Use Of Non-sterile Gloves Research Articles

The Added Value of Sterility in Minor Surgical Procedures in Preventing Infection: A Systematic Review

Background: The necessity of maintaining sterility during minor surgical procedures is a debated topic due to concerns over the cost, environmental impact of sterile supplies, and the unclear benefits of sterility in minor surgical procedures. This review aims to evaluate the available evidence on this topic. Methods: A systematic review of studies comparing sterile and non-sterile techniques in minor surgical procedures was conducted. Databases searched included PubMed and Cochrane up to May 2024. Studies were selected based on predefined criteria. Results: A total of eight studies met the inclusion criteria. Non-sterility was mostly defined by the use of non-sterile gloves, whereas the remainder of the procedure was performed with the same technique as a sterile procedure. The analysis showed no significant difference in infection rates between sterile and non-sterile techniques. However, sterile techniques may reduce the risk of complications in specific contexts, such as in immunocompromised patients or in procedures performed in tissues deeper than subcutaneous fascia. Conclusions: The evidence suggests that for most minor surgical procedures, non-sterile techniques do not significantly increase the risk of postoperative infections. Further high-quality studies are needed to identify specific scenarios where sterility can be safely omitted to decrease surgical waste and costs without increasing the risk of infection.

Factors responsible for student nurses' use of non-sterile gloves: An exploratory qualitative study.

Disposable non-sterile gloves are part of the personal protective equipment (PPE) to be considered to protect oneself from the risk of infection. They have subsequently become the topic of concern related to increased use, inappropriate use, and potentially increasing the risk of cross-infection and environmental impact of plastic waste. This study aimed to explore the views of pre-registration student nurses about non-sterile glove use in clinical practice and to identify the factors that impact student nurses' decision on whether to wear non- sterile gloves. Using a social constructivist approach, the study was organised in a higher education institution. Semi-structured interviews were conducted with second year student nurses, utilising a theoretical domains framework (TDF). The key findings showed that students had limited awareness of the national infection prevention and control best practice procedures. The primary influential factors for non-sterile gloves use behaviour were personal protection, the type of care interventions required and the observations of peers and role models. The study found limited awareness on the importance of infection prevention and control precautions, including the correct procedure for donning, and doffing of personal protection equipment, along with a lack of confidence to challenge non-compliance.

The combined application of hand hygiene and non-sterile gloves by nurses in a tertiary hospital: a multi methods study

BackgroundThe application of hand hygiene (HH) and the use of non-sterile gloves (NSG) in daily care is highly intertwined. We aimed (1) to assess the combined application of HH and NSG among nurses and (2) to explore determinants that influence their ability to combine both measures in their care.MethodsIn a multi-methods study, we combined direct observations of care episodes with semi-structured interviews with nurses in two affiliated university hospitals. Topics were based on Flottorp’s checklist of determinants of practice.ResultsIn total, we observed 205 care episodes and interviewed 10 nurses. Observations revealed that the combination of NSG and HH was correctly applied in 19% of care episodes in which a single procedure was executed, and in 2% of care episodes in which multiple procedures were performed. From the interviews, we found determinants that influenced compliance, covered mainly by three out of seven of Flottorp’s checklist domains. Nurses indicated that their knowledge of protocols was limited to HH and protocols were hardly ever actively consulted; visual reminders within their workplace were used as sources of information. Nurses’ behavior was primarily influenced by their ability to operationalize this information and their ability to integrate both infection prevention measures into their care. The intention to apply and combine HH and NSG use was influenced by their risk assessment of cross-contamination, by the urge to self-protect and gut feeling. The feasibility to execute HH and NSG protocols is influenced by the urgency and the complexity of the care episode.ConclusionsThe combined correct application with HH and NSG measures by nurses is low. Nurses are instructed in a fragmented way while in the day to day care HH and NSG use are highly intertwined. Operationalization and simplification of infection prevention protocols, in which instructions on both infection prevention measures are fused, should be considered. Strategies to improve practice should consider the power of habit and nurses urge to self-protect.

Kepatuhan Tenaga Kesehatan dalam Penggunaan Sarung Tangan Non Steril

This study aims to identify factors that influence compliance with the use of non-sterile gloves among health workers. The method used is a literature review. There are ten articles obtained from online databases on Pubmed, Science Direct, and other sources. Articles were selected using PRISMA and article appraisal. The results of this study show that health workers use gloves not in accordance with guidelines such as not carrying out hand hygiene before and after using gloves, using gloves more often than necessary, and failing to remove or change gloves at the right time. Factors that encourage health workers to wear non-sterile gloves are personal protection, patient protection, motivation to create a professional image and follow in the footsteps of seniors. Meanwhile, misuse and non-compliance with the use of gloves is influenced by a lack of knowledge and situational understanding of indications for use, age, gender, discomfort due to the use of PPE, lack of availability and access to PPE, attitude of health workers, and lack of supervision. In conclusion, health workers' compliance in using gloves can be improved with health education about controlling and preventing the spread of disease, training and refreshers in the proper use of PPE, supervision and management support to increase the availability and accessibility of PPE.
 
 Keywords: Compliance, Non-Sterile Gloves, Health Workers

Time for change: compliance with RCS green theatre checklist-facilitators and barriers on the journey to net zero.

Climate change is an era-defining health concern, with healthcare related emissions paradoxically compounding negative impacts. The NHS produces 5% of the UK's carbon footprint, with operating theatres a recognised carbon hotspot. NHS England aims to become Net Zero by 2045. Consequently, UK Royal Colleges of Surgery have published guidance to foster an evidence-based sustainable transformation in surgical practice. A single-centre quality improvement project was undertaken, aiming to provide an overview of sustainable practice locally. The Intercollegiate "Green Theatre Checklist" was taken as an audit standard, focusing on "preparing for surgery" and "intraoperative equipment" subsections. Any general surgical procedure was eligible for inclusion. Usage of reusable textiles, non-sterile gloves, catheters, antibiotics, alcohol vs. water-based scrub techniques, skin sterilisation choices, and skin closure materials were recorded. Baseline data collection occurred over a 3 week period, followed by dissemination of results locally via clinical governance meetings and poster displays. A re-audit of practice was conducted using the same methodology and duration. Datasets 1 (n = 23) and 2 (n = 23) included open (n = 22), laparoscopic (n = 24), elective (n = 22) and non-elective (n = 24) cases. Good practice was demonstrated in reusable textiles (trolley covers 96%, 78%, drapes 100%, 92%) however procurement issues reduced otherwise good reusable gown use in Dataset 2 in (90%, 46%). No unnecessary catheter use was identified, and loose skin preparations were used unanimously. Uptake of alcohol-based scrubbing techniques was low (15%, 17%) and unnecessary non-sterile glove use was observed in >30% of procedures. All laparoscopic ports and scissors were single use. Carbon footprints were 128.27 kgCO2e and 117.71 kgCO2e in datasets 1 and 2 respectively. This project evidences good practice alongside future local focus areas for improved sustainability. Adoption of hybrid laparoscopic instruments, avoiding unnecessary equipment opening, and standardising reusable materials could reduce carbon and environmental impact considerably. Successful implementation requires considered procurement practices, improved awareness and education, clear leadership, and a sustained cultural shift within the healthcare community. Collaboration among professional institutions and access to supporting evidence is crucial in driving engagement and empowering clinicians to make locally relevant changes a reality.

Risk of post-vasectomy infections in 133,044 vasectomies from four international vasectomy practices.

To estimate the risk of post-vasectomy infections in various settings and across various surgical techniques and sanitization practices. Retrospective review of the records of 133,044 vasectomized patients from four large practices/network of practices using the no-scalpel vasectomy (NSV) technique in Canada (2011-2021), Colombia (2015-2020), New Zealand (2018-2021), and the United Kingdom (2006-2019). We defined infection as any mention in medical records of any antibiotics prescribed for a genital or urinary condition following vasectomy. Post-vasectomy infection risks were 0.8% (219 infections/26,809 procedures), 2.1% (390/18,490), 1.0% (100/10,506), and 1.3% (1,007/77,239) in Canada, Colombia, New Zealand, and the UK, respectively. Audit period comparison suggests a limited effect on the risk of infection of excising a short vas segment, applying topical antibiotic on scrotal opening, wearing a surgical mask in Canada, type of skin disinfectant, and use of non-sterile gloves in New Zealand. Risk of infection was lower in Colombia when mucosal cautery and fascial interposition [FI] were used for vas occlusion compared to ligation, excision, and FI (0.9% vs. 2.1%, p<0.00001). Low level of infection certainty in 56% to 60% of patients who received antibiotics indicates that the true risk might be overestimated. Lack of information in medical records and patients not consulting their vasectomy providers might have led to underestimation of the risk. Risk of infection after vasectomy is low, about 1%, among international high-volume vasectomy practices performing NSV and various occlusion techniques. Apart from vasectomy occlusion technique, no other factor modified the risk of post-vasectomy infection.

Perceptions of Glove Use During Vaccination: A Cross-Sectional Study.

To better understand clinic attendees' perceptions of nonsterile glove (NSG) use during vaccination and their concern for the environment. This was a cross-sectional, self-administered, in-person survey. A nonrandom volunteer sample of vaccination clinic attendees (n = 789) completed a survey assessing their perception of NSG use during influenza vaccination administration and their concern for the environment. Nearly all respondents equated NSG use with increased safety and professionalism. More than half of respondents reported feeling concerned about environmental waste associated with NSG use. NSG are not indicated for routine vaccination. Adherence to evidence-based practices on NSG use during vaccination can substantially reduce associated medical waste. Nurses can lead by example by only using NSG when indicated.

Gloves use and possible barriers - an observational study with concluding questionnaire.

Aim: The basic assumption of this study was that the use of medical non-sterile gloves represents a barrier to correct hand hygiene behaviour. The aim of this study was to examine this assumption and detect reasons for possible incorrect behaviour. Accordingly, the hypothesis is that peri-glove compliance is lower than hand-disinfection compliance. Methods: The study involved the direct observation of the use of non-sterile, single-use medical gloves in three different wards of a university hospital. Nursing staff and physicians were observed. After the observation period, the observed persons received a custom-designed questionnaire in order to test their self-assessment, knowledge as well as structural conditions relating to the use of gloves. The results were evaluated and compared with the observation data. Results: All employees disinfected their hands in 18.6% of cases before and in 65% of cases after the use of non-sterile gloves. Gloves were changed in the event of the indication for hand disinfection/change of gloves in 27.5% of cases. When changing gloves, the employees disinfected their hands in 47.2% of cases. The respondents assessed themselves as being significantly better than the observations revealed. The respondents are aware of the rules about hand disinfection before and after the use of gloves. However, it was less commonly known that gloves are not an absolute barrier to the transmission of bacteria.Conclusion: Non-sterile single-use gloves seem to be a barrier to hand disinfection. Solutions must be found in order to improve peri-glove compliance, in particular with regard to hand disinfection before and during the wearing of gloves. Alongside the mere transfer of knowledge, the use of non-sterile gloves with regard to the current structural conditions in everyday clinical practice should be critically scrutinised, questioned, tested and developed for the users through precise instructions.

Alcohol Pads and Nonsterile Gloves in Preparation of Aflibercept

Use of nonsterile gloves and an alcohol pad does not significantly impact the contamination of the rubber septum of the aflibercept vial. Other contamination points might instead be explored for endophthalmitis risk.

Use of non-sterile gloves in the ward environment: an evaluation of healthcare workers' perception of risk and decision making.

Studies have found that inappropriate use of non-sterile gloves (NSG) can affect hand hygiene compliance; the main risks are missing opportunities for hand hygiene and gloves being a vector for microbial transmission. The aims of this study were to explore the accuracy of healthcare worker (HCW) risk assessment and decision making regarding the use of NSG. The study was conducted in two acute NHS Trusts and a community social enterprise. A cross-sectional survey was carried out, followed by qualitative semi-structured interviews. There were highly significant differences at the 95% probability level between staff groups, unqualified staff being significantly more likely than qualified staff to report NSG use when not indicated (P < 0.0001). The primary motivating factor for staff to wear NSG was for personal protection; the secondary factor being the protection of patients. Staff were also motivated by a desire to create an image of professionalism. Respondents were more likely to follow the lead of seniors in their own profession. The results suggest a necessity for change interventions aimed at unqualified staff such as healthcare assistants (HCAs). It would be beneficial to review the indications for glove use and amend organisational policies accordingly. Leaders in each professional staff group would be required to influence practice across organisations, taking into account motivating factors, and in association with multi-modal interventions to improve practice.

Sterility and cost of gloves during Mohs micrographic surgery: Sterile or peril?

In recent years, the focus in the field of health care has shifted toward cost-saving strategies without the sacrifice of patient safety and clinical outcomes. Therefore, we decided to look into the use of nonsterile gloves and sterile gloves during Mohs micrographic surgery. This practice varies widely between Mohs surgeons. However, studies have shown no differences in infection rates. Here, we review the pertinent studies and also combine the data to offer readers an overall financial analysis.

Scabies outbreak at the Hospital Víctor Lazarte Echegaray, Trujillo, 2017

Objective: To describe the characteristics of a scabies outbreak and assess the effect of the control measures. Materials and methods: A descriptive and prospective epidemiological study was conducted at a reference hospital with220 inpatient beds. Data was collected by visiting the Medicine Service on a daily basis, interviewing the healthcare personnel and examining the medical records. The description of the outbreak includes epidemiological variables such as subject, place and time. Descriptive statistics was used to determine the absolute and relative frequencies, as well as the attack rate. Patients and healthcare personnel were requested to sign an informed consent and received information about the benefits of the research. The intervention consisted of isolation measures and contact transmission-based precautions. The use of non-sterile gloves was emphasized. Results: The outbreak took place between the epidemiological weeks 29 and 37 in the year 2017. The index case was a 93-year-old male patient who had Norwegian scabies and was admitted to the hospital due to Alzheimer’s disease. The scabies occurred in nine female nurses, seven residents, six nurse technicians, one intern y five inpatients. Conclusions: This propagated-source outbreak lasted nine epidemiological weeks; and affected nurses, residents, interns and inpatients. The attack rate was 40 %. The prevention and control measures were isolation of the index case and patients, hand hygiene before and after patient care, use of non-sterile gloves, use of scrubs, use of individual medical supplies for each patient, handling of clothing from scabies-infected patients in sealed bags and using gloves, surface cleaning, withdrawal of scabies-infected health workers from their duties until 24 hours of treatment onset, and epidemiological surveillance. Medical treatment was 5 % permethrin lotion for three days. Use of biosafety standards is recommended for patient care, especially when patients are admitted to the hospital with skin lesions. The implemented measures must be considered to prevent and control this type of outbreak.

Ultrasound assessment of the myofascial trigger point, where is the local twitch response located?

Background A myofascial trigger point (MTrP) is defined as a nodule or hyperirritable spot of focal pain in response to pressure which is found on a palpable taut band of skeletal muscle. For the physical therapy diagnosis, assessment tools such as musculoskeletal ultrasound have shown that it is possible to visualize the MTrP in gray scale (B mode) and in elastography; however, no previous studies have evaluated the correlation between the appearance of a local twitch response and the presence of a myoaponeurotic septum. The aim of the present study was to evaluate the correlation between the local twitch response and the presence of a myoaponeurotic septum at the time of the response. Material and Methods A prospective observational study was performed at the Sannus Clinic center (Madrid) including patients with the following inclusion criteria: subjects over the age of 18, with the presence of active MTrPS according to the criteria established by Travell &amp; Simons. The ultrasound-guided dry needling technique was performed (US-guided DN) on the dysfunctional muscles, according to the methods described by Valera &amp; Minaya, as follows: 1) manual identification and localization of the myofascial trigger point; 2) Ultrasound assessment of the area corresponding to the identified MTrP. The palpatory hand was substituted in this case by the ultrasound probe which applies pressure upon this band, for its study; 3) Establishment of safety measures during the procedure; 4) The extremes of the probe were marked using a dermographic pen; 5) Removal of the probe and asepsis of the skin of the area prior to needling; 6) Pre-intervention measures: hand-washing, use of non-sterile gloves and a probe cover, followed by preparation of the sterile needle and gauze; 7) The probe was placed on the area of study, with the marks established on the skin; 8) Ultrasound-guided intervention; 9) Needle removal and compression during 30 seconds; 9) Re-assessment. Once the local twitch response was visualized, the position of the needle tip was marked on the ultrasound image. Results The sample was comprised of 40 patients (23 men; 17 women) who received the US-guided DN procedure in the following muscles: upper trapezius (n = 32), extensor digitorum (n = 25), infraspinatus (n = 14), medial gastrocnemius (n = 8), gluteus medius (n = 12). In 87.9% of muscles (n = 80) a local twitch response was obtained when the needle tip was close to the myoaponeurotic septum. Discussion From our point of view, the myoaponeurotic septum of a muscle with an active MTrP could represent a place for load transmission, which would justify the activation of the muscle tissue, and the genesis of the MTrP. Considering the diagnostic criteria of the MTrP, the local twitch response is one of the most determinant elements, therefore, its location in the proximity of this anatomical area could be used as a reference. Conclusions The local twitch response is often obtained in the proximity of a myoaponeurotic septum of the dysfunctional muscle.

1200. Parent Perspectives on Infection Prevention and Control in the NICU

BackgroundInfants admitted to the neonatal intensive care unit (NICU) are at high risk for healthcare-associated infections (HAIs) due to their immature immune systems and need for invasive devices. Parents have frequent contact with their infants and present an opportunity for prevention practices. The objective of this study was to evaluate parental opinions related to infection prevention and control (IPAC) in the NICU.MethodsAn online survey was sent to a network of 2,000 parents from the Canadian Premature Babies Foundation. The survey included questions about patient-centered outcomes, IPAC practices experienced during their infants’ NICU admission, and specifically, opinions regarding nonsterile glove use by both healthcare workers (HCWs) and parents.ResultsA total of 72 parents responded to the survey. The majority were parents of infants born at less than 37 weeks (94%) and had been admitted to an NICU after 2010 (89%). When asked about preventing infections in the NICU, 82% of parents indicated they had been given information on how the NICU prevents infection and 96% had been told how they can prevent infection in their infant (Table 1). The most common information was related to hand hygiene (96%) and what to do if they were unwell (89%). Opportunities for improvement included being bare below the elbow, nail care, and feeding human milk. With respect to IPAC outcomes of interest, 96% agreed that it was important to study interventions to reduce bloodstream infections (BSIs). Other outcomes of interest (Table 2) included necrotizing enterocolitis (72%), antibiotic-resistant organism acquisition (69%), and length of stay (67%). With respect to glove use, 89% of parents felt that it was acceptable for HCWs to wear gloves when caring for their infant. Only 37% of parents indicated that they would want to wear gloves if HCWs were wearing gloves, but 47% would consider wearing gloves if there was evidence that it reduced infection in their infant.ConclusionReducing infections, specifically BSIs, in infants admitted to the NICU is an outcome of interest for parents. Nonsterile gloving by HCWs is considered an acceptable strategy by parents to reduce infections. Missed opportunities exist for the education of parents in the NICU on IPAC practices. Disclosures All authors: No reported disclosures.

1199. Provider Perspectives on Nonsterile Glove Use in the NICU

BackgroundLate-onset infection is a serious cause of mortality and long-term morbidity in NICU patients. Healthcare worker hands are the most common vehicle for transmission of pathogenic organisms to neonates. Studies have suggested a reduction in infections in neonatal and pediatric patients cared for with universal nonsterile glove use.MethodsWe developed an online survey (https://fhspeds.mcmaster.ca/pedsCapOne/surveys/?s=9RDX7EHT79) for clinicians to understand the current glove use and hand hygiene practices in NICUs in North America. The survey was sent to neonatologists and Pediatric Infectious Disease Specialists via the AAP Neonatal-Perinatal Section listserv, SHEA and the Canadian Neonatal Network.ResultsOf 336 responses; the majority were from physicians at level 3 to 4 NICUs (97%), and from the United States (96.1%). Beyond sterile procedures, sterile gloves were used for central line dressing changes (88.4%), contact with central nervous system shunts (61.0%), and direct contact with central lines (57.4%). Nonsterile gloves were used most commonly for universal precautions and diaper changes (Table 1). Almost half of participants also used nonsterile gloves for all patients and 37.5% for extremely low birth weight (<1000 g) infants. While most sites (76.8%) stated that nonsterile gloves were not required for parents, 15.8% requested gloves also for parents. 58% of respondents felt there was not enough evidence for a practice change at this time and 53.3% felt further study was needed to assess the effect of nonsterile gloves and infection (Figures 2 and 3). Almost a third of respondents (n = 109) would be interested in participating in a randomized study to assess glove-based care. Major concerns with this approach included a possible reduction in hand hygiene compliance, environmental waste, and glove contamination (Figure 4).ConclusionThere is variability in gloving practices across NICUs in North America, with equipoise and interest in a potential randomized study to further explore the hypothesis that nonsterile gloves prevent late-onset infections in neonates. Disclosures All authors: No reported disclosures.

Hand hygiene before donning nonsterile gloves: Healthcare workers' beliefs and practices

Understanding the perceptions and beliefs of health care workers (HCWs) regarding glove use and associated hand hygiene (HH) may be informative and ultimately improve practice. Research in this area is limited. This study examined the practices and beliefs of HCWs surrounding the use of nonsterile gloves and HH before gloving. The study was conducted at 3 large academic US hospitals using a parallel convergent mixed-method design. To estimate compliance rates, the gloving and HH practices of HCWs were observed at entry to patient rooms for 6 months. Interviews were conducted with 25 providers, nurses, and nursing assistants to investigate their beliefs and perceptions of these practices. Observed HH compliance rates before gloving were 42%, yet in the interviews most HCWs reported 100% compliance. Observed compliance with gloving before entering contact precaution rooms was 78%, although all HCWs reported always gloving for standard and contact precautions. Most HCWs described using gloves more often than necessary. HCWs generally use gloves for their own safety and sanitize hands before gloving for patient safety. Numerous barriers to compliance with HH before gloving were discussed, including beliefs that gloves provide enough protection. HH and glove use are highly intertwined in clinical practice and should be considered jointly in infection prevention improvement efforts.

Wet work exposure and hand eczema among healthcare workers: a cross-sectional study.

Hand eczema is more common in healthcare workers than in the general population. Hands are subject to changing occupational exposures as a result of mandatory hygiene regulations for healthcare workers. To describe exposure to hygiene procedures and investigate the associations between occupational hand washing, use of nonsterile gloves and hand disinfectant, and self-reported hand eczema. This was a cross-sectional study; an electronic questionnaire was distributed to 28762 hospital employees in southern Sweden. Nurses, assistant nurses or physicians constituted the group of healthcare workers analysed. Adjustments were made for sex, age, wet work at home, lifestyle factors and atopic dermatitis. In total, 12288 (43%) responded, including 9051 healthcare workers. In this group the 1-year prevalence of self-reported hand eczema was 21%. On a daily basis, 30% reported hand washing with soap > 20 times at work, 45% used hand disinfectants > 50 times and 54% wore nonsterile gloves for > 2h. After adjustment for confounding factors, a dose-dependent association with self-reported hand eczema was found for the daily number of hand washes with soap at work and time working with disposable gloves but not for alcoholic disinfectant use. Hand washing outside work was not associated with self-reported hand eczema in the adjusted multivariate analysis. In this study, we found a higher 1-year prevalence of self-reported hand eczema among Swedish healthcare workers than reported in the general population. Hand washing with soap and use of disposable gloves were associated with the occurrence of self-reported hand eczema in a dose-dependent way. Use of hand disinfectant was not associated with self-reported hand eczema.

Healing complications of dental extraction performed with and without sterile gloves

Introduction: Dental extractions are usually carried out in non-sterile environment using clean non-sterile gloves. However, the use of non-sterile gloves are frequently probed for post surgical socket healing complications. Hence it is necessary to gather clinical proofs to answer this query. The present study aimed to compare healing complications of dental extraction performed with and without sterile gloves.&#x0D; Methods: The study design was comparative cross-sectional. The sample size was calculated as 51 per group. The patients were randomly allocated to either group by allowing them to choose a lottery. All the patients undergoing non surgical dental extraction constituted the study population for present study. History taking and observation technique was used to collect data. The proforma was prepared and filled up by the researcher.&#x0D; Results: Four (7.8%) cases in clean sterile group and 3 (5.9%) cases in surgical gloves group had some complications. The difference in presence of complications across groups was not significant.&#x0D; Conclusion: The non-sterile clean gloves do not increase the incidence of postoperative complications as compared to sterile gloves.

The application of epic3 guidelines: the complexity of practice.

Healthcare-associated infection (HCAI) is a major patient safety concern and is associated with morbidity, mortality and increased healthcare costs. Prevention and control requires a multi-modal approach, but the individual's accountability and rigorous application of standard infection prevention and control behaviours is at its core. The third instalment of the epic3 guidance ( Loveday et al, 2014a ) provided the evidence and advanced the importance of hand-hygiene behaviour, the use of non-sterile gloves and environmental cleanliness. This discussion considers some of the recommendations made in these areas of practice and some of the underlying complexities. Producing guidelines based on the best available evidence and transforming them into policies can be a useful adjunct to communicating the necessary standards. However, policies often erase the complexity of implementation. To strive for the best possible standard is an understandable and laudable objective, but organisations need to be mindful of the difficulties and obstacles that stand in their way, particularly in an era where the philosophy of 'zero tolerance' is gaining popularity.

The misuse and overuse of non-sterile gloves: application of an audit tool to define the problem.

The use of non-sterile gloves (NSG) has become routine in the delivery of health care, often for procedures for which they are not required; their use may increase the risk of cross contamination and is generally not integrated into hand hygiene audit. This paper describes a small-scale application and validation of an observational audit tool devised to identify inappropriate use of NSG and potential for cross contamination. Two observers simultaneously observed the use of NSG during episodes of care in an acute hospital setting. The inter-rater reliability (IRR) of the audit tool was measured corrected for chance agreement using Kappa. A total of 22 episodes of care using NSG were observed. In 68.6% (24/35) of procedures there was no contact with blood/body fluid; in 54.3% (19/35) NSG-use was inappropriate. The IRR was 100% for eight of 12 components of the tool. For hand hygiene before and after NSG removal it was 82% (Kappa = 0.72) and 95% (Kappa = 0.87). In this small-scale application of a glove-use audit tool we demonstrated over-use and misuse of NSG and potential for cross transmission on gloved hands. The audit tool provides an effective mechanism for integrating glove use into the audit of hand hygiene behaviour.