Jennie Wilson, PhD, MSc, RGN, HonMFPH, an associate professor in the Infection Prevention Society in Brentford, United Kingdom, delved into some of the emotional and psychological aspects of glove use recently in Charlotte, NC, at the annual meeting of the Association for Professionals in Infection Control and Epidemiology (APIC).
“We defined as appropriate glove use [when healthcare workers] were doing a procedure with their gloves on that involved direct contact with blood and body fluid, mucous membranes, or that involved a patient under contact precautions,” she said. “If they were weren’t doing any of those things, we considered the glove uses inappropriate. Almost 60% of the [observed] episodes where gloves were used, there wasn’t an indication to use them. This tells us that people are widely using gloves when they don’t need to use gloves for infection control.”
In a study that included interviews with healthcare workers, Wilson found workers wearing gloves for routine tasks like making a bed. Others had “no particular reason” to be wearing gloves, but nevertheless were doing so.
“I asked the auditors, what were these people doing?” Wilson says. “We don’t know, really; they were just wandering around with a pair of gloves on — sometimes for about 20 minutes.”
Of course, wearing gloves routinely — apparently for the worker’s protection — translates to contamination via other environmental surfaces, equipment, and the like before the worker approaches the patient bedside.
“When you have a nice pair of blue gloves on, you’re very hygienic,” she says. “Not necessarily — because you have probably touched hundreds of things before you get to the patient. But the impression given is you are very hygienic because you have gloves on.”
Even some workers who changed their gloves appropriately to begin care made the mistake of leaving them on for more than one task with the same patient.
“They may empty a catheter bag, give the patient mouth care, check the patient’s blood sugar — all with the same pair of gloves on,” she said.
Williams and colleagues interviewed some 50 healthcare workers in two hospitals to better understand their rationale for such ubiquitous glove use. The following are some of the comments they received from healthcare workers explaining why they wear gloves:
- “Some older men or women can’t always wash their own clothes and things. They cannot always be as clean as they might have been when they were younger.”
- “When patients have skin conditions, even when you know that it’s not anything which is contagious and catching…it looks horrible.”
- “I find that when I have gloves on I’m less OCD about needing to wash my hands.”
- “I was told in induction that we don’t need gloves for washing patients …but, for me, I don’t feel comfortable not wearing gloves. I feel a lot safer and I feel a lot more relaxed.”
- “[Gloves] make me feel safer, more relaxed, more comfortable, and more confident.”
- “If I wasn’t wearing gloves [for washing a patient], I think I’d feel kind of awkward.”
- “Obviously if it’s quite personal areas, you’re definitely going to wear your gloves.”
- “I’d take a judgment from the patient, I think, because sometimes they might be more uncomfortable if you didn’t wear gloves. Whereas if you’ve got your gloves on, it’s a bit more clinical, so they feel more dissociated from it.”
Ultimately, glove use is highly influenced by personal decisions and healthcare workers may feel they have the right to wear them for their own peace of mind.
“That’s really critical because if we are going to change behavior, we have to recognize that that’s how people feel about it,” Williams says. “They don’t think anybody else has the right to tell them when they should or should not wear gloves.”
Workers observed erred on the side of wearing gloves, in part because they don’t know if the patient may be infectious.
“To me, that sounds like a conflation of standard precautions — treat everybody the same — and contact precautions — you wear gloves for everything,” Williams says. “They’ve merged the two things, and said that means you wear gloves with everybody because that’s what we do when we know somebody has an infection.”