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When should gloves be used?
It is important for HCW to think whether wearing gloves is required before starting any clinical task.1 Gloves should be used when there is a possibility that a HCW will come to contact with blood, body fluids, mucous membranes and non-intact skin,2 or if there is an indication of contact precautions such as when the patient is known or suspected to be colonised or infected with a pathogen, or during emergency epidemics and outbreaks.2
Gloves should not be used when there is no exposure to blood or body fluids and no reason for contact precautions.3
How are gloves misused?
Healthcare workers have been shown to don gloves too soon, remove them too late and wear the same pair for different patients. Two independent studies showed that 42% of the times gloves were used for procedures when they were not required, and HCW were observed wearing gloves when talking to the patients, answering phones or writing notes.1,2 Other studies showed that the HCW are less likely to wash their hands after they were wearing gloves.3-6
What happens when the gloves are not used appropriately?
Risk of contamination and infection: wearing gloves too soon, removing them too late, and not changing the gloves between tasks or patients increases the risk of transfer of the microorganisms between patients, HCW and environment.1 This could potentially lead to the increased risk of healthcare infections. Similarly, substituting hand hygiene with the use of gloves can result in increased infection risk for the patients.
Financial burden: using gloves when not necessary means wasting money that could be allocated elsewhere.3 Unnecessary disposing of gloves in clinical waste also increases the cost. The NHS spends over £35 million a year on more than 1.5 billion boxes of examination gloves, many of them unnecessary.
Occupational dermatitis: wearing gloves continuously may damage the skin barrier and lead to the development of contact dermatitis.7 One study has shown that allergic contact dermatitis due to latex or other ingredients is common in healthcare workers.8
Impact on the environment: this is a growing concern for many industries, including healthcare.9 Gloves are disposable and so far, there is no validated procedure for their safe re-use or reprocessing. Latex comes from natural rubber, but its use is increasingly discouraged due to potential allergies. The majority of the gloves used in healthcare are nitrile, which are synthetically produced and not biodegradable. This means that many gloves end up in a landfill or are burned releasing hazardous materials into the environment.
What do healthcare workers think about gloves?
It has been suggested that when HCW use gloves they think about protecting themselves but not necessarily patients3 and they believe that using gloves creates a barrier between them and their patients.1 This perceived barrier protects the HCW and their families from transfer of fluid and infectious pathogens while also making the task seem less intimate and more ‘clinical’.1 Healthcare workers also perceive the use of gloves as their professional responsibility, with the decision of wearing them influenced by policy as well as patient and peer expectations.3 One study reporting on the survey of final year nursing students on their perceptions of glove use found some inconsistencies in their behaviour.10 For example, while many would use gloves when washing or changing the incontinence pad of an adult patient, they would be less likely to use gloves when performing the same tasks on babies.
What do patients think about the healthcare workers wearing gloves?
One study indicated that patients notice the HCW wearing gloves and almost a quarter of them reported that the use was not always appropriate.10 Some criticisms included overuse, not changing gloves between tasks or patients, an impression that gloves are to protect HCW rather than patients and gloves being used instead of hand hygiene. Many patients reported they felt uncomfortable when gloves were used in some situations such as being assisted to the toilet, being dressed or serving food. On the other hand, they reported they would like the HCW to wear gloves during the more clinical procedures such as giving injections, taking the blood sample or dressing wounds as well as during personal hygiene, especially when washing private parts or helping the patients off the toilet.
Conclusion – Be glove aware
Gloves are frequently misused and lead to consequences opposite to their intention. Healthcare workers do not always use the gloves as recommended by the hospital policies, and justify their choice to do so by citing their professional integrity to protect themselves as others as well as complying with perceived patient preferences.