Healthcare workers were this week accused of overusing clinical gloves, increasing the chance of patients contracting potentially-deadly bugs and wasting hundreds of thousands of pounds of NHS money every year.
Delegates at the Infection Prevention 2012 conference in Liverpool this week were told that one trust spent £700,000 on gloves in a single year, despite many members of staff using them inappropriately.
As well as having cost implications, research suggests this overuse of hand protection could also have a detrimental effect on overall hygiene, with staff thinking they do not have to wash their hands as often.
This is what staff say they do, but when we watched them they often did not take their gloves off immediately after leaving the patient or quickly enough after a procedure. They put them on too early and take them off too late
To determine exactly how many times healthcare workers put on gloves, why they use them, and when they decide to take them off, scientists from the Richard Wells Research Centre at the University of West London and Imperial College Healthcare carried out an observational audit and qualitative study on the behaviour of all staff who wore clinical gloves.
And they found that of 164 observations, 58.5% of glove wearing was deemed to be inappropriate. In addition, in 39% of cases there was a risk of cross contamination between patients, and some staff were unaware of current guidance on clinical glove use.
Siobhan Lynam of the Richard Wells Research Centre, who was involved in the research, said: “The cost of examination gloves is substantial and reducing inappropriate use can have a big effect. To achieve this we needed to understand when and why staff are using gloves.
“Our research looked at what influenced the decision to wear gloves and how they decided when to remove them.”
The most common reasons for staff putting on gloves were personal factors such as self protection and disgust; patient factors including the assumption that patients expect healthcare workers to wear them; external influences including colleagues’ behaviour ; and due to the confusion over the current policy. Most members of staff said they removed their gloves to reduce cross contamination, when leaving a patient, and on completing procedures.
The cost of examination gloves is substantial and reducing inappropriate use can have a big effect. To achieve this we needed to understand when and why staff are using gloves
However, Lynam revealed: “This is what staff say they do, but when we watched them they often did not take their gloves off immediately after leaving the patient or quickly enough after a procedure. They put them on too early and take them off too late.”
The researchers are now planning to look deeper into the comments made by healthcare workers about patients expectations. They also intend to draw up new guidelines to ensure the same standards are used across the board and that they reflect best practice in terms of saving money and protecting patients.
“Multiple factors influence a healthcare worker’s decision at present and this variation might explain why initiatives have failed to reduce inappropriate use,” said Lynam. “There is confusion about what constitutes inappropriate use and this requires further research.”
A policy document drawn up by Salisbury NHS Foundation Trust for its staff states: “Medical gloves are classified as medical devices and in accordance with relevant health and safety requirements personal protective equipment is designed to protect the wearer and patient from substances which may cause harm to their skin, to protect users hands from becoming contaminated with organic matter and microorganisms, and to reduce the risk of transmitting of organisms from staff to patients and vice versa.
“Staff should wear gloves only when necessary and gloves should be changed after contact with each patient and at the end of each procedure.”
Addressing the concerns raised in the research, the document adds: “Gloves should be worn to minimise cross infection by preventing the transfer of micro-organisms from staff to patients or patients to staff. However, this aim can only be fully achieved if gloves are worn and removed appropriately.”
Similar guidance by West Hertfordshire Hospitals NHS Trust advises staff to wear gloves for all invasive procedures, when they are in contact with sterile sites and mucous menbranees, on contact with non-intact skin, and during all activities where there is a risk of exposure to body fluids when handling sharp or contaminated instruments.
But it adds: “Gloves do not replace the need for thorough handwashing and should be worn as a single-use item.”