Glove: Use for safety or overuse?

Paradoxes of pandemic infection control: Proximity, pace and care within and beyond SARS-CoV-2

From the adoption of mask-wearing in public settings to the omnipresence of hand-sanitising, the SARS-CoV-2 pandemic has brought unprecedented cultural attention to infection prevention and control (IPC) in everyday life. At the same time, the pandemic threat has enlivened and unsettled hospital IPC processes, fracturing confidence, demanding new forms of evidence, and ultimately involving a rapid reassembling of what constitutes safe care. Here, drawing on semi-structured interviews with 63 frontline healthcare workers from two states in Australia, interviewed between September 2020 and March 2021, we illuminate some of the affective dimensions of IPC at a time of rapid change and evolving uncertainty. We track how a collective sense of risk and safety is relationally produced, redefining attitudes and practices around infective risk, and transforming accepted paradigms of care and self-protection. Drawing on Puig de la Bellacasa's formulation, we propose the notion of IPC as a multidimensional matter of care. Highlighting the complex negotiation of space and time in relation to infection control and care illustrates a series of paradoxes, the understanding of which helps illuminate not only how IPC works, in practice, but also what it means to those working on the frontline of the pandemic.

Modified glove use for contact precautions: Health care workers' perceptions and acceptance

BACKGROUND

Patients colonized or infected with methicillin-resistant Staphylococcus aureus and or vancomycin-resistant Enterococcus are placed under contact precautions. Contact precautions require patients to be placed in single rooms and their health care workers (HCWs) to wear gowns, aprons and gloves on entry and doffing on exit. Glove use is widely accepted to be associated with poor hand hygiene compliance. We trailed the removal of gloves for contact precautions for contacts not expected to involve body fluids to improve hand hygiene between multiple contacts of the patient and patient zone.

METHODS

We have conducted a 5 phase study of the removal of gloves for contacts without body fluids in 250 HCWs using pretrial focus groups (N = 12), hand microbiology (N = 40) (reported elsewhere), development of a modified contact precautions poster, trial of modified poster (n = 100), posttrial focus group discussion (n = 22), and a survey of HCWs postrollout in additional locations (n = 76).

RESULTS

Pretrial focus groups identified 4 themes, and the leading theme identified as the facilitator for glove use as self-protection. HCWs viewed current contact precaution guidelines as preventing them from making their own judgement regarding the need for gloving for patient contacts, leading continuous glove use without changing gloves between multiple contacts. Participants believed that the trial empowered them to make their own clinical judgment for gloves and to consciously use hand hygiene between dry (no body fluid) contacts. Four themes were discussed during the posttrial focus groups and although self-protection remained the central theme, hand hygiene replaced glove use. Participants spoke of an appreciation of and increased trust in hand hygiene during nonglove use for dry contacts. The survey responses from additional sites were mostly positive for the safety of nonglove use for dry contacts, it improved hand hygiene and that the adoption of the modified guidelines was empowering.

CONCLUSIONS

The trial of nonglove use for expected dry contact, while caring for patients under contact precautions for methicillin-resistant S aureus and or vancomycin-resistant Enterococcus, was successful in refocusing HCWs reliance on hand hygiene for self-protection. Mandatory glove use for contact precautions was believed to contribute to their failure to change gloves between procedures on the same patient and patient zone, with HCWs now recognizing multiple contacts with the same gloves as a risk for contamination.

Safe removal of gloves from contact precautions: The role of hand hygiene

BACKGROUND

Routine hand hygiene effectively removes methicillin-resistant Staphylococcus aureus (MRSA) and/or vancomycin resistant Enterococcus (VRE) from the ungloved hands of healthcare workers (HCWs) who are caring for patients under contact precautions, when exposure to bodily fluids is not expected.

METHODS

HCWs' ungloved hands were cultured after hand hygiene with alcohol-based hand rub (ABHR) or soap-and-water wash after routine clinical care of patients known to be colonized or infected with MRSA or VRE.

RESULTS

Two hundred forty samples from 40 HCWs were tested and found to be culture negative for either MRSA or VRE after contact with patients when 3 pumps of ABHR (0/80) or plain soap-and-water wash (0/80) were used. No VRE was observed in any of the 120 samples collected. Two plates (2/40) grew 1 colony-forming unit of MRSA after 2 pumps of ABHR. Two HCWs with positive plates were cultured negative on retesting.

CONCLUSION

We showed that appropriate hand hygiene was effective in removing MRSA and VRE even when gloves were not used for routine clinical care, despite contact with patients known to be colonized with MRSA or VRE. A modified approach to glove use for dry contact with patients on contact precautions might improve patient safety within healthcare settings.