As we warm up for world hand hygiene day tomorrow, it’s a good time to have a talk about gloves. I challenge you to go onto a hospital ward and time how long it takes before you see some questionable glove practice. It won’t be long before you see somebody coming out of a room used by a patient on some transmission based precautions with gloves on. Or somebody commuting around the ward with gloves on. Or somebody putting gloves on in preparation for patient care who can’t quite articulate why. So, as many of us launch new patient care pathways in the next phase of the pandemic, and as the national IPC manual has just been published in England, it’s a really good time to talk about when we don’t need to use gloves, which is most of the time!
If you’re looking to swat up on evidence for and against the use of gloves in healthcare, go back to epic 3 (published 2014) or a review of the evidence (published 2016) undertaken by NHS Scotland to inform the development of the Scottish national IPC manual. But in short, why should we be worried about over-use of gloves?
- Glove use provides a false sense of security to staff, who feel protected and don’t then do hand hygiene when the gloves are removed
- Gloves tend to be worn for too long, way beyond the duration of the immediate task for which they were selected
- Gloves add mountains to hospital plastic waste
The IPC indications for glove use are:
- When contact with body fluids is anticipated e.g. contact with blood, non-intact skin, or mucous membranes; this includes when handling patient waste and contaminated devices
- Some sterile procedures
And that’s about it! (It’s not a very long list.) There’s a rule of thumb that I quite like that goes something like: “If it’s wet or sticky and not yours, then wear gloves!”
There’s a dogma in IPC that gloves are required for all direct patient contact for a patient being cared for under some type of transmission based precautions (e.g. contact or respiratory precautions). But let’s check the logic here. A patient who is on contact precautions may well have a pathogen on their skin, and that pathogen may well find its way onto your hand if you touch their skin. But since you are going to do hand hygiene after patient contact, where’s the risk? Let’s say you decide to wear gloves instead. The organism that would have been on your hands is now on your glove, and you still need to deal with it (by removing your gloves and doing hand hygiene). So, you’ve slowed down the patient interaction, created plastic waste, and missed the opportunity to make your patient feel a bit more human by touching their skin with your bare hand. No, the more I think about it, I am becoming more convinced that the same rules apply for glove use even if a patient is being cared for using transmission based precautions, in that body fluid exposure risk is the key indication for glove use.
I ran a quick Twitter poll today, and presented essentially this scenario: 80% of respondents agreed that gloves are only indicated when there’s body fluid exposure risk, even when caring for a patient using transmission based precautions:
During the pandemic waves of COVID-19, PPE guidance in the hospitals that I have worked in has been fairly didactic. By that I mean staff have had their PPE selections largely dictated by the part of the hospital that they are working in. This has meant that gloves, aprons, surgical mask, and eye protection have become pretty much the default PPE for most interactions with patients. Things are changing now, and it’s the right time to move back to a dynamic risk assessment to select PPE based on the patient in front of you, and the task(s) at hand. The default PPE selection from now on should no longer include gloves; instead gloves should be useful purposefully and sparingly for a small number of specific tasks. This will require a bit of a shift in culture, but learning from the excellent “Gloves Off” campaign, I’m convinced that we can do it and that it will make our hospitals safer for everybody.