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Effective hand hygiene protects patients, staff and the planet, which is why we need to challenge inappropriate glove use
When my mother received end of life care in hospital and then in a care home earlier this year, her care was exemplary, her death dignified and the staff compassionate and kind.
Emergency Nurse. 31, 5, 9-9. doi: 10.7748/en.31.5.9.s6
Published: 05 September 2023
However, what I did not see at any point was anyone wash or gel their hands. Instead, I observed gloves being used for every contact with mum during this 18-day period, including to help move her up the bed, change her clothes and to wheel her trolley out of the ambulance.
At the end of the first year of the COVID-19 pandemic, writers in the BMJ argued that infection control measures that had been put in place swiftly possibly lacked the backing of robust evidence to guide these decisions. Doubtless, it was comforting for the worried public to observe healthcare professionals wearing personal protective equipment.
Yet we are now post-pandemic and the use of gloves appears to have become standard practice. National Institute for Health and Care Excellence guidelines and the World Health Organization clearly state that glove use is only necessary when anticipating contact with blood or another body fluid.
This would include touching or emptying a urinary catheter, cleaning a person whose continence is compromised, performing a vaginal or rectal examination, contact with non-intact skin or mucous membrane, mouth care or when anticipating contact with chemical hazards.
So, according to these guidelines, the instances of daily care in which gloves were used with my mother, such as moving her in the bed, do not require glove use.
The thoughtless use of disposable gloves is also dismaying during what is now recognised as a climate emergency. The NHS is responsible for 4% of England’s carbon footprint and a staggering 1.5 billion boxes of disposable gloves are purchased by the NHS each year.
During the pandemic, it is estimated that between 25 February 2020 and 31 March 2022 around 12.7 billion gloves were sent for use in health and social care services in England.
Gloves are made of fossil fuels and incinerated with clinical waste, a process that emits 1 tonne of CO2 for every tonne of waste. The RCN has regularly highlighted the proper use of gloves through its annual glove awareness week, pointing to the risk of dermatitis from over-use, as well as environmental and resource-related issues.
Infection control is vital in healthcare. Hand hygiene has consistently been proven to be the most effective way of doing this; there is no evidence that wearing gloves is better than hand-washing.
My experience with my mother’s care made me wonder if the glove habits of the pandemic have become too deeply entrenched. It appears that many healthcare staff have been unable to resume the practice of simply washing or gelling their hands in line with the widely known evidence base.
When in clinical practice, think back to what you have been taught about infection control, and when you reach for a pair of gloves consider why you are wearing them. Is it for your protection or that of your patient? Or is it for fear of judgement for going gloveless when colleagues are not, or because it takes less time than to wash or gel your hands?
It can be difficult to challenge others about their practice, or to be seen as different, but draw strength from the robust evidence base and your common sense. Healthcare staff must be mindful of the environmental impact and financial costs of care they provide. The planet and our NHS deserve it.
Hear about the ‘gloves off’ campaign at Great Ormond Street Hospital in London at Nursing Live – a unique, free event for nurses nursinglive.com
NICE: Healthcare-associated Infections: Prevention and Control in Primary and Community Care. nice.org.uk/guidance/cg139
