A recent study by Burdsall and colleagues published in the American Journal of Infection Control, followed by story in McKnight’s, highlights the importance of monitoring not just hand hygiene, but also glove use in long-term care facilities. This observational study in a LTC facility examined the degree of inappropriate glove use among certified nursing assistants when helping residents with bathing or toileting activities.
The researchers developed a glove-use surveillance tool to examine two indicators of inappropriate glove use:
(1) the number of failed glove changes and
(2) the number of contaminated touch points and surfaces touched with contaminated gloves.
A failed glove change was defined as occurring when a CNA failed to remove gloves immediately after touching a surface contaminated or potentially contaminated with patient blood, secretions or excretions, or failed to change gloves between caring for different patients. A contaminated touch point (gloved or bare-handed) was defined as occurring when a CNA failed to remove gloves immediately either after touching a surface potentially contaminated with patient blood, secretions or excretions, or failed to change gloves or to perform hand hygiene between caring for different patients, and continued to touch surfaces.
Over the study period, 74 CNAs and 2,213 touch points were observed. Gloves were worn for 80% of these touches and gloves were changed 160 times. CNAs failed to change their gloves at 66% of the glove change points (when a glove change was indicated) for a median of 2.5 failed glove changes per patient-care event. In addition, 82% of CNAs either touched patients or surfaces in the patient care area more than one time with gloves that were considered contaminated. Objects most frequently touched with contaminated gloves were wipes, wipes packages, patient skin, clothing, and patient equipment such as wheelchairs, walkers and patient care lifts.
In healthcare, gloves should be used during all patient care activities that may involve exposure to blood and all other bodily fluids (including contact with mucous membranes and non-intact skin).
Wearing gloves when assisting with toileting or perineal care is in line with guidelines and standards, as it is reasonable to assume there might be an exposure to bodily fluids during such activities; however, gloves were donned before the point at which they were necessary.
We work in a “glove culture” in healthcare today. Another recently published study by Wilson and colleagues underscores the need for a critical look at glove use. According to the authors, the use of gloves when not indicated represents a waste of resources, does not contribute to a reduction of cross-transmission, and may also result in missed opportunities for hand hygiene. Lack of knowledge contributes to this problem, but they found that emotion and socialization are also powerful drivers of healthcare worker glove use.
The World Health Organization provides information around safe and proper glove use, which should be reviewed upon hire and annually with all HCWs. In addition, HCWs need hand hygiene and glove use education in the context of their workflow. Just-in-time coaching using trained observers can help identify issues, solicit the barriers to best practice, and coach improvement in noncompliant behavior.
Megan J. DiGiorgio, MSN, RN, CIC, FAPIC, is a clinical specialist at GOJO.
References: Burdsall DP, Gardner SE, Cox T, Schweizer M, et al. Exploring inappropriate certified nursing assistant glove use in long-term care. Am J Infect Control. 2017;45:940-945; Glove use information leaflet. World Health Organization Web site. http://www.who.int/gpsc/5may/Glove_Use_Information_Leaflet.pdf. Accessed September 7, 2017; Wilson J, Bak A, Loveday HP. Applying human factors and ergonomics to the misuse of nonsterile clinical gloves in acute care. Am J Infect Control. 2017;45:779-786.