The gloves are off!

 

The ‘Gloves are Off’ campaign aims to combat the use of non-sterile gloves that have been associated with a significant potential for cross-contamination and transmission within the healthcare industry. This is because medical gloves are a single-use item that are being used unnecessarily and left unchanged at crucial points. The Lead Nurse and Lead Practice Educators developed the ‘Gloves are Off’ Campaign to improve patient and staff safety by ensuring that patients and their families are seen by staff with clean hands.

 

  • Introduction

  • Hurting Hands: The Effects of Wearing Gloves Inappropriately

  • The Crucial Moments: When Should You Wash Your Hands?

  • A Helping Hand for the Planet


Introduction

 

Launched in April 2018 by Great Ormond Street Hospital (GOSH), the ‘Gloves are Off’ campaign received an overwhelming positive response from within the healthcare industry. Hygiene has always been regarded with the utmost of importance for anyone working in healthcare, and with the recent threat from the COVID pandemic, the focus on hand sanitisation has become a focal point. However, when do gloves really need to be on and when is it appropriate to take those gloves off?

Rose Gallagher, RCN Professional lead for Infection Prevention and Control, states that “health care workers face a lot of visual imagery that does not show glove use with its right function or purpose in real life”, and though personal protective equipment (PPE) has become a crucial part of everyday healthcare, with gloves being a “fundamental and very necessary element of personal protective equipment”, there is a risk that the misuse of plastic gloves will have a negative impact on both the user and the environment.


Hurting Hands: The Effects of Wearing Gloves Inappropriately

 

An RCN survey, published in 2020, shows that 93% of nurses had reported at least one symptom of hand dermatitis in the previous 12 months, with the long wearing time of gloves being the underlying reason. Rose Gallagher, Professional lead for Infection Prevention and Control, explains; “Wearing gloves inappropriately can cause skin problems for staff and also prevent hand hygiene, putting patients at risk of infection”. This problem persists, Rose continues, as there is a disparity between the educational understanding surrounding “classroom use” and the actuality of ‘practically working’. Too often, gloves are used when they are not needed, put on too early, taken off too late, or not changed at critical points (Wilson, Loveday, 2017).

Nicola Wilson, Practise Educator at Great Ormond Street Hospital(GOSH), found that the practice of wearing gloves has become such an ingrained behaviour, common to all hospital staff, that the reality of gloves providing protection is actually being undermined by the misuse of this repeating behaviour. “Research shows that nurses and other healthcare professionals put gloves on because they believe it is protecting their patient in some way”, however, “it is not”, explains Nicola. “The gloves used are non-sterile nitrile gloves, so your clean hands are better for patients. We should only wear those gloves if we’re going to come into contact with bodily fluid, non-intact skin, or mucus membrane”.


The Crucial Moments: When Should You Wash Your Hands?

 

The World Health Organisation (WHO) advises that health professionals should decontaminate their hands at five critical points, known as the ‘Five Moments For Hand Hygiene’:

  •           Before Touching a Patient
  •           Before clean/aseptic procedure
  •           After body fluid exposure/risk
  •           After touching a patient
  •           After touching patient surrounding

By following the guide on ‘Five Moments for Hand Hygiene’, and replacing the unnecessary use of gloves with hand sanitisation, there has been a noticeable reduction in staff attendances to occupational health for hand and skin related problems. Meanwhile, the CVL infection rate remains within the normal parameters and there has been no adverse rise in hospital acquired infections. 

Many sectors in healthcare have found that hand sanitisation provides a more appropriate and beneficial method of undertaking everyday tasks. Unfortunately, as Helen Dunn, nurse consultant for infection control at GOSH, identifies: “Through audit, we have discovered that one of the biggest reasons why staff weren’t washing their hands is because they were wearing gloves”. This misunderstanding on when it is necessary to wear gloves as a form of protection and when it is unnecessary, shares a distinct correlation with the recorded volume of symptoms linked to hand dermatitis amongst nursing staff. Ali Upton, Chair of the RCN UK Safety Representatives Committee, shares an example: “Sometimes, gloves are worn when entering data onto tablets or computers. Hand hygiene is, and should, be preferable to glove wearing when completing work such as administrative tasks”.


A Helping Hand for the Planet

 

Currently, medical gloves are single-use items, and as such, the number of gloves used in healthcare has a direct impact on the environment. According to the NHS, following the ‘Gloves Are Off’ campaign, there has been a significant reduction in the number of medical gloves ordered by hospitals and associated trusts. This environmental change to produce less waste has helped engage the nursing staff to consciously make a change to their routine, and has encouraged a healthy approach to both the well-being of now and the future. Nicola Wilson, Practise Educator at Great Ormond Street Hospital (GOSH), found that ‘one of the main reasons staff were persuaded to ditch the gloves was one that we hadn’t anticipated. It was the environmental factors. Nicola continues, ‘We have young staff here, and for them, how we treat our environment is really important”. Although the figures have not been published, the RCN states that glove use had reduced by an average of 36,608 pairs each week, compared to before the campaign began. Nicola states how well the movement has benefited GOSH and has already, one year later, shown significant results, beneficial for environmental concerns, as well as improving the staff and patient wellbeing.


Further Information