Understanding of Glove-Use Behavior Required to Design Interventions to Reduce Misuse and Overuse

Clinical gloves are routinely used in the delivery of patient care but unless integrated with the World Health Organization (WHO)'s 5 moments of hand hygiene have the potential to increase the risk of HCAI transmission. Wilson, et al. (2013) sought to examine glove use in an acute-care setting, the extent to which they are associated with a risk of cross-contamination, and factors that influence healthcare workers' decision to wear them.

Observation of the use of clinical gloves was conducted in six wards by two trained observers. Independent observations were compared for inter-rater reliability. Glove use was considered appropriate if the episode involved potential contact with blood/body fluid (BBF). Risk of cross-contamination was defined as violation of one or more of the moments of hand hygiene during the glove-use episode. Semi-structured interviews were conducted with a purposive sample of 25 HCW from audited wards to explore attitudes toward the use of gloves.

The researchers observed 164 glove use episodes over 13 hours. Glove use was appropriate in 58 percent (95/164) of episodes, but gloves were commonly used for procedures with minimal risk of exposure to BBF. In 39 percent of glove-use episodes there was a risk of cross-contamination, this was significantly more likely to occur where gloves were used inappropriately (58.4% vs 28.4%; Chi2 p <0.01). In 24 percent (39) episodes more than five objects were touched by a gloved hand before the procedure was performed. In one-third of episodes, hand hygiene was not performed after glove removal. The key themes from qualitative interviews with HCW indicated that the decision to wear gloves was influenced by multidimensional socialization and emotion. Key emotions were disgust and fear, but assumptions about patients and their preferences regards glove use, confusion about when to wear them and peer pressure, were also important influences.

The researchers concluded that glove use in acute clinical settings is associated with a significant risk of cross-contamination and needs to be more explicitly integrated into hand hygiene policy. An understanding of drivers of glove use behavior is required to design interventions to reduce their misuse and overuse.

Reference: Wilson J, Lynam S, Singleton J and Loveday H. Oral presentation O003 at 2nd International Conference on Prevention and Infection Control (ICPIC 2013): The misuse of clinical gloves: risk of cross-infection and factors influencing the decision of healthcare workers to wear gloves. Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O3 doi:10.1186/2047-2994-2-S1-O3