Hand hygiene.pdf

Prior to the emergence of the Human Immunodeficiency Virus (HIV) and the Acquired
Immunodeficiency Syndrome (AIDS) epidemic, gloves were worn primarily by HCWs either
caring for patients colonized or infected with certain pathogens or exposed to patients with
a high risk of hepatitis B. Since 1987, a dramatic increase in glove use has occurred in an
effort to prevent the transmission of HIV and other bloodborne pathogens from patients
to HCWs 611 . The National Institute for Occupational Safety and Health Administration in
the USA (NIOSHA) mandates that gloves be worn during all patient-care activities that
may involve exposure to blood or body fluids that may be contaminated with blood 612 .
In addition, gloves should be worn in activities that include contact with potentially infectious
material other than blood, such as mucous membranes, and non-intact skin, or during
outbreak situations, as recommended by specific requirements for Personal Protective
Equipment (PPE) 7,612 .
Gloves used by HCWs are usually made of natural, rubber latex or synthetic non-latex
materials such as vinyl, nitrile and neoprene (polymers and copolymers of chloroprene).
Because of the increasing prevalence of latex sensitivity among HCWs and patients, the FDA
has approved a variety of powdered and powder-free latex gloves with reduced protein contents,
as well as synthetic gloves that can be made available by health-care institutions for
use by latex-sensitive individuals. This leads to calls for access to latex-free gloves for HCWs
who are sensitive to latex or who are caring for patients with latex hypersensitivity 613 .
In published studies, the barrier integrity of gloves has varied considerably based on
the type and quality of glove material, intensity of use, length of time used, manufacturer,
whether gloves were tested before or after use, and the method used to detect glove
leaks 614-621 . In some published studies, vinyl gloves more frequently had defects than did
latex gloves, the difference being greatest after use 614,615,618,622 . However, vinyl gloves that
are intact provide protection comparable to that given by latex gloves 614 . Limited studies
suggest that nitrile gloves have leakage rates that are close to those of latex gloves 623-626 . It is
appropriate to have more than one type of glove available, allowing HCWs to select the type
that best suits their patient-care activities. Although recent studies suggest that improvements
have been made in the quality of gloves 620 , the laboratory and clinical studies cited
above provide strong evidence that hands should still be decontaminated or washed after
glove removal 13,29,69,85,377,615 .
Use of petroleum-based hand lotions or creams may adversely affect the integrity of latex
gloves 627 . Following the use of powdered gloves, some alcohol-based handrubs 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 handrubs should
be tested following removal of powdered gloves in order to avoid selecting a product that
causes this undesirable reaction 377,615 .
The effectiveness of gloves in preventing contamination of HCWs’ hands has been confirmed
in several clinical studies 28,63,85 . One study found that HCWs who wore gloves
during patient contact contaminated their hands with an average of only 3 CFUs per
minute of patient care, compared with 16 CFUs per minute for those not wearing gloves 28 .
Two other studies of HCWs caring for patients with C. difficile or VRE found that wearing
gloves prevented hand contamination among a majority of those having direct contact
with patients 63,85 . Wearing gloves also prevented HCWs from acquiring VRE on their hands
when touching contaminated environmental surfaces 85 . Preventing gross contamination of
the hands is considered important because handwashing or hand antisepsis may not remove
all potential pathogens when hands are heavily contaminated 44,204 .
Furthermore, several studies provide evidence that wearing gloves can help reduce transmission
of pathogens in health-care settings. In a prospective controlled trial that required