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:


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







WHO (World Health Organization). Save Lives: Clean Your Hands Campaign. Why, How & When? Revised August 2009




WHO (World Health Organization). Glove Use Information Leaflet. Revised August 2009




Joint Commission Center for Transforming Healthcare. Hand Hygiene Project.




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





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