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“The Dirty Hand in the Latex Glove”: A Study of Hand Hygiene Compliance When Gloves Are Worn

Published online by Cambridge University Press:  02 January 2015

Christopher Fuller ,
Joanne Savage ,
Sarah Besser ,
Andrew Hayward ,
Barry Cookson ,
Ben Cooper  and
Sheldon Stone
Christopher Fuller*
Affiliation:
University College London (UCL) Research Department of Infection and Population Health, UCL (Hampstead Campus), Royal Free Hospital, London, United Kingdom
Joanne Savage
Affiliation:
University College London (UCL) Research Department of Infection and Population Health, UCL (Hampstead Campus), Royal Free Hospital, London, United Kingdom
Sarah Besser
Affiliation:
King's Centre for Risk Management, King's College London, London, United Kingdom
Andrew Hayward
Affiliation:
University College London (UCL) Research Department of Infection and Population Health, UCL (Hampstead Campus), Royal Free Hospital, London, United Kingdom
Barry Cookson
Affiliation:
Laboratory of Healthcare Associated Infection, Centre for Infections, Health Protection Agency, Colindale, London, United Kingdom
Ben Cooper
Affiliation:
Mahidol-Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand
Sheldon Stone
Affiliation:
Health Services for Elderly People, Royal Free Hospital NHS Trust, London, United Kingdom
*
University College London, Research Department of Infection and Population Health, UCL (Hampstead Campus), Royal Free Hospital, London NW3 2PF, United Kingdom ([email protected])
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Abstract

Background and Objective.

Wearing of gloves reduces transmission of organisms by healthcare workers' hands but is not a substitute for hand hygiene. Results of previous studies have varied as to whether hand hygiene is worse when gloves are worn. Most studies have been small and used nonstandardized assessments of glove use and hand hygiene. We sought to observe whether gloves were worn when appropriate and whether hand hygiene compliance differed when gloves were worn.

Design.

Observational study.

Participants and Setting.

Healthcare workers in 56 medical or care of the elderly wards and intensive care units in 15 hospitals across England and Wales.

Methods.

We observed hand hygiene and glove usage (7,578 moments for hand hygiene) during 249 one-hour sessions. Observers also recorded whether gloves were or were not worn for individual contacts.

Results.

Gloves were used in 1,983 (26.2%) of the 7,578 moments for hand hygiene and in 551 (16.7%) of 3,292 low-risk contacts; gloves were not used in 141 (21.1%) of 669 high-risk contacts. The rate of hand hygiene compliance with glove use was 41.4% (415 of 1,002 moments), and the rate without glove use was 50.0% (1,344 of 2,686 moments). After adjusting for ward, healthcare worker type, contact risk level, and whether the hand hygiene opportunity occurred before or after a patient contact, glove use was strongly associated with lower levels of hand hygiene (adjusted odds ratio, 0.65 [95% confidence interval, 0.54-0.79]; P<.0001).

Conclusion.

The rate of glove usage is lower than previously reported. Gloves are often worn when not indicated and vice versa. The rate of compliance with hand hygiene was significantly lower when gloves were worn. Hand hygiene campaigns should consider placing greater emphasis on the World Health Organization indications for gloving and associated hand hygiene.

Trial Registration.

National Research Register N0256159318.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 12 , December 2011 , pp. 1194 - 1199
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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