Infection Control & Hospital Epidemiology (2019), 40, 103–105 doi:10.1017/ice.2018.293
Concise Communication
Mixed-methods analysis of glove use as a barrier to hand hygiene Blake A. Acquarulo MPH1, Linda Sullivan BSN, MBA2, Anthony L. Gentile2, John M. Boyce MD3 and
Richard A. Martinello MD2,4 1Yale School of Public Health, New Haven, Connecticut, 2Yale New Haven Health, Department of Infection Prevention, New Haven, Connecticut, 3J.M. Boyce Consulting, LLC, Middletown, Connecticut and 4Yale School of Medicine, Departments of Internal Medicine and Pediatrics, New Haven, Connecticut
Abstract
Examination gloves have been previously noted as a possible barrier to hand hygiene. We performed a prospective quantitative and qualitative study to investigate. Glove usage was found to be a potential barrier to hand hygiene; this was driven by desire for personal safety and potentially learned during professional training.
(Received 12 June 2018; accepted 1 October 2018; electronically published 19 November 2018)
Hand hygiene and the use of examination gloves in healthcare is critical. The WHO highlights that healthcare personnel should perform hand hygiene (HH), either using alcohol-based hand-rub (ABHR) or soap and water, before and after donning gloves and that gloves should only be worn in certain scenarios.1 Evidence has suggested that inappropriate use of examination gloves was a significant cause of missed HH opportunities at our and other institutions.2 We performed a mixed-methods study to char- acterize glove use as a potential barrier to proper HH.
Methods
This prospective quantitative and qualitative study was performed between August 11, 2016 and December 30, 2016, in adult and pediatric medical–surgical wards and intensive care units at an urban, 1,541-bed, tertiary-care hospital. Periods of observation were selected to optimize timing for healthcare professionals (HCP) participation and observer efficiency and included obser- vations during nights and weekends. Hand hygiene performance of HCP providing hands-on inpatient care was measured by a validated observer using a “secret-shopper” method focused on wash-in and wash-out HH opportunities and instances where gloves were worn in lieu of HH. Between August 11, 2016, and August 18, 2016, a convenience
sample of staff who did not perform HH and donned gloves prior to room entry (wash-in opportunity) were approached with request for a brief interview. The interviews were conducted by an investigator who was not involved in obtaining secret-shopper HH observations. Episodes where gloves were indicated (eg,
Author for correspondence: Richard Martinello MD, Hunter 527, 20 York Street,
New Haven, CT 06520. E-mail:
richard.martinello@
yale.edu PREVIOUS PRESENTATION: These data and findings were presented in part at the
Society for Healthcare Epidemiology of America (SHEA) Spring Conference in 2017 on March 31, 2017, in St Louis, Missouri.
Cite this article: Acquarulo B, et al. (2019). Mixed-methods analysis of glove use as a
barrier to hand hygiene. Infection Control & Hospital Epidemiology 2019, 40, 103–105. doi: 10.1017/ice.2018.293
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
Table 1. Open-Ended Questions Asked of Interviewed Healthcare Personnel
1) When you’re providing care to a patient and are wearing gloves, what has your routine been?
2) Why are you using gloves in this situation? 3) Does anything prevent you from performing proper hand hygiene? 4) Do you know the hospital’s policy on gloves and hand hygiene? 5) What can be done to promote good hand hygiene among staff?
visiting a patient on contact precautions) or where it appeared that an HCP was anticipating contact with body fluids were excluded. Interviews were semistructured in nature. Open-ended questions were used to prompt discussion and focused on glove use knowledge and practices in addition to barriers to HH (Table 1). No further interviews were sought once saturation appeared to be achieved. Survey results were analyzed to identify themes and their relation to the use of gloves in lieu of HH.
Results
During the 4-month study period, compliance with HH was 74.5% for both wash-in (n=2,181) and wash-out (n=2,419) opportunities; 18% of these observations occurred outside of daytime, weekday working hours. Among all HH opportunities observed (n=4,600), 1,906 (41%) were performed by registered nurses, 756 (16%) were performed by licensed independent practitioners (LIPs, ie, physician, physician assistant, advanced practice registered nurses, etc), and 737 (16%) were performed by nursing assistants (Table 2). Of the 556 wash-in episodes lacking compliance with wash-in HH, 249 (45%) were performed by registered nurses, 143 (26%) were performed by nursing assis- tants, and 22 (4%) were performed by LIPs. Among the 556 wash- in episodes lacking compliance with wash-in HH, 247 of staff (44%) wore gloves. Episodes of glove use without HH were
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124 |
Page 125 |
Page 126 |
Page 127 |
Page 128 |
Page 129 |
Page 130 |
Page 131 |
Page 132 |
Page 133 |
Page 134 |
Page 135 |
Page 136
