Hand Hygiene and the Wearing of Gloves
Organization for Safety, Asepsis, and Prevention
Hand hygiene is the single most effective way for preventing
transmission of infections. Hospital-based
studies indicate that noncompliance with hand hygiene practices can be
correlated with healthcare–associated infections and the spread of multi-resistant
organisms. Noncompliance has been a major contributor to outbreaks. The
prevalence of healthcare–associated infections decreases as adherence to proper
hand hygiene measures improves.
Hand hygiene is the cleaning
of the hands by either application of alcohol-based hand rubs (ABHR) or traditional
soap-and-water hand washing. Recent evidence has demonstrated superiority of
ABHR for decontaminating hands in all healthcare settings and it is now the
preferred method of hand hygiene unless the hands are visibly soiled, when washing
with soap and water is required.
compliance by healthcare workers has been notoriously low, averaging 40% to 50%.
However, recent campaigns have modestly increased compliance rates. Even when
hand hygiene occurs, however, it sometimes fails to follow proper procedures
(e.g., times less than 15 seconds for soap and water washing or incomplete
coverage of all skin surfaces when using ABHR).
Healthcare providers should practice hand hygiene at key
points in time to disrupt the transmission of microorganisms to patients and
themselves. One such time involves the use of gloves. Wearing gloves alone is
not enough to prevent the transmission of pathogens in healthcare settings. When
properly used, gloves reduce hand contamination by 70% to 80%. Hand
hygiene must deal with the remaining 20% to 30%.
When asked, many respondents with lower
levels of compliance stated “that wearing gloves was a suitable substitute for
hand hygiene.” Most infection prevention organizations and experts,
governmental agencies and professional associations recommend that hand hygiene
be performed before donning examination and sterile surgical gloves and
immediately after removing the gloves. Some studies report lower rates of hand
hygiene compliance if gloves are worn, while others indicate the opposite. Most
of these studies were small (one facility) with limited indications for glove
However, a larger study (Fuller VC, Savage
J, Besser S, et al. “The dirty hand
in the latex glove”: a study of hand hygiene compliance when gloves are worn. Infect Control Hosp Epdidemiol 2011;32(12):194-199)
was recently published. The authors performed an observational study of glove
use and associated hand hygiene behaviors on 56 wards in 15 hospitals during
249 one-hour sessions. Observed were glove wearing and performance of hand
hygiene. The quality of the hand hygiene was not evaluated. The rate of hand
hygiene after patient contact by ungloved workers was 50.0%, while compliance
when wearing gloves was 41.4%. After adjusting for ward, healthcare worker
type, contact risk level and whether the hand hygiene opportunity occurred
before and/or after patient contact, glove use was strongly associated
(p<0.001) with lower levels of hand hygiene.
The authors were unclear as to why glove
use should be associated with poorer hand hygiene compliance and suggested that
glove use and performance of hand hygiene may be two distinct behaviors with
different behavioral determinants. Wearing gloves protects both the wearer and
the patient, thus obviating the need for hand hygiene. The reality is when
gloves are worn without hand hygiene, the contamination present on hands
multiples rapidly under gloves (warmth and moisture) and may not be cleaned
after glove removal. This result can be called ”the dirty hand in the glove.”
This poses a hazard for the worker and for the patient if contacted by an
ungloved hand or if glove integrity is compromised during treatment.
*Courtesy of the Organization for Safety, Asepsis, and Prevention