By Judith Fine, Vitalacy Clinical Consultant
For this year's World Hand Hygiene Day on May 5, starting an initiative to educate healthcare staff about the correct and incorrect uses of clinical gloves would be a worthy endeavor. Allow me to relate a personal experience I had that illustrates what unfortunately is an all-too-common situation in hospitals.
My husband was recently hospitalized, and I was visiting on a Sunday afternoon. Two young men entered his room, both wearing gloves. As an infection prevention and control (IPC) professional, I know that entering a patient room already wearing gloves is considered an inappropriate use of personal protective equipment (PPE). I identified myself as his wife and as an IPC professional and began discussing the antibiotic treatments given to my husband and the culture reports.
I waited for the young men to remove their gloves after I told them I was an infection control professional, but they did not. As they didn't remove their gloves, they didn't wash their hands either. I later found out they were infectious disease fellows. As the Joint Commission's "Speak Up" Campaign encourages, my husband and I had the right to ask them to remove their gloves and wash their hands in this situation.
The use of non-sterile gloves in healthcare is pervasive
Several research studies have documented the pervasive use of non-sterile gloves in healthcare. Boudjema, et al., 2017, identified the misuse of gloves as the most common breach of hand hygiene protocol. Kurtz, 2017, found that donning non-sterile gloves is a significant factor in lowering nurses' compliance with hand hygiene. Wilson, et al., 2017, found the inappropriate use of non-sterile gloves occurring in 59% of procedures and the risk of cross contamination occurring in 49% of care episodes.
Despite the ongoing promotion of hand hygiene as a key way to reduce healthcare-associated infections, the use of non-sterile gloves dominates routine clinical practice (Wilson, et al., 2017).
This year's theme for World Hand Hygiene Day encourages us to add to our facility's culture of safety and quality by cleaning our hands and by practicing other important aspects of hand hygiene. One of those aspects is understanding the correct and incorrect use of gloves.
The use of gloves was introduced to health care during the implementation of IPC protocols and other standard precautions in the 1980s. The concept of glove use then and now is to protect the health care worker during exposure to a patient's blood, body fluids, bodily tissues, mucous membranes, or broken skin (NLM, 2022). A glove, when used properly, is a bidirectional protector of both the patient and the provider treating the patient from exposure to germs and infections.
Gloves were never meant to be worn in lieu of hand hygiene
Healthcare workers should wash their bare hands according to the World Health Organization's five moments of hand hygiene. These five moments to wash hands are 1) before touching a patient, 2) before clean/aseptic procedure, 3) after body fluid exposure risk, 4) after touching a patient, and 5) after touching patient surroundings.
Gloves should be worn only during potential exposure to a patient's blood, body fluids, bodily tissues, mucous membranes, or broken skin.
Gloves should never be worn in the hallways, in the elevators, or for serving multiple patients.
Gloves are not meant to be worn over and over, nor to be washed in between usage.
Healthcare workers have been observed wearing layers of gloves and then removing the outer layer as they move from room to room. While this layering of gloves may seem to be a safe time-saver, it does not protect the worker or patient. Rather, it increases the risk of exposure to high-touch areas that are not cleaned or disinfected appropriately, resulting in the transmission of germs from room to room via the gloves of the individual. The layers of gloves also harm the condition of the skin barrier of the individual.
The misuse of gloves extends beyond clinical personnel
The misuse of gloves extends beyond clinical staff to non-clinical workers such as environment service workers who clean and disinfect high-touch areas, transporters who move patients in wheelchairs and stretchers, and other workers who touch equipment in patient care areas. All of these workers must understand the essential need to wash or disinfect their hands before encountering the patient, before touching the equipment used to serve the patient, or before maintaining the sanitary environments of the facility.
All healthcare workers must put on gloves immediately prior to serving the patient, so they are not touching surfaces with gloved hands prior to touching the patient. Otherwise, they are not protecting themselves and the patient. They must always wash and or disinfect their hands prior to putting on the gloves and immediately after removal.
Another aspect of correct glove use is proper fit. The fingers should not be too long, and the glove should cover the wrist area. Also, healthcare workers with open non-healing lesions should be excluded from direct patient care. Covering the lesions with bandages or with gloves is detrimental to the health of the individual's skin and would certainly not prevent transmission of infections, nor ensure the healing of lesions.
We have a family saying that Mother’s Day and Father’s Day are not only in May and June but are everyday. In the same spirit, World Hand Hygiene Day should be every day -- and every hour, every minute at work during our scheduled shifts in our health care facilities, at home, and in our communities.
Boudjema S, et al. Merging video coaching and an anthropologic approach to understand health care provider behavior toward hand hygiene protocols. American Journal of Infection Control, 2017;45(5):487-491.
Kurtz SL. Identification of low, high, and super gelers and barriers to hand hygiene among intensive care unit nurses. American Journal of Infection Control, 2017;45(8):839-843.
National Library of Medicine (NLM). MedlinePlus. Wearing gloves in the hospital, April 1, 2022.
Wilson J, et al. Applying human factors and ergonomics to the misuse of nonsterile clinical gloves in acute care. American Journal of Infection Control, 2017;45(7):779-786.