Hand hygiene.pdf

HCWs routinely to wear vinyl gloves when handling any body substances, the incidence
of C. difficile diarrhoea among patients decreased from 7.7 cases/1000 patient discharges
before the intervention to 1.5 cases/1000 discharges during the intervention 326 . The prevalence
of asymptomatic C. difficile carriage also decreased significantly on “glove” wards, but
not on control wards. In ICUs where VRE or MRSA have been epidemic, requiring all HCWs
to wear gloves to care for all patients in the unit (universal glove use) appeared to contribute
to the control of outbreaks 628,629 .
A few caveats regarding the use of gloves by HCWs are needed. HCWs should be informed
that gloves do not provide complete protection against hand contamination. Bacterial flora
colonizing patients may be recovered from the hands of up to 30% of HCWs who wear
gloves during patient contact 69,85 . Doebbeling and colleagues 377 conducted an experimental
study where the artificial contamination of gloves was undertaken with conditions close
to clinical practice. The authors cultured the organisms used for artificial contamination
from 4–100% of the gloves and observed counts between 0 and 4.7 log on hands after
glove removal. In a recent study identifying neonatal-care activities at higher risk for hand
contamination, the use of gloves during routine neonatal care did not fully protect HCWs’
hands from bacterial contamination with organisms such as Enterobacteriacae, S. aureus
and fungi 29 . In such instances, pathogens presumably gain access to the caregivers’ hands
via small defects in gloves or by contamination of hands during glove removal 69,377,614,615 .
Furthermore, wearing gloves does not provide complete protection against the acquisition
of infections caused by the hepatitis B virus and herpes simplex virus 614,630 . These studies
provide definitive evidence that gloves must be removed after care of a single patient and
during the care of a patient, when moving from a contaminated to a clean body site or
procedure within the same patient, and that hand cleansing must be performed after glove
removal.
The impact of wearing gloves on adherence to hand hygiene policies has not been definitively
established since published studies have yielded contradictory results 151,502,513,631 .
Several studies found that HCWs who wore gloves were less likely to cleanse their hands
upon leaving a patient’s room 502,532,631,632 . In contrast, two other studies found that HCWs
who wore gloves were significantly more likely to cleanse their hands following patient
care 151,513,567 . One study found that the introduction of gloves increased the overall compliance
with hand hygiene, but the introduction of isolation precautions did not result in a
better compliance with hand hygiene 633 .
Different groups of HCWs have shown different rates of compliance with infection control
procedures. In one study, glove use compliance rates were 75% or higher in all HCW
groups except doctors, whose compliance was only 27% 73 . HCWs should be reminded that
the failure to remove gloves between patients or between different body sites of the same
patient may contribute to the transmission of organisms 29,629,632,634 . In two reports, failure
to remove gloves and gowns and failure to wash hands between patients were associated
with an increase in transmission of MRSA during the SARS outbreak 635,636 . In addition to
this type of misuse of gloves which could contribute to the transmission of pathogens, the
unnecessary use of gloves in situations when their use is not indicated represents a waste of
resources without necessarily leading to a reduction of cross-transmission 632 .
Several new technologies are emerging, e.g. impregnated glove materials which release
chlorine dioxide when activated by light or moisture to produce a disinfecting microatmosphere
637 . None of these has so far led to changes in glove-use recommendations. The correct
and consistent use of existing technologies with documented effectiveness is encouraged
before new technologies are introduced. Studies are needed to identify specific indications
for new, potentially more expensive products.