Universal Gloving and Hand Hygiene With Gloves On: Concerns.

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To the Editor We read with interest the recent special article by Bowdle et al1 mentioning key recommendations for appropriate infection prevention precautions for routine anesthesia care during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. We wish to add our perspective and concern regarding the use of gloves—an important personal protective equipment (PPE). Universal gloving—a horizontal intervention of contact precautions—was introduced to decrease the exposure of health care workers (HCW) to infectious pathogens while performing patient care. During current pandemic situation like coronavirus disease 2019 (COVID-19) and Ebola virus epidemics, many HCW prefer to wear the same pair of gloves for the extended time while working in contact with patients in operating rooms and intensive care units (ICU). Bowdle et al1 have also recommended wearing double gloves during airway management, with the first pair to be removed immediately after the procedure to prevent surface contamination.1 As per World Health Organization recommendations (2015), when wearing 2 pairs of gloves, change of outer gloves should be practised between patients and before exiting patient care area.2 Also, application of alcohol-based hand rub (ABHR) is often done over gloves, for example, during doffing PPE and routine patient care. We wish to highlight that the impact of this practice on incidence of health care-associated infections (HAI) needs special attention. A meta-analysis of 8 heterogeneous studies concluded that universal gloving may be associated with minimal protection against HAI and may be implemented only in high-risk settings.3 Universal gloving may pose more difficulty for hand hygiene by adding another barrier.4 Also, it remains unclear how more frequent application of AHBRs on worn gloves will affect the incidence of HAI in operating rooms and ICU, both COVID and non-COVID. The other concern is that multiple applications of ABHR on gloves may alter their physical properties. Gao et al5 observed ABHRs affected the tensile strength of the tested nitrile more than latex gloves. In addition, ethanol-containing ABHR led to minimal changes in tensile strength of gloves compared to isopropanol containing ABHR.5 Birnbach et al,6 however, showed that the application of ABHR on widely available nitrile examination gloves does not hamper glove integrity and allows safe performance of anesthesia practices. The possible changes in glove properties with multiple applications of ABHR need to be addressed. This is especially significant in the context of safety of HCW working in COVID areas. In the current COVID-19 scenario, when HCW are advised to perform patient care along with self-care, these concerns need to be explored to understand the impact of universal gloving and application of ABHR over worn gloves on incidence of HAI while maintaining safety of HCW. Neeru Sahni, MDKomal A. Gandhi, MDDepartment of Anesthesia & Intensive CarePost-Graduate Institute of Medical Education and ResearchChandigarh, India[email protected] Manisha Biswal, MDDepartment of Medical MicrobiologyPost-Graduate Institute of Medical Education and ResearchChandigarh, India