Misuse of gloves: the foundation for poor compliance with hand hygiene and potential for microbial transmission?

https://doi.org/10.1016/j.jhin.2004.03.010Get rights and content

Abstract

Improvement in hand hygiene compliance is important for reducing cross-infection by micro-organisms. The objective of this prospective observational study was to measure how the improper use of gloves limits compliance to hand hygiene and exposes patient's to infection. The study was conducted in five wards (three intensive care units and two medical wards) in a French university hospital. Staff–patient and staff–environment contacts were observed in 120 healthcare workers caring for patients colonized or infected with pathogenic bacteria. Hand hygiene was not undertaken due to improper gloving in 64.4% (95%CI, 64.1% to 65.1%) of instances. Possible microbial transmission might have occurred in 18.3% (95%CI, 17.8% to 18.8%) of all contacts because used gloves were not removed before performing care activities that necessitated strict aseptic precautions. Failure to change or remove contaminated gloves was a major component in the poor compliance with hand hygiene and carried a high-risk of microbial transmission. Improving hand hygiene compliance will require changing healthcare workers behaviour towards glove use.

Introduction

Gloving is recommended as a barrier protection for healthcare workers to reduce the risk of contamination during contact with body fluids, mucous membranes or the damaged skin of patients.1., 2., 3. When used properly, gloving may also reduce cross-transmission of micro-organisms from healthcare workers' hands.4., 5., 6., 7. In a study evaluating the dynamics of bacterial contamination of the hands of healthcare workers in daily hospital practice, wearing gloves was associated with a marked reduction of bacterial contamination of hands.8 However, when gloves are not removed after each contact, they become a ‘second skin’ and expose patients to cross-transmission of micro-organisms.6., 9., 10., 11., 12. In 1999, we implemented a hand hygiene improvement programme in our hospital by introducing hand rubbing with an alcohol-based solution and monitoring hand hygiene compliance with repeated observational studies of care activities.13 While performing these studies, we realized that gloves were overused and often misused. We report the results of a prospective study examining specifically the appropriateness of glove use during patient care activities, with two objectives: to determine the impact of gloving on compliance with hand hygiene, and to estimate the potential risk of bacterial transmission associated with glove misuse.

Section snippets

Observation of glove use

We performed an obtrusive observation of glove use in five wards of a 908-bed tertiary-care teaching hospital: one medical intensive care unit (ICU; 26 beds), two surgical ICUs (10 and 16 beds, respectively), the dermatology ward (19 beds), and the medical ward admitting diabetic patients (26 beds). These wards were selected because of a high prevalence of multiresistant bacteria. A screening policy was implemented in these wards only to detect carriage of methicillin-resistant Staphylococcus

Results

A total of 101 observation periods were undertaken during which 120 healthcare workers were observed and performed 784 contacts with 30 patients infected or colonized with potentially pathogenic bacteria (Table II, Table III).

Discussion

This study demonstrates that failure to change or remove contaminated gloves is a major component of poor hand hygiene compliance. The improper use of gloves was associated with healthcare workers missing more than half the opportunities for hand hygiene. Our results are consistent with those reported by Thompson et al.,10 where gloves were appropriately changed in only 16% of instances.

The misuse of gloves may be due to several reasons. In the early 1980s, guidelines stated that as there was

Acknowledgements

We thank the staff of the five wards who participated in the study.

References (24)

  • M. Slota et al.

    The role of gown and glove isolation and strict handwashing in the reduction of nosocomial infection in children with solid organ transplantation

    Crit Care Med

    (2001)
  • S. Slaughter et al.

    A comparison of the effect of universal use of gloves and gowns with that of glove use alone on acquisition of vancomycin-resistant enterococci in a medical intensive care unit

    Ann Intern Med

    (1996)
  • Cited by (131)

    View all citing articles on Scopus
    View full text