by Kirk Huslage, RN, BSN, MSPH, CIC
Two hundred thrity Healthcare personnel were randomized into two groups, hand hygiene prior to donning gloves (n=115) and direct gloving without hand hygiene(n=115). Workers for whom hand hygiene was observed prior randomization or they had already participated. For both groups, hand imprint cultures were taken prior to any intervention, and were repeated following donning of non-sterile gloves for both groups. Both groups were also timed to see how long it took to don gloves.
The researchers found no statistical difference in the average colony forming units (CFU) counts of gloved hands between the hand hygiene prior to gloving and direct gloving groups (6.9 vs 8.1 CFU, p=0.52). Pathogenic organisms were rarely identified (1 MRSA isolate in hand hygiene prior to gloving group and 2 MSSA isolates in the direct gloving group), with most other organisms constituting expected transient flora including CONS, micococcus, diphtheroids adn bacillus. They also found that the average time needed per episode for the hand hygiene and direct gloving groups were 53.3 seconds and 21.8 seconds (p <0.01), respectively.
Based on their findings, they concluded hand hygiene prior to non-sterile gloving did not significantly decrease the bacterial count on gloves, and that hand hygiene prior to gloving took an additional 31.5 seconds, which results in 19 minutes of unnecessary hand hygiene prior to gloving per 12 hr shift.
Reviewer's Comments: This is an informative study and is certainly important when considering changes to current hand hygiene recommendations. That being said, it is a relatively small single center study and is not generalizable to all healthcare settings. Additional studies should be done in other settings before conclusions can be made about the findings. This study should not lead to a rapid decline in hand hygiene prior to non-sterile glove use, as gloves are not a replacement for hand hygiene. A study published in ICHE in 2011 found that the rate of compliance with hand hygiene was significantly lower before and after patient contact when gloves are worn (30% and 47%, respectively) compared to when gloves are not worn (40% and 52%). Gloves are intended to prevent the spread of germs from a patient/object/surface to a person's hands, and to prevent the spread of germs from a person's hands to a person/object/surface. That being said, gloves are not a fail-safe barrier. Even new gloves can have holes in them. The FDA allows 1.5% of medical gloves to have defects large enough to allow water to leak through. Additionally, gloves can also be damaged during use, which often go unnoticed by wearers and can create the opportunity for pathogen transfer. These concerns alone make proper hand hygiene before and after glove use incredibly important for mitigating potential pathogen transfer. Gloves are not a substitute for good hand hygiene.
References:
1. Rock, C, Harris, AD, Reich, NG, Johnson, JK, Thom, KA. Is hand hygiene before putting on nonsterile gloves in the intensive care unit a waste of health care worker time? - A randomized controlled trial. Am J Infect Control 2013; 41(11); 994-996.
2. Fuller C, et al. "The dirty hand in the latex glove": A study of hand hygiene compliance when gloves are worn. Infect Control Hosp Epidemiol 2011; 32(12): 1194.
