Study Finds Hand Washing Before Gloving Hinders Adherence

A study recently published by the Journal of the American Medical Association (JAMA) Network Open has concluded that hand washing before donning gloves in a medical setting might not only be unwarranted but hinders adherence to policy as well.

According to the study, evidence is lacking to support current guidelines that require hand hygiene to be performed before putting on nonsterile gloves. Furthermore, these requirements appear to influence, in a negative way, adherence to infection prevention practices.

In mixed-method, multicenter, cluster randomized trial, which included 3,790 healthcare personnel across 13 hospital units of four academic centers, 87% of the participants adhered to a “direct-gloving” strategy, where individuals donned nonsterile gloves without tending to hand hygiene first. In comparison, just 41% adhered to the method where hand hygiene was performed before donning gloves.

When participants were asked about the perceived benefits of a direct-gloving policy, 68% saw potential benefits, including increased efficiency in time and cost, less skin irritation, improved adherence to expectations, and improved staff satisfaction. Additionally, 60% did not perceive risks or concerns associated with a direct-gloving strategy if proven safe; participants who did cite risks related them to undermining habits and uncertainty about contamination.

As for safety with the direct-gloving method, the report cited a previous trial that showed no significant difference on total bacterial colony counts between the two strategies. It also found both methods had a low overall prevalence of potential pathogenic organisms on gloves. The current report found similar results in all settings except emergency departments, where adherence to both hand hygiene and glove use was also found to be the lowest of all the healthcare units studied.

The report cited insufficient time, high workload, and understaffing as “important barriers” that might be keeping healthcare personnel from performing hand hygiene as often as they should.

Overall, the results concluded that a direct-gloving policy was “as safe as the current strategy requiring hand washing before donning gloves in areas in which hand hygiene rates were otherwise high” and could help healthcare facilities improve its staff’s adherence to “expected infection prevention practices and overall glove use.” However, the study also noted that a direct-gloving strategy should not be used in emergency departments or other areas where overall adherence to hand hygiene and glove use is low until further studies have been completed.