Hand Hygiene before non-sterile gloving: a waste of time?

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.  

by Kirk Huslage, RN, BSN, MSPH, CIC

Hand hygiene is recognized as a basic measure for the prevention of HAIs, but there have been limited studies about the importance of hand hygiene prior to donning non-sterile gloves.   A group of researchers from the University of Maryland School of Medicine conducted a prospective, randomized controlled trial of healthcare personnel entering Contact Isolation rooms in 7 ICUs in an academic medical center. 

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.