Taking off the gloves: Poor habits among staff play a role in infection

Nurse Manager Website, August 1, 2007

After reading this article, you will be able to:

  • Determine under what circumstances and in which settings wearing gloves is appropriate
  • Identify two ways to prevent staff members from wearing gloves when inappropriate

    You see them in elevators pushing buttons, in hallways transporting patients, and walking out of patient rooms-healthcare workers wearing gloves.

    If the gloves are contaminated, it can be a major infection control (IC) issue. If they are not, wearing them can still give the wrong impression to other staff members, patients, and patients' families. So why is this still such a very common sight in hospitals?

    "People get a false sense of security with gloves," says Francine Kidd, an IC professional at University Hospital in Cincinnati. "Workers put on the gloves and gowns to work with a patient in isolation and then leave the room with them on. They may be so focused on protecting themselves that they don't realize they may be infecting others."

    Unfortunately, Kidd's observations are not unique.

    "I see it especially with [emergency medical technicians who come] to pick up patients. They put gloves on to move a patient and keep them on when bringing the patient out of the room," says Phyllis Stutzman, RN, MBA, CIC, IC coordinator at Chelsea (MI) Community Hospital.

    However common these occurrences are, there are few times when it is permissible for staff members to wear gloves in the facility hallways, says Gail Bennett, RN, MSN, CIC, executive director at ICP Associates in Rome, GA.

    One time this might be appropriate is when a healthcare worker is working with a patient in a room and then needs to bring something soiled into the hallway, she says.

    But more often than not, there is no reason for a health-care worker to wear gloves in the hallway. And any worker who does may be in violation of the Occupational Safety and Health Administration's (OSHA) bloodborne pathogen regulations.

    Staff members who wear gloves in hallways when circumstances do not warrant their use may also put your hospital at risk for a possible citation from Joint Commission surveyors or state or federal regulators for inappropriate use of personal protective equipment (PPE), she says.

    Specifically, such uses could trigger Joint Commission citations under environment of care (EC) standard EC.1.10, which outlines steps that a hospital must take to manage risks, including using policies and procedures "that achieve the lowest potential for adverse impact on the safety and health of patients, staff, and other people coming to the hospital's facilities."

    Standard IC.3.10 requires that hospitals set goals to prevent healthcare-associated infections (HAI). IC.4.10 requires hospitals to follow through on those goals, and your hospital's policies regarding the use of gloves and other PPE could come under scrutiny.

    Relevant regulations

    OSHA generally makes determinations as to the appropriateness of wearing PPE outside of patients' rooms on a case-by-case basis, says a spokesperson with the organization.

    "At a minimum, gloves must be used where there is reasonable anticipation of employee hand contact with blood, other potentially infectious material (OPIM), mucous membranes, or nonintact skin, and when handling or touching contaminated surfaces or items," says the spokesperson.

    However, OSHA requires that all PPE be removed prior to leaving the work area.

    "This is in line with [the Centers for Disease Control and Prevention's] infection control recommendations, which promote good hand hygiene and glove use strategies to minimize the migration of contamination beyond the work area. While work area must be determined on a case-by-case basis, the term generally means the area where work involving exposure or potential exposure to blood or OPIM occurs or where the contamination of surfaces may occur," says the OSHA spokesperson.

    However, keep in mind that because OSHA standards set minimum requirements, facilities may institute IC measures that exceed the OSHA requirements.

    Changing behavior

    The good news about staff members wearing gloves in the hallway is that it's not an issue that is hidden from view, says Bennett. A person wearing gloves in the hallway is easy to spot, and therefore, it is a behavior you can address quickly. But it will take a change in the way staff members think to get inappropriate use of gloves under control.

    Bennett, Stutzman, and Kidd offer the following tips to help you get a grip on the problem:

  • Ensure that you have appropriate policies and procedures regarding the use of gloves and PPE.
  • Monitor for compliance with those policies and procedures.
  • Include this topic in annual training for IC, and provide education for those seen violating the policy. "A lot of this issue is increasing awareness about transmission route," says Kidd.
  • Use demonstrations during training to show proper technique. For example, during a training session for transporters at University Hospital, trainers showed them how to properly transport a patient. The trainers also used "glow germ" to demonstrate how germs are spread. This helped drive the point home, Kidd says.
  • Give employees the facts about glove use. "People think they're safe with gloves on, but in reality gloves can develop microscopic tears that allow bacteria in," says Stutzman. Organisms can thrive in the space between the gloves and your hand. Even the boxes of gloves can become colonized with bacteria if the first person to take gloves from the box doesn't wash his or her hands.
  • Be realistic. "Keep in mind, it's easy [for an IC professional] to sit in an office and dictate how things are done in theory," says Stutzman. But in reality, the situation is not always as clear-cut as it might appear, and a healthcare worker might genuinely need to protect him- or herself in a certain situation.
  • Hold one another accountable. People need to be willing to speak up if they see a lapse in hand hygiene or PPE being used improperly. Encouraging this type of behavior is the best way to make changes.
  • Realize that people have deeply ingrained ideas about the use of gloves that may take time to change. "We're having some success, but it's not overwhelming. I think people are starting to get it," says Stutzman.

    Source: Briefings on Infection Control, July 2007, HCPro, Inc.