Hand Washing: Is It Necessary Before Putting on Non-Sterile Gloves?

Clare Rock, MD Department of Epidemiology and Public Health University of Maryland School of Medicine Baltimore, MD, 21201MedicalResearch.com Interview with:

Clare Rock, MD
Department of Epidemiology and Public Health
University of Maryland School of Medicine
Baltimore, MD, 21201

Summary paragraph:

Dr. Rock: Hand hygiene is an essential step in infection prevention and a focus on improving and sustaining hand hygiene compliance is needed.  However, it remains unclear whether or not hand hygiene is required prior to non-sterile glove use.  Our study would support that it is not a necessary step and a potential waste of healthcare worker time.

MedicalResearch.com: What are the main findings of the study?

Dr. Rock: We conducted a prospective randomized controlled trial to examine the need for hand hygiene before putting on non-sterile gloves in the ICU. We randomized healthcare workers on room entry to perform hand hygiene and then don non-sterile gloves or to directly don non-sterile gloves.  Gloved hands were cultured using modified direct plate method.  The main finding was a similarly low number of colony forming units (CFU) of bacteria on gloves independent of hand hygiene prior to donning gloves (6.9 vs 8.1 CFU, “hand hygiene prior to gloving” and “direct gloving” group respectively, P=0 .52).  The average time needed per episode for “hand hygiene prior to gloving” group was much longer at 53.3 seconds, compared with 21.8 for “direct gloving” group (P < .01).

MedicalResearch.com: Were any of the findings unexpected?

Dr. Rock: Although this is the first randomized controlled trial examining the need for hand hygiene before non-sterile gloves the findings are not unexpected.  Our hypothesis for the study was that there would be no microbiological benefit to hand hygiene before non-sterile gloves and that it was a potentially unnecessary hand hygiene step. We also, not unexpectedly, found that healthcare workers in the ICU spend a great length of time per shift on this potentially unnecessary step. The group who performed hand hygiene before donning non-sterile gloves took an additional 31.5 seconds per episode compared with the group who directly put on non-sterile gloves. An ICU nurse enters a Contact Isolation room to perform patient care an average of one-and-a-half to 3 times per hour. This indicates approximately 19 minutes of unnecessary hand hygiene prior to gloving per 12-hour shift.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Rock: Hand hygiene is an essential step in infection prevention and a focus on improving and sustaining hand hygiene compliance is needed.  However, it remains unclear whether or not hand hygiene is required prior to non-sterile glove use.  Our study would support that it is not a necessary step and a potential waste of healthcare worker time.  In addition, infection preventionists and hospital epidemiologists spend time educating, monitoring compliance, and enforcing the performance of hand hygiene prior to donning non-sterile gloves. This study demonstrates that it is potentially of no benefit and perhaps this time and focus could be spent more productively in providing education on hand hygiene movements with proven benefit, such as after glove removal. The direct time saved by the healthcare worker could be spent more productively in direct patient care or another quality control measure in the ICU that is proven to impact patient safety and/or quality of care.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?
More research is needed to examine this question across multiple healthcare settings and outside the ICU. Our next step is to examine the need for hand hygiene prior to non-sterile gloves outside the ICU including outpatient clinics and long-term care facilities.

Citation:

Is hand hygiene before putting on nonsterile gloves in the intensive care unit a waste of health care worker time?—A randomized controlled trial

Clare Rock, Anthony D. Harris, Nicholas G. Reich, J. Kristie Johnson, Kerri A. Thom

AJIC: American Journal of Infection Control – 26 July 2013 (10.1016/j.ajic.2013.04.007)