Nurses donning gloves may risk infecting patients with faecal bacteria after research found contaminated gloves pulled from boxes across a busy hospital ward.
The University of Otago research within a few days of glove boxes being in use on the ward that faecal bacteria like klebsiella pneumoniae were found on unused gloves along with high levels of common skin bacteria.
Lead researcher and microbiologist Dr Heather Brooks said the study highlighted the need for better adherence to hand hygiene and improved design of glove boxes so health workers do not have to delve deep into the box to pull out gloves.
“We have uncovered the potential for gloves to transmit infection,” said Brooks.
The study has just been published in the latest Australasian Medical Journal. It is a follow-up to a pilot study (reported in Nursing Review in September 2010) prompted by a nursing colleague of Dr Jon Cornwall, a former Otago Polytechnic nursing school staff member, who was involved in both studies.
The latest research involved testing gloves pulled from 10 boxes of non-sterile disposable gloves placed in random rooms in an orthopaedic ward of Dunedin Hospital. Glove samples tested from nine of the freshly opened boxes were found to contain the common environmental bacteria bacillus and only one box was found to have contamination from common skin bacteria.
But within a few days of the boxes being in use skin bacteria (like Staphylococcus epidermidis) were found in unused gloves tested from nearly all the boxes and four pathogenic bacteria associated with hospital-acquired infections, including Staphylococcus aureus, were also found in five samples.
Cornwall said nurses and other health workers using the non-sterile gloves often wore them to protect themselves from the patient. “I don’t think people consider that there could be transfer of bacteria from health care worker to the glove box to the patient,” says Cornwall. “I think they would be surprised to know that the spread of all this bacteria could occur.”
Brooks said health care workers following proper handwashing procedure would remove the risk of health workers contaminating gloves in the box and the risk of gloves transmitting infection-causing bacteria or viruses like Norovirus, which the research did not test for.
She said to absolutely prove that infections could be transmitted by contaminated gloves would take a much larger study but the study had found gloves were a potential source of nosocomial (hospital acquired) infections.
The study also inoculated gloves with two of the bacteria to see how long disease-causing bacteria can survive on the gloves and found the bacteria remained viable for several days.
Brooks said while environmental bacteria like bacillus are harmless to most people they can cause infection in severely immuno-compromised patients.
She said better box design and packing of the gloves could reduce the risk of contamination including being able to pull the gloves out by the wrist so people did not have to delve their hands deep into the boxes to get the last of the gloves.
The research was carried out in a 32 bed general orthopaedic ward staffed by six fulltime nurses, one fulltime nurse aide, four house surgeons, seven registrars and eleven consultants. The ward’s handwashing procedure was in line with the WHO guidelines that require washing hands before and after individual patient contact regardless of whether gloves were used or not.
