Comment

Glove use: the COVID-19-driven habit we need to break

The pandemic has blurred understanding of guidance, so it’s time we were clear on the basics

The pandemic has blurred understanding of guidance, so its time we were clear on what is needed

The COVID-19 pandemic has seen a huge increase in the use of gloves, not just in health and care settings but also by the public.

It has caused behaviour to change, creating a modern-day nursing ritual that is not supported by evidence, and bringing into focus questions over the need for gloves.

When disposable gloves should be used

Non-sterile disposable gloves (NSDGs) should be used when healthcare workers anticipate exposure to blood or other body fluids, says National Institute for Health and Social Care Excellence (NICE) guidance .

It also says that NSDGs should be used

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The pandemic has blurred understanding of guidance, so it’s time we were clear on what is needed

Picture: iStock

The COVID-19 pandemic has seen a huge increase in the use of gloves, not just in health and care settings but also by the public.

It has caused behaviour to change, creating a modern-day nursing ritual that is not supported by evidence, and bringing into focus questions over the need for gloves.

When disposable gloves should be used

Non-sterile disposable gloves (NSDGs) should be used when healthcare workers anticipate exposure to blood or other body fluids, says National Institute for Health and Social Care Excellence (NICE) guidance.

It also says that NSDGs should be used for self-protection when handling toxic chemicals, and to prevent the spread of infection when handling patients or items likely to be heavily contaminated.

The guidelines are sensible and few would take issue with them, yet there is increasing evidence that despite these recommendations, gloves are overused.

They are frequently worn at inappropriate times and used at the expense of hand hygiene, increasing risk of cross-infection.

Stigma, sustainability and an increased risk of infection

Overuse and inappropriate use are inextricably linked. Both have implications for cost, disposal and sustainability, and also risk making patients feel ‘dirty’ and stigmatised. Most nurses would agree that gloves are not needed to make beds or to help patients with hygiene, yet most have witnessed their use in these and similar situations.

We have all seen gloves worn inappropriately to attend to successive patients; after the completion of a clinical procedure, for example, when labelling a specimen; when risk of exposure to blood, body fluids or high levels of contamination is unlikely; to undertake ‘dirty’ and ‘clean’ tasks for the same patient; and for no apparent reason when simply walking around.

Problems are often compounded because NSDGs are donned and doffed carelessly, risking the transfer of contaminated material from hands to the glove surface and vice versa.

Glove misuse has become permissible as part of a culture of care

So why has misuse of NSDGs become so widely entrenched in the culture of care? Perhaps it’s because the guidelines are not explicit after all.

‘Inappropriate and overuse of non-sterile disposable gloves has become a ritual, but one that nurses, as professionals who are accountable for their actions, cannot afford to perpetuate’

Use of NSDGs is part of standard precautions – the minimum infection prevention practices that apply to all patient care, regardless of whether the patient has a confirmed or suspected infection, in any setting where healthcare is delivered.

These practices are designed to protect healthcare workers and prevent transmission to other patients. Yet interpretation of these standard precautions might be at the root of the problem.

As it’s impossible to tell whether somebody is carrying a blood-borne infection, some nurses will wear NSDGs for all patients, whenever contact with blood or body fluids is possible.

If a patient is known or suspected to have an infection, nurses might choose to wear gloves as a default, no matter how superficial or brief their contact with the patient.

Clear guidelines are needed to stop gloves replacing good hand hygiene

Despite risk assessment being central to the implementation of standard and transmission-based precautions, many seem to have difficulty putting this into practice.

Instead, NSDGs are worn as a proxy for hand hygiene, irrespective of infectious status.

This may be because staff feel under pressure through lack of time and don’t always think it through, or because they are concerned primarily with protecting themselves rather than vulnerable patients.

There can be a misunderstanding of how to manage risks that can lead to an over-reliance on gloves.

Meanwhile, inappropriate NSDG use simply becomes a habit, ingrained and difficult to change, especially when the practice is adopted by newcomers, such as new staff and students, who are anxious to fit in.

The unpredictable nature of clinical work and speed of events in the clinical setting further confound attempts at risk assessment and clinical decision-making.

This is especially true for the less experienced, who quickly come to rely on blanket policies that they hope will meet all needs and situations.

Overturning our reliance on gloves

Inappropriate use and overuse of NSDGs has become a ritual, but one that nurses, as professionals who are accountable for their actions, cannot afford to perpetuate.

To move forwards we need to ask ourselves what we are trying to achieve when we don NSDGs and implement standard or transmission-based precautions.

And before we do that, we need to agree a common language to describe the different types of precautions so we all know what we’re talking about.


Dinah Gould is an independent consultant and former professor of nursing at Cardiff School of Nursing and Midwifery Studies


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Glove Awareness Week resources

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