Last week I promised to discuss glove use in clinical care. So here it is.
There has been growing concern that donning gloves for patient care has led to a literal and figurative loss of touch between doctor and patient. In many ways, the gloved hands represent an artificial barrier to the healing touch. This was nicely explored by Dr. Pauline Chen in the following article. My quote in this article would suggest that glove use is a modern reality with little chance of reversal, especially given today’s emphasis on universal precautions and on controlling drug resistant bacteria.
Consider, however, the alternative. There are many advocates of aggressive screening of patients with implementation of contact isolation (precautions). I refer the reader to a spirited back and forth commentary on the expansion of contact precautions in the HAI Controversies blog. There is a growing body of literature highlighting the adverse effects of contact isolation in the hospital. For a nice review, click here. In brief, patients in contact isolation are visited less frequently by HCWs, have vital signs taken less often, have increased adverse events and experience symptoms of depression and dissatisfaction.
We favor the least restrictive approach. We aggressively promote broad based infection prevention efforts without hospital wide active detection and isolation. Hand hygiene and adherence to infection prevention best practice has allowed us to control drug resistant pathogens effectively in our ICUs. We published a manuscript documenting that universal gloving (without contact precautions) in a surgical ICU is as effective as the standard of care with contact precautions. This approach was well received by our HCWs, suggesting that it is sustainable.
So, gloving may result in a latex barrier, however, it is less restrictive and likely less damaging to the doctor-patient relationship than the barrier of isolation.
