The use of latex gloves is a highly effective infection control measure adopted by hospitals worldwide. While gloves work well to minimize the spread of infectious diseases, they are designed to augment, not replace, basic hygiene practices, such as handwashing.
Recent research published in Infection Control & Hospital Epidemiology suggests that for a significant proportion of nurses, latex gloves may compromise patient safety. How? By encouraging them to forgo thorough hand hygiene practices when using latex gloves.
The Impact of Gloves on Hand Hygiene
A study observing the hand hygiene practices of healthcare professionals providing inpatient care on adult and pediatric medical-surgical wards and ICUs over a four-month period revealed that correct hand hygiene practices were not followed 25 percent of the time.
Furthermore, 44 percent of those who failed to clean their hands properly were staff who wore gloves — a behavior most commonly seen among registered nurses.
These findings suggest that some healthcare professionals, namely nurses, may incorrectly believe that wearing gloves is a suitable alternative for correct hand hygiene.
Why Glove Use May be a Barrier to Proper Hand Hygiene
World Health Organization (WHO) guidelines state that healthcare professionals should carry out proper hand hygiene, using alcohol-based hand sanitizer or soap and water, both before and after wearing gloves. Furthermore, gloves should only be worn in certain scenarios, such as when carrying out surgical procedures, cleaning up bodily fluids and handling waste.
However, the aforementioned study by Richard Martinello and co-authors from the Yale School of Medicine and Yale New Haven Hospital found that staff often wore latex gloves for their own personal safety, rather than because of clinical recommendations.
The likelihood of a healthcare professional using gloves was also influenced by additional factors, including the availability of gloves, previous medical training guidance, workload and distance to hand-washing sinks.
Some of these factors suggest that the ease and speed with which gloves can be worn, compared with carrying out thorough hand hygiene procedures, may drive some healthcare professionals to wear gloves instead of practicing correct hand hygiene.
Why Effective Hand Hygiene Matters
As WHO guidelines on hand hygiene state: “Glove use is not sufficient to prevent germ transmission and infection if not rigorously accompanied by previous and successive preventive measures.”
Indeed, the guidelines highlight that practicing correct hand hygiene is the only way to prevent cross-transmission of infectious agents between patient and caregiver if gloves become damaged or are not worn properly during use.
It’s clear that patient safety cannot be maximized without strict adherence to hand hygiene, so what can be done to encourage healthcare professionals to do so, even when using latex gloves?
Martinello and colleagues pinpoint medical training as a key opportunity for reversing the results seen in their study. They observed that the practice of using gloves instead of correct hand hygiene is potentially learned during medical training. With this in mind, hospitals should take the time to re-educate health care professionals about appropriate and effective glove use and hand hygiene practices.
However, the focus cannot be placed solely on qualified and practicing healthcare professionals if a paradigm shift in behavior is to take place. Instead, it may be worth reinforcing correct hand hygiene practices in medical and nursing schools. Doing so should help to ensure that the healthcare professionals of tomorrow do not pick up ineffective hand hygiene practices that can compromise their own safety and that of their patients.
Lauretta Ihonor is a medical doctor and a freelance health journalist and writer. She is based in London, UK and specializes in medical technology and general medicine. She has worked for CNN International, BBC and Sky News.
Acquarulo BA, Sullivan L, Gentile AL, Boyce JM, Martinello RA. Mixed-methods analysis of glove use as a barrier to hand hygiene. Infect Control Hosp Epidemiol; Published online: 19 November 2018.
World Health Organization (WHO). WHO guidelines on hand hygiene in health care. 2009. http://apps.who.int/iris/bitstream/handle/10665/44102/9789241597906_eng.pdf (Accessed 15 Dec 2018)