While medical facilities appear to have gained some ground against Hospital Acquired Infections (HAIs,) the problem is still a great and very real daily threat to human life. Bacteria that cause HAIs, such as C. diff, MRSA, E. coli, and S. aureus result in an astounding 2 million infections a year and an estimated $6.7 billion in hospital costs. The most sobering statistic is that these deadly infections kill 100,000 people each year – that’s more than all of the deaths from car accidents, AIDS and breast cancer in the U.S. combined.
According to the World Health Organization (WHO,) “hand hygiene is the single most important measure to protect patients, HCWs and the environment from microbial contamination.” Unfortunately, compliance with this practice is dismally low. According to the New England Journal of Medicine, less than 40% of Health Care Workers (HCWs) practice proper hand hygiene.
Several studies have shown that wearing medical gloves reduces hand hygiene compliance. For instance, in one study HCWs were less likely to perform hand hygiene after removing gloves upon leaving a patients room. In contrast, other studies have shown that glove use increased overall compliance, but these studies did not investigate glove misuse. For these reasons the impact of wearing medical gloves on hand hygiene policies has not been determined. One thing we know for certain, though, is that proper use of gloves combined with proper hand hygiene is critical to reducing infections.
WHO Guidelines for the appropriate and safe use of medical gloves includes the following:
Medical glove use does not obviate the need to comply with hand hygiene. When hand hygiene is indicated, handwashing or handrubbing should be performed before donning gloves.
Careful attention should be paid to glove removal. Gloves should be removed to perform handwashing or handrubbing to protect a body site from the flora from another body site previously touched on the same patient. WHO states that “HCWs often fail to remove gloves between patients or between contact with various sites on a single patient, thus facilitating the spread of microorganisms.”
Perform hand hygiene after glove removal. Hand hygiene must be performed immediately after glove removal to prevent HCW contamination and spread of microorganisms.
Clear direction about medical glove use should be provided. HCWs should be able to clearly identify situations requiring gloves, situations that do not require gloves, and how to correctly select a glove. This requires that medical facilities have clear glove use procedures to help HCWs reason and adjust their behavior to comply with proper hand hygiene and glove use. This includes a clear understanding of when glove use should start and end.
Medical gloves should always be stored in their original boxes. Tucking gloves away in pockets and carrying them about is not safe. Gloves should remain in their original box until donned to ensure the gloves do not become contaminated. This requires that glove boxes should always be available at point of care.
Appropriate use of medical gloves, combined with proper hand hygiene, is an evidence-based measure to protect HCWs, patients and the environment from HAIs. HCWs that fail to remove gloves or perform proper hand hygiene between patients risk spreading deadly infections.
Fortunately, the medical community is working hard to increase compliance. New education campaigns, surveillance programs and other tools are helping ensure more HCWs do their part to reduce the cost of HAIs – in lives lost and the billions spent to treat them.
What do you think? Can we do more to reduce HAIs with improved hand hygiene and glove use?