What’s New in the Patient Safety World
November 2015
Hand Hygiene: Paradoxical Solution?
You glove up when you interact with patients on contact precautions, don’t you? That’s common sense. But is it evidence-based? Could we actually be doing more harm than good by using gloves?
The WHO (World Health Organization). Save Lives: Clean Your Hands Campaign (WHO 2009a) includes the following statement about gloves and hand hygiene:
“The impact of wearing gloves on adherence to hand hygiene policies has not been definitively established, since published studies have yielded contradictory results. However, the recommendation to wear gloves during an entire episode of care for a patient who requires contact precautions, without considering indications for their removal, such as an indication for hand hygiene, could actually lead to the transmission of germs.” (WHO 2009b).
Our January 5, 2010 Patient Safety Tip of the Week “How’s Your Hand Hygiene?” discussed The Joint Commission Center for Transforming Healthcare multi-hospital project on hand hygiene. In that project among the list of causes for failure to clean hands were:
- Wearing gloves interferes with the process
- Perception that hand hygiene is not needed if wearing gloves
Now a recent study actually challenges the practice (Cusini
2015). Cusini and colleagues assessed
compliance with hand hygiene during
contact precautions before and after eliminating mandatory glove use. They found that hand hygiene compliance
increased from 52% to 85% in patients on contact precautions after the policy
change (during the same period hospital-wide hand hygiene compliance increased
from 63% to 81% but the relative increase was significantly higher in the
contract precautions group). The authors conclude that eliminating mandatory
glove use in the care of patients on contact precautions increased hand hygiene
compliance in their institution, particularly before invasive procedures and
before patient contacts. They do, however, recommend that further studies on
the effect on pathogen transmission are needed before current official
guidelines on the topic be revised.
We’re not quite ready to remove gloves from contact precautions but the Cusini study certainly is of interest in two regards. First, it reaffirms that gloves are a barrier to hand hygiene compliance. And it would suggest that additional studies with actual patient outcomes and infection transmission rates are needed.
Very interesting.
Some of our other columns on handwashing:
January 5, 2010 “How’s Your Hand Hygiene?”
December 28, 2010 “HAI’s: Looking In All The Wrong Places”
May 24, 2011 “Hand Hygiene Resources”
October 2011 “Another Unintended Consequence of Hand Hygiene Device?”
March 2012 “Smile…You’re on Candid Camera”
August 2012 “Anesthesiology and Surgical Infections”
October 2013 “HAI’s: Costs, WHO Hand Hygiene, etc.”
November 18, 2014 “Handwashing
Fades at End of Shift, ?Smartwatch to the Rescue”
January 20, 2015 “He
Didn’t Wash His Hands After What!”
September 2015 “APIC’s
New Guide to Hand Hygiene Programs”
References:
WHO (World Health Organization). Save Lives: Clean Your Hands Campaign. Why, How & When? Revised August 2009
http://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochure.pdf?ua=1
WHO (World Health Organization). Glove Use Information Leaflet. Revised August 2009
http://www.who.int/gpsc/5may/Glove_Use_Information_Leaflet.pdf
Joint Commission Center for Transforming Healthcare. Hand Hygiene Project.
http://www.centerfortransforminghealthcare.org/projects/detail.aspx?Project=3
Cusini A, Nydegger D, Kaspar T, et al. Improved hand hygiene compliance after eliminating mandatory glove use from contact precautions - Is less more? American Journal of Infection Control 2015; 43(9): 922-927
http://www.ajicjournal.org/article/S0196-6553%2815%2900607-0/abstract
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