Glove use in patient care: do you know when to wear them and when not to?
They have a place in infection prevention and control, but gloves are bad for your skin, your patients and the environment – and are no substitute for hand hygiene
Using gloves when they are not required carries risks for our patients, ourselves and the environment.
In the NHS in England more than 1.5 billion boxes of examination gloves are purchased annually at a cost of £35 million. Creating a culture of appropriate glove use would not only improve health and support environmental protection, it would reduce unnecessary financial costs.
‘If there is no risk to you or the patient, you do not need to wear gloves’
Protecting patients and healthcare workers from infection is a core element of everyday clinical practice. It can, and should, start with hand hygiene.
Gloves do have their place in hand hygiene and must be available for use, but too often I hear healthcare workers describe a physical interaction with a patient as requiring gloves when this is simply not the case. The inappropriate use of gloves can also make patients feel stigmatised in certain situations, such as washing, dressing and routine bed-making.
The impact of preventable work-related dermatitis
The impact of glove use on health and care staff – in particular, on the health of their skin – is often not considered. The rate of contact dermatitis among health and social care staff is significantly higher than that for staff in other industries – 8.6 per 10,000 workers compared with 3.8 – with the highest rate among nursing and dental staff.
Healthcare workers’ hands may come into contact with multiple irritants at work, such as cleaning or disinfectant solutions or wipes, soap and irritants in gloves (for example, accelerators). In isolation these may not cause harm, but when combined with over-hydration of skin as a result of excessive glove use, the impact can be significant.
Against a backdrop of 40,000 nurse vacancies we can ill afford to lose staff to preventable work-related dermatitis.
Not a failsafe method for preventing contamination
Gloves are not a substitute for hand hygiene and do not provide a failsafe method of preventing hand contamination. Contaminated gloves are capable of transmitting infections in just the same way as dirty hands.
- RELATED: Hand hygiene needn’t mean sore skin
It is important to remember that, in addition to changing gloves between patients, you should change gloves between different care activities for an individual patient, to prevent distribution of bacteria from one part of the body (for example, the groin) to another (for example, the face), which can result in infection. It is also important to wash your hands or use an alcohol hand sanitiser immediately after removing gloves.
‘One of the ways we can practise in a more sustainable way is to be mindful of when gloves are required and only use them if a risk genuinely exists’
Nurses and midwives are holistic care practitioners and, as with the wider public, are increasingly aware of the need to consider environmental issues and the impact our actions have on climate change. Medical nitrile examination gloves – those used most commonly in the NHS – originate from oil. The impact of their production and supply, from oil extraction to manufacturing and transporting to the UK, should also be a consideration.
Challenge accepted practice related to glove use
One of the ways we can start to practise in a more sustainable way is to be mindful of when gloves are required and only use them if a risk genuinely exists – not ‘just in case’ or as a result of accepted common practice in the workplace.
Infection prevention and control can be very complex, and there is no doubt that when done properly it is a life-saver. When it comes to gloves, however, it can be very simple: they should be used when in contact with blood or other fluid, non-intact skin or mucous membranes and in situations involving chemical hazards such as disinfectants or cytotoxic drugs.
If there is no risk to you or the patient, you do not need to wear gloves. In practice, our hands are our tools and we must care for them and protect them, for our benefit and that of our patients.
Rose Gallagher is RCN professional lead for infection prevention and control