WHO Guidelines on Hand Hygiene in Health Care - Safe Care ...

<strong>WHO</strong> GUIDELINES ON HAND HYGIENE IN HEALTH CARE
for glove use in health care are as crucial as the identification
of indications. Indications represent a frame to limit the start
and end of glove use. Importantly, gloves must be donned
immediately before the contact or the activity that defines the
indication and removed immediately after this contact or activity
is over. 945
Glove use does not obviate the need to comply with hand
hygiene. 884 1) When the hand hygiene indication occurs before
a contact requiring glove use, handwashing or handrubbing
must be performed before donning gloves to prevent glove
contamination and possible cross-transmission in case of glove
damage or improper use/efficacy. 2) Gloves must be removed
to perform handwashing or handrubbing to protect a body site
from the flora from another body site or skin area previously
touched within the same patient. 3) Hand hygiene must be
performed immediately after glove removal to prevent HCW
contamination and further transmission and dissemination of
microorganisms. It should be noted that handwashing with soap
and water is necessary when gloves are removed because of a
tear or a puncture and the HCW has had contact with blood or
another body fluid; this situation is considered to be equivalent
to a direct exposure to blood or another body fluid.
Further crucial conditions for appropriate glove use are their
mechanical and microbiological integrity. Medical gloves should
be kept in their original package or box until they are donned; 945
this requires that gloves are available at the point of care as well
as alcohol-based handrubs. Moreover, it is appropriate to have
more than one type of gloves available, thus allowing HCWs to
select the type that best suits their patient-care activities as well
as their hand size. When removed, gloves should be discarded
and disposed of; ideally, gloves should not be washed,
decontaminated, or reprocessed for any reuse purpose.
These conditions are essential to prevent germ transmission
through contaminated gloves to the patient and the HCW, and
their further dissemination in the environment. When gloving
is required continously because contact precautions are in
place, all these conditions are difficult to integrate as part of
usual care activities. Indeed, while the general indication to don
gloves should remain until the contact with the patient and his/
her immediate surroundings is completed, indications for glove
removal, hand hygiene and, again, further indications for gloving
may occur.
23.1.5 Factors potentially interfering with glove use
The use of petroleum-based hand lotions or creams may
adversely affect the integrity of latex gloves. 946 Following the
use of powdered gloves, some alcohol-based hand rubs may
interact with residual powder on HCWs’ hands, resulting in a
gritty feeling on hands. In facilities where powdered gloves are
commonly used, a variety of alcohol-based hand rubs should be
tested following removal of powdered gloves in order to avoid
selecting a product that causes this undesirable reaction. 520,914
As a general policy, health-care settings should preferably
select non-powdered gloves for both examination and surgical
purposes.
23.1.6 Caveats regarding washing, decontaminating and
reprocessing gloves
Manufacturers are not responsible for glove integrity when
the principle of “single usage” is not respected. Any practice
of glove washing, decontamination or reprocessing is not
recommended as it may damage the material integrity and
jeopardize the glove’s protective function. Although these
practices are common in many health-care settings, essentially
in developing countries, where glove supply is limited, 947 no
recommendation exists concerning the washing and reuse of
gloves, nor the washing or decontamination of gloved hands
followed by reuse on another patient.
In one study, washing gloved hands between patient treatments
using 4% chlorhexidine and 7.5% povidone-iodine liquid soaps
for 30 seconds eradicated all organisms inoculated from
both glove surfaces. 948 Another study describes a significant
reduction of bacterial count on perforated gloves to permit their
reuse for non-sterile procedures after cleansing of the gloved
hand using an alcohol-based preparation with chlorhexidine. 949
Although the microbial efficacy of glove washing and
decontamination is demonstrated, the consequences of such
processes on material integrity still remain unknown. More
research on glove integrity after washing, decontaminating, and
reprocessing is necessary to answer numerous unsolved issues
before arriving at consistent recommendations. To this end, we
call upon the manufacturers of gloves for medical application to
concentrate on this issue and to conduct research to develop
recyclable gloves for both examination and surgical use, and to
provide also information about safe reprocessing methods for
the reuse of gloves in resource-limited settings.
Cleansing gloved hands to allow for prolonged use on the
same patient may result in considerable savings of disposable
examination gloves. Some evidence exists that cleansing
latex-gloved hands using an alcohol-based handrub solution is
effective in removing micro-organisms and shows increasing
contamination rates of hands only after 9–10 cycles of
cleansing. 950,951 However, cleansing plastic-gloved hands with an
alcohol-based formulation leads to early dissolving of the plastic
material. If there is an intention to proceed with the process
of glove decontamination, this should be started only after
performing a local study using the type of gloves and products
provided at the facility. It should be noted that this process
may be applied only in the framework of contact precautions
implementation 907 and as long as gloves are not soiled with
blood and other body fluids. As a consequence, this limited
context for glove decontamination probably does not represent
an effective response to the serious problem of glove shortage
in developing countries.
In conclusion, no evidence-based recommendation currently
exists regarding glove reprocessing. While this may be an
interesting option at facilities where supply is insufficient, all
consequences of the reprocessing should be anticipated
and measured before putting it into practice. A reprocessing
method has been suggested by the Johns Hopkins Program
for International Education in Reproductive Gynaecology and
Obstetrics (JHPIEGO). 952 This process is not standardized
nor validated, and no recommendation of this or any other
reprocessing process can be expressed in the absence of good
quality research. This protocol firstly includes a situation analysis
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