Monday, August 26, 2013

Hand Hygiene Before Putting on Nonsterile Gloves: A Waste of Time?

Here is a very intriguing article on the utility of hand hygiene prior to donning examination gloves.

The study was a prospective, randomized, controlled trial of health care workers entering contact isolation rooms in intensive care units. Baseline finger and palm prints were made from dominant hands onto agar plates. Health care workers were then randomized to directly don nonsterile gloves or perform hand hygiene and then don nonsterile gloves. Postgloving finger and palm prints were then made from the gloved hands. Plates were incubated and colony-forming units (CFU) of bacteria were counted.

Total bacterial colony counts of gloved hands did not differ between the 2 groups (6.9 vs 8.1 CFU, respectively, P = .52). Staphylococcus aureus was identified from gloves (once in "hand hygiene prior to gloving" group, twice in "direct gloving" group). All other organisms were expected commensal flora.

These data sugest that hand hygiene prior to donning nonsterile gloves does not decrease the already low bacterial counts on gloves and questions the utility of this practice.

So are we ready to stop washing out hands prior to putting on examination gloves?

Admittedly, slipping a still damp hand into an examination glove can be a hassle and yes hand hygiene is time consuming, but one study does not eliminate the time honored tradition of hand hygiene prior to patient care. 

Before suspending hand hygiene prior to examination glove use (while still encouraging hand hygiene following glove removal), prospective studies should assess the impact of this practice change on infection rates.

Until then, I am washing my hands.

1 comment: