The Use of Gloves in Infection Control: Factors Influencing Glove Use In Student Nurses
Glove use may prevent the spread of micro-organisms in healthcare settings, but student nurses’ use of gloves appears to follow ward culture rather than formal policies
Gloves can prevent infection but their use among student nurses is inconsistent.
To explore pre-registration student nurses’ views of non-sterile glove use in clinical practice.
An online survey was conducted and focus groups carried out among third-year student nurses.
The online survey showed that gloves were often worn inappropriately, while the focus groups revealed students conformed to their mentors’ use of gloves.
Student nurses’ decisions on wearing gloves seem to be based on the culture of the clinical care environment rather than trust policy. Glove overuse deprives patients of therapeutic touch and may lead to contact dermatitis in nurses.
All student nurses must be able to identify clinical situations when gloves are not indicated, using appropriate risk assessment.
5 KEY POINT
1.Infection prevention and control is an integral part of pre-registration nursing education
2.Appropriate glove use is an important way to prevent the spread of healthcare-associated infection
3.There is still confusion among student nurses regarding the appropriate use of non-sterile gloves
4.Role modelling and the culture of the clinical care environment influence student nurses’ decision making
5.The World Health Organization’s “glove pyramid” may be a useful tool to inform student nurses’ clinical practice
Infection prevention and control are integral to pre-registration nurse education and practice (Nursing and Midwifery Council, 2010). A vital part of this education is enabling students to understand appropriate glove use in clinical practice. This pilot study explored student nurses’ glove use when carrying out routine, non-invasive nursing interventions such as bed making, personal cleansing and dressing, and recording vital signs.
Wearing gloves as a routine measure may have implications for the nurse-patient relationship, as gloves may act as a barrier to therapeutic touch (Gleeson and Timmins, 2005). There are also implications linked to inappropriate glove use including: costs; an increased risk of dermatitis during long-term glove use, with associated loss of employment (Royal College of Nursing, 2012); and a negative impact on hand hygiene (Loveday et al, 2014).
The prevention and control of healthcare-associated infections (HCAIs) has always been an integral part of nursing practice. During the last decade, concern about the increase in HCAIs has lead to a greater emphasis on infection prevention and control. The Epic guidelines for preventing HCAIs provide the most systematic and comprehensive advice, based on up-to-date evidence, to prevent the spread of HCAIs in acute care environments (Loveday et al, 2014a). They state that gloves should be worn to:
Protect hands from contamination with organic matter and micro-organisms;
Reduce the risk of cross-transmission of micro-organisms to staff and patients (Loveday et al, 2014a).
The guidelines also state there is evidence that clinical gloves are not used in line with current guidance, and that glove use has a negative impact on hand hygiene (Loveday et al, 2014a).
In England and Wales, the National Patient Safety Agency (200 reinforced its 2004 Cleanyourhands campaign with the message: “Clean hands save lives.” The Department of Health subsequently published a code of conduct to ensure that health and social care providers comply with the Care Quality Commission’s registration requirements for cleanliness and infection control (DH, 2010).
In response to global concerns related to HCAIs, the World Health Organization has produced guidelines on hand hygiene in healthcare (WHO, 2009a). The guidelines suggest that since 1987 there has been an increase in glove use, and recognise that this may result in their misuse and overuse. They also suggest there is a poor understanding among healthcare workers about appropriate glove use.
WHO’s (2009b) “glove pyramid” (Fig 1) provides guidance for glove use in clinical practice, suggesting a hierarchal approach to glove use within clinical practice. At its base are the indications for not wearing gloves, followed by indications for using examination gloves then, at the top, sit the indicators for wearing sterile gloves.
The use of gloves for routine care has been observed by lecturers when pre-registration students are practising in clinical education simulation sessions. Anecdotally, when questioned, students suggested they were role modelling their mentors in practice or acting in accordance with trust policies or protocols. A recent qualitative study by Loveday et al (2014b) identified that health professionals’ decisions to wear gloves were influenced by role modelling, or they had been instructed to wear gloves when challenged by other members of the clinical team. It is interesting to note that local trust policies and protocols, while ostensibly based on research evidence, do not always provide clear guidance for the wearing of non-sterile disposable gloves in situations where there is no perceived risk.