could be contributing to the spread of infection in healthcare settings, the researchers say.
Glove use is appropriate for situations when contact with body fluids is anticipated or when patients are to be managed with contact precautions. However, use of gloves should not be considered a substitute for effective hand hygiene practices taking place before and after patient contact. Although gloves can reduce the number of germs transmitted to the hands, germs can sometimes still get through latex. Hands can also be contaminated by back spray when gloves are removed after contact with body fluids.
The researchers, led by Dr. Sheldon Stone of the Royal Free Hospital NHS Trust, observed more than 7,000 patient contacts in 56 intensive care and acute care of the elderly wards in 15 United Kingdom hospitals, making this one of the largest and most detailed studies on gloves and their impact on hand hygiene. Overall, the study found that hand hygiene compliance was disappointingly low, at just 47.7 percent. Compliance was even lower in instances where gloves were worn, dipping to just over 41 percent.
The chances of hands being cleaned before or after patient contact appear to be substantially lower if gloves were being worn, says Stone, the principal investigator. We call this the phenomenon of the dirty hand in the latex glove.
Though troubling, the results also reveal an opportunity to reduce healthcare-associated infections (HAIs) by focusing further hand hygiene improvement efforts on better hand hygiene when using gloves. Doing so may prove the critical step in getting overall hand hygiene levels to the levels needed to prevent transmission of infection, the researchers say.
Stone and his colleagues suggest further study on the behavioral reasons behind why healthcare workers are less likely to wash their hands when wearing gloves. Regardless, the researchers recommend that campaigns such as the World Health Organizations Clean Care is Safer Care program should emphasize better hand hygiene associated with gloving practices.
Reference: Christopher Fuller, Joanne Savage, Sarah Besser, Andrew Hayward, Barry Cookson, Ben Cooper, Sheldon Stone. The Dirty Hand in the Latex Glove: A Study of Hand-Hygiene Compliance When Gloves Are Worn. Infection Control and Hospital Epidemiology 32:12 (December 2011)