Gloves hinder, not help, good hand hygiene

5 May 2014

Putting on gloves makes nurses and other healthcare workers more likely to fail to wash their hands when caring for patients, the latest national statistics show.

Today is World Hand Hygiene Day and audit statistics from Hand Hygiene New Zealand show that good hand hygiene is now practiced nearly 73 per cent of the time in our public hospitals compared to 62 per cent nearly two years ago.

Nurses are still the top performers, with 75 per cent of the time being observed to wash their hands at the appropriate times.  Medical practitioners and student doctors remain amongst the worst at 62.5 per cent and 61 per cent respectively.

“Medical practitioners continue to feature low down in the compliance results and continue to fare little better than clerical workers,” says the Hand Hygiene NZ (HHNZ) report.

Another issue was the inappropriate use of non-sterile gloves, which HHNZ identified as one cause of missed hand hygiene opportunities saying glove use rated “highly as one of the barriers to excellent hand hygiene”.

When gloves were taken off only 13.4 per cent of hand cleaning moments were missed compared to 33.3 per cent when gloves were put on.

“Once healthcare workers donned gloves they then went on to fail to complete hand hygiene at the appropriate five moment times due to continuous wearing of gloves 30 per cent of the time.”

The World Health Organisation’s ‘Five moments for hand hygiene’ requires hand hygiene to be performed at each required ‘moment’ irrespective of whether or not gloves are used (see the five moments below).

A recent hand hygiene attitude survey also indicated that healthcare workers still don’t understand the need to perform hand hygiene at the appropriate times whether or not they are wearing gloves.

The survey responded to by 344 health care workers from 17 district health boards showed that 93 per cent of respondents did not think that glove use was a substitute for good hand hygiene.  But when asked in what instances did they need to clean their hands when wearing gloves, only 40 per cent ticked all three correct options.

The most commonly identified barriers to improving hand hygiene by respondents were "bad habits" and "being too busy". These were followed by forgetfulness, the hand gel and glove use.

Meanwhile the clinical lead of HHNZ, Dr Joshua Freeman, joined WHO’s call to combat the spread of antibiotic resistant infections through good hand hygiene practice in healthcare settings.

“Good hand hygiene helps to create a protective ‘fire break’ around hospitalised patients, making them less likely to acquire antibiotic resistant infections,” says Freeman.

“Healthcare associated infections caused by antibiotic resistant microorganisms, such as methicillin-resistant Staphylococcus aureus [MRSA], have worse outcomes than infections caused by organisms that are less resistant.”

Click here to check out a Nursing Review article from last year into research into lack of hand-hygiene contaminating gloves while still in the box.

WHO’s Five moments for hand hygiene:

  • Before patient contact
  • Before a procedure
  • After a procedure or body fluid exposure risk
  • After patient contact
  • After contact with patient surroundings.