Skipping hand hygiene before putting on gloves may be just as safe, trial suggests

Among healthcare providers, a direct glove-wearing strategy led to better compliance and was as safe as the current practice of hand hygiene before donning non-sterile gloves, a trial showed cluster randomized clinic.

Among 13 hospital units comprising nearly 3,800 health care providers, adherence to expected practices was higher in units asked to wear gloves directly without washing hands than in units asked to wash hands before washing. put on gloves (87% versus 41%, P.<0.001), reported Kerri Thom, MD, MS, of the University of Maryland School of Medicine in Baltimore, and colleagues.

This remains true even when controlling for baseline hand hygiene rates, unit type, and universal glove policies (relative risk (RR) 1.76, 95% CI 1.58-1.97 ), they noted in Open JAMA Network.

Glove use was also higher in direct glove units than in hand hygiene units when entering contact precaution rooms (87% versus 67%, P.=0.008).

Pathogens were identified in 4% of samples obtained from usual practice units, with an average total bacterial colony count of 16.3 colony-forming units (CFU), while 2% of samples obtained from usual practice units usual had identified pathogens, with an average of 9.5 CFU.

“Many infection control practices, such as hand hygiene and glove use, represent a time burden on busy healthcare workers,” said co-author Eli Perencevich, MD, MS, of Carver College of Medicine at the University of Iowa in Iowa City. Page Med today in an email. “The recommendation to wash your hands with soap and water or an alcohol-based hand rub before putting on gloves is particularly burdensome, because you must wait a minute or more for your hands to dry before putting on gloves.”

“If the guidelines were adjusted to allow health professionals not to wash their hands before putting on gloves, time would be saved and hospital safety could be improved,” he added.

A previous randomized trial also showed no difference in glove contamination when non-sterile gloves are put on directly compared to after performing hand hygiene.

Current guidelines from the Society for Healthcare Epidemiology of America (SHEA) recommend that health care workers wash their hands or use an alcohol-based sanitizer and wear gloves. SHEA recognized that effectiveness can be an issue, with only 7% of healthcare workers cleaning the entire surface of their hands effectively.

However, Suraj Kumar Saggar, DO, of Holy Name Medical Center in Teaneck, New Jersey, said: Page Med today that the results of this study are likely less relevant now since the data was collected before the COVID-19 pandemic.

“COVID-19 has reiterated and brought infection prevention to the forefront,” he said. “This (study) was done before that, (so) the potential benefits of wearing the gloves directly and saying it’s more or less equivalent and increases adherence, the benefit may not be as as this document tries to say.”

However, Saggar noted that the study addresses an interesting topic related to infection prevention in hospitals.

“Hand hygiene is extremely important, so I would say any study that can show a way to increase compliance without compromising effectiveness is welcome,” he said.

“I wouldn’t say there’s a lack of guidance at the federal level, at the state level, at the local level, as well as internally within hospitals. I think every major medical system in the United States recognizes that now, and they have infection prevention teams,” he added. “There is a lot of awareness of the potential benefits, as well as the downsides if these (practices) are not followed.”

Perencevitch acknowledged that since the study was conducted before the COVID-19 pandemic, the data might not apply to practices during and after the pandemic, especially if infection control practices in hospitals have changed.

This cluster randomized clinical trial was conducted at four academic centers – two in Baltimore and two in Iowa City – from January 2016 to November 2017. In total, the trial involved 3,790 healthcare providers from 13 hospital units .

Thom and his colleagues assigned each participating unit to either continue usual glove practices or use a direct glove approach. They observed baseline rates for 6 months before launching the intervention in six randomly selected units, which included an emergency department, a hemodialysis unit, a pediatrics unit, and three intensive care units.

Researchers used a standardized hand hygiene data collection tool at each site to capture hand hygiene and glove use upon entering and exiting the room.

The direct glove wearing strategy was associated with greater detection of pathogenic bacteria (adjusted incidence RR 10.18, 95% CI 2.13-44.94) on gloves in the emergency department and a reduction in the number of colonies in pediatric units (adjusted incidence RR 0.34, 95% CI 0.19-0.63), with no change in the total number of colonies (RR 0.87, 95% CI 0.60 -1.25 for intensive care units and RR 0.59, 95% CI 0.31-1.10 for hemodialysis unit) nor in the presence of pathogenic bacteria (RR 0.93, 95) . (CI% 0.40-2.14 for adult intensive care units and RR 0.55, 95% CI 0.15-2.04 for hemodialysis unit) in other units.

The authors concluded that a rigorous approach to evidence-based guidelines will be necessary to increase acceptance and compliance with hand hygiene and glove use in hospitals. A limitation was that the study did not apply to surgical settings where healthcare personnel must wear sterile gloves.