Hand hygiene compliance in a universal gloving setting

The use of gloves for every patient contact (ie, universal gloving) has been suggested as an infection prevention adjunct and alternative to contact precautions | American Journal of Infection Control

Image source: Michael Coghlan – Flickr // CC BY-SA 2.0

Background: The use of gloves for every patient contact (ie, universal gloving) has been suggested as an infection prevention adjunct and alternative to contact precautions. However, gloves may carry organisms unless they are changed properly. In addition, hand hygiene is required before donning and after removing gloves, and there are scarce data regarding glove changing and hand hygiene in a universal gloving setting.

Methods: This nonrandomized observational before-after study evaluated the effect of education and feedback regarding hand hygiene. Compliance with hand hygiene and glove use was directly observed in a universal gloving setting at a 10-bed intensive care unit in a Japanese tertiary care university teaching hospital.

Results: A total of 6,050 hand hygiene opportunities were identified. Overall, hand hygiene compliance steadily increased from study period 1 (16.1%) to period 5 (56.8%), although there were indication-specific differences in the baseline compliance, the degree of improvement, and the reasons for noncompliance. There were decreases in the compliance with universal gloving and the incidence of methicillin-resistant Staphylococcus aureus.

Conclusion: It is difficult to properly perform glove use and hand hygiene in a universal gloving setting, given its complexity. Direct observation with specific feedback and education may be effective in improving compliance.

Full reference: Kuruno, N. et al. (2017) Hand hygiene compliance in a universal gloving setting. American Journal of Infection Control. Vol. 45 (Issue 8) pp. 830–834

Beyond hand hygiene: preventing cross-contamination on hospital wards

Hospital-acquired infections are the most common adverse event for inpatients worldwide | BMJ Quality & Safety


Background: Efforts to prevent microbial cross-contamination currently focus on hand hygiene and use of personal protective equipment (PPE), with variable success. Better understanding is needed of infection prevention and control (IPC) in routine clinical practice.

Results: We found that healthcare workers’ routine IPC work goes beyond hand hygiene and PPE. It also involves, for instance, the distribution of team members during rounds, the choreography of performing aseptic procedures and moving ‘from clean to dirty’ when examining patients. We account for these practices as the logistical work of moving bodies and objects across boundaries, especially from contaminated to clean/vulnerable spaces, while restricting the movement of micro-organisms through cleaning, applying barriers and buffers, and trajectory planning.

Conclusions: Attention to the logistics of moving people and objects around healthcare spaces, especially into vulnerable areas, allows for a more comprehensive approach to IPC through better contextualisation of hand hygiene and PPE protocols, better identification of transmission risks, and the design and promotion of a wider range of preventive strategies and solutions.

Full reference: Hor, S. et al. (2017) Beyond hand hygiene: a qualitative study of the everyday work of preventing cross-contamination on hospital wards. BMJ Quality & Safety. 26:552-558.


Use of personal protective equipment among health care personnel

Kang, J. et al. American Journal of Infection Control 45(1) pp. 17-23

Background: Very little is known about how health care personnel (HCP) actually use personal protective equipment (PPE).

Conclusions: Although HCP knew they were being videotaped, contamination occurred in 79.2% of the PPE simulations. Devising better standardized PPE protocols and implementing innovative PPE education are necessary to ensure HCP safety.

Read the full article here

Can the design of glove dispensing boxes influence glove contamination?

Assadian, O. et al. The Journal of Hospital Infection. Published online: September 15 2016

Image source: Michael Coghlan – Flickr // CC BY-SA 2.0

Background: Few studies have explored the microbial contamination of glove boxes in clinical settings. The objective of this observational study was to investigate whether a new glove packaging system in which gloves are dispensed one by one vertically with the cuff-end first has lower levels of contamination on the gloves and on the surface around the box aperture compared to conventional horizontally dispensed glove boxes.

Methods: Seven participating sites were provided with vertical glove dispensing systems and conventional boxes. Before opening boxes, the surface around the aperture was sampled microbiologically to establish base-line levels of superficial contamination. Once the boxes were opened, the first pair of gloves in each box were sampled for viable bacteria. Thereafter, testing sites were visited on a weekly basis over a period of six weeks and the same microbiological assessments made.

Results: The surface surrounding the aperture of the modified dispenser boxes became significantly less contaminated than the conventional boxes (P < 0.001) with an average of 46.7% less contamination around the aperture. Overall, gloves from modified boxes showed significantly less colony-forming units contamination than gloves from conventional boxes (P < 0.001). Comparing all sites over the entire six-week period, modified dispensed gloves had 88.9% less bacterial contamination.

Conclusion: This simple improvement to glove box design reduces contamination of unused gloves. Such modifications could decrease the risk of microbial cross-transmission in settings that utilise gloves. However, such advantages do not substitute for strict hand-hygiene compliance and appropriate use of non-sterile, single-use gloves.

Read the abstract here

Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff

Verbeek,J.H. et al. Cochrane Database of Systematic Reviews.2016, Issue 4.

Clothes and equipment for healthcare staff to prevent Ebola and other highly infective diseases

NHS Framework Documant 2008

Healthcare staff are at much greater risk of infections such as Ebola Virus Disease or SARS than people in general. One way of preventing infection is to use personal protective equipment, such as protective clothing, gloves, masks, and goggles to prevent contamination of the worker. It is unclear which type of equipment protects best and how it can best be removed after use. It is also unclear what is the best way to train workers to comply with guidance for this equipment.

Studies found

We found six studies with 295 participants in which workers’ protective clothing was sprayed with a fluorescent marker or a harmless virus to simulate what happens in hospitals. Four of these compared different types of protective clothing. Two studies compared different ways of putting clothing on and taking it off. Three studies with 905 participants compared the effect of active training on the use of protective equipment to passive training. All studies had a high risk of bias.

Various types of clothing compared

In spite of protective clothing, the marker was found on the skin of 25% to 100% of workers. In one study, more breathable clothing did not lead to more contamination than non-breathable clothing, but users were more satisfied. Gowns led to less contamination than aprons in another study. Two studies did not report enough data to enable conclusions. This evidence was of very low quality.

Various types of removal of clothing compared

In one study, two pairs of gloves led to less contamination than only one pair of gloves. The outer gloves were immediately removed after the task was finished. In another study, following CDC guidance for apron or gown removal led to less contamination. This evidence was also of very low quality.

Active training

Active training, including computer simulation and spoken instructions, led to less errors with guidance on which protection to use and how to remove it among healthcare staff compared to passive training.

Quality of the evidence

We judged the quality of the evidence to be very low because of limitations in the studies, indirectness and small numbers of participants.

What do we still need to find out?

There were no studies on the effects of goggles, face shields, long-sleeved gloves or taping on the risk of contamination. We need simulation studies with several dozens of participants, preferably using exposure to a harmless virus, to find out which type and combination is most protective. The best way to remove protective clothing after use is also unclear. We need studies that use chance to assign workers to different types of training to find out which training works best. Healthcare staff exposed to highly infectious diseases should have their protective equipment registered and be followed for their risk of infection. We urge WHO and NGOs to organise more studies.

Read the full article here

Occupational health risks associated with the use of germicides in health care

Weber, D.J. et al. American Journal of Infection Control.Volume 44, Issue 5, Supplement, 2 May 2016, Pages e85–e89

Image source: Cade Martin, Dawn Arlotta // CC0

Environmental surfaces have been clearly linked to transmission of key pathogens in health care facilities, including methicillin-resistant Staphylococcus aureus, vancomycin-resistantEnterococcus, Clostridium difficile, norovirus, and multidrug-resistant gram-negative bacilli. For this reason, routine disinfection of environmental surfaces in patient rooms is recommended. In addition, decontamination of shared medical devices between use by different patients is also recommended.

Environmental surfaces and noncritical shared medical devices are decontaminated by low-level disinfectants, most commonly phenolics, quaternary ammonium compounds, improved hydrogen peroxides, and hypochlorites.

Concern has been raised that the use of germicides by health care personnel may increase the risk of these persons for developing respiratory illnesses (principally asthma) and contact dermatitis. Our data demonstrate that dermatitis and respiratory symptoms (eg, asthma) as a result of chemical exposures, including low-level disinfectants, are exceedingly rare. Unprotected exposures to high-level disinfectants may cause dermatitis and respiratory symptoms. Engineering controls (eg, closed containers, adequate ventilation) and the use of personal protective equipment (eg, gloves) should be used to minimize exposure to high-level disinfectants.

The scientific evidence does not support that the use of low-level disinfectants by health care personnel is an important risk for the development of asthma or contact dermatitis.

Read the abstract here

Face shields for infection control: A review

Roberge, R. J.  Journal of Occupational and Environmental Hygiene. Volume 13, Issue 4, 2016

N0037783 A male surgeon during an operation
Image source: Slyvain Teissier – Wellcome Images

Face shields are personal protective equipment devices that are used by many workers (e.g., medical, dental, veterinary) for protection of the facial area and associated mucous membranes (eyes, nose, mouth) from splashes, sprays, and spatter of body fluids. Face shields are generally not used alone, but in conjunction with other protective equipment and are therefore classified as adjunctive personal protective equipment.

Although there are millions of potential users of face shields, guidelines for their use vary between governmental agencies and professional societies and little research is available regarding their efficacy.

Read the abstract here