Hand Hygiene Before Gloving - How Important?
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If you work anywhere in the health care industry, you are likely aware of the importance of performing proper hand hygiene and glove use to reduce the spread of infectious organisms.

In the “Five Moments for Hand Hygiene” as outlined by the World Health Organization (WHO,) the first “moment” for performing hand hygiene is Before Patient Contact.

But is this step really necessary, especially when you are about to don a pair of gloves before touching the patient?

Recent studies on unused, non-sterile exam gloves removed from glove boxes in patient areas suggest it really is that important.

Glove Contamination in the ICU

At University Medical Center, a 412-bed tertiary care hospital in Lubbock, TX, a study compared rates and burden of non-sterile glove contamination among specialty ICUs.

A total of ninety glove pair samples were taken from occupied rooms in a 32-bed Medical ICU, a 21-bed Trauma/Surgical ICU, and a 6-bed Burn ICU.  The gloves were collected from glove boxes housed in glove box dispensers or patient carts in patient rooms where health care providers had unrestricted access to the gloves.

The results?

“We found an average contamination rate of 81.1% across all glove pairs sampled with an average bioburden of 5.83 CFU (SD = 8.04).”  These findings were consistent with previous studies, where contamination rates were 55-87% and average bioburdens ranged from 3.4-6.2 CFU per glove pair.

The study also found evidence of methicillin-resistant organism (MRO) contamination on 36.7% of glove pairs sampled.  The study noted that “because our contamination rate estimate most likely underestimates the true rate of MRO contamination due to the selective culturing process followed, actual rates of MRO contamination may be higher than those reported in this study.”

Pathogen Contamination in a Large Ward

Another study conducted in New Zealand investigated glove use on a hospital orthopaedic ward to examine whether pathogen contamination occurs prior to contact with patients.

Glove samples were removed from boxes on opening and days 3, 6 and 9 thereafter.

The results?

“Total bacterial counts ranged from 0 to 9.6 x 103 cfu/glove.  Environmental bacteria, particularly Bacillus species, were present on 31/38 (81.6%) of samples.  Half (19/38) the samples were contaminated with skin commensals; coagulase negative staphylococci were predominant.  Enterococcus faecalis , Klebsiella pneumoniae , Pseudomonas sp. or methicillin susceptible Staphylococcus aureus were recovered from 5/38 (13.2%) of samples.  Significantly more skin commensals and pathogens were recovered from samples from days 3, 6, 9 than box-opening samples.”

Clearly, both studies demonstrate that health care workers can introduce pathogenic bacteria into glove boxes, and unused, non-sterile exam gloves can become pathogen transmission vehicles in hospitals and potentially other healthcare settings.

Adhering to handwashing guidelines and performing hand hygiene before donning gloves is a critical, not to be skipped step in reducing the spread of dangerous bacteria.

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