Handwashing and use of examination gloves

Abstract

Compliance with anti-infection precautions has stimulated use of unsterile examination gloves and decreased handwashing in health-care settings. Latex gloves are currently used at the rate of 9·15 billion annually in the USA. Health-care workers were observed to wash their hands 27% of times before putting on gloves; change gloves appropriately 16% times after patient interaction; and potentially transmit microbes via gloved hands in 82% of interactions. UK dental health-care workers were seen via hidden videocameras to wash their hands 23% of times before gloving; and to change gloves between patients in 56% of contacts. In rooms of patients in hospital having meticillin-resistant Staphylococcus aureus (MRSA) wound or urinary tract infections, 42% of health-care workers having no direct contact with patients, were found to have MRSA on the external surfaces of their gloves. Possibly related is an alarming recent increase in nosocomial blood stream infections with coagulase-negative staphylococcus, Staphylococcus aureus or enterococcus with increasing vancomycin resistance. We opened six boxes of unsterile examination gloves (latex four, vinyl one, nitrile one) in boxes of 100 from different manufacturers. Counting parts of each glove presenting from the oval opening of the box, we found that 11% of presenting parts were thumbs, 33% fingers; 24% palms, and 29% cuffs. An average of seven times per box, bunches of 2–15 came out; and were included in the count of 100 according to the part first grasped by fingers. During the count six health-care workers from departments in the Holy Cross Hospital, Taos, New Mexico, USA, were asked to extract and don the 41st and 42nd glove as a pair and observed while doing so. Then, before glove thumbs, fingers, or palms touched anything else, each glove was inverted with help from sterile forceps, 10 mL of sterile thioglycolate broth was introduced, the cuff tied up, and the glove incubated for 24 h then plated onto blood agar. As controls, the 50th glove from each box was extracted with sterile surgical gloves and tested similarly; three gloves from the one box of powdered vinyl gloves were contaminated with coagulase-negative staphylococci. We observed no consistent method of gloving by healthcare workers, partly owing to diversity of glove parts presenting. Six of six grasped thumbs, fingers, or palms at least once (range one to eight) while donning a pair. Four of six with unwashed hands added skin bacteria to external glove surfaces (coagulase-negative staphylococcus three, strep one). Two of six with washed hands added no bacteria to the external surface. The control from one box showed that powder-free latex from all three gloves tested were contaminated with saprophytic bacilli; three controls from boxes of powdered vinyl gloves were contaminated with coagulase-negative staphylococcus. Control gloves from four of six boxes showed no bacterial contamination (some examination gloves are chlorinated during manufacture). These samplings indicate that various unsterile examination gloves cannot be extracted or donned in pairs by health-care workers with unwashed hands without adding common skin-borne bacteria to external surfaces. To minimise nonsocomial infections, health-care workers should wash their hands before gloving, and gloves supplied should be sterile in critical areas of patients’ care.