Gloves are critical personal protective equipment (PPE) used in multiple industries and professions to prevent direct contact between a potential harmful microorganism, chemical, object, solution or surface and the wearer's hand(s). In healthcare, gloves are used primarily as a barrier to prevent a healthcare worker (HCW) from having direct contact with a contaminated surface, an infectious patient, blood and body fluids and/ or harmful solutions or chemicals. As well, patients are protected from contamination by the HCW's hands when the HCW wears gloves. Whilst a variety of medical gloves are used widely in healthcare settings the scope of this edition of InTouch is limited to consideration of single use examination or surgical gloves and their use for the purposes of infection prevention and control.

Gloves are critical personal protective equipment (PPE) used in multiple industries and professions to prevent direct contact between a potential harmful microorganism, chemical, object, solution or surface and the wearer's hand(s). In healthcare, gloves are used primarily as a barrier to prevent a healthcare worker (HCW) from having direct contact with a contaminated surface, an infectious patient, blood and body fluids and/ or harmful solutions or chemicals. As well, patients are protected from contamination by the HCW's hands when the HCW wears gloves. Whilst a variety of medical gloves are used widely in healthcare settings the scope of this edition of InTouch is limited to consideration of single use examination or surgical gloves and their use for the purposes of infection prevention and control.

In every healthcare setting gloves must be comfortable, flexible and durable otherwise users may be disinclined to don gloves or the level of concentration or performance may suffer. In a very recent study Loveday considered how various healthcare disciplines used gloves (Loveday, Lynam, Singleton, & Wilson, 2014). She explored the long recognized practice of non-compliant HCWs who failed to change gloves appropriately between patients and procedures. Loveday found that glove use was appropriate in only 42% of observed occasions. This deviation from recommended glove use practice is concerning especially given the co-existing increased transmission risks associated with ongoing poor hand hygiene compliance. The World Health Organization (WHO) reported global rates ranging from 5% to 89%, with an overall average of 38.7% (World Health Organization, 2009) and likely inadequate and infrequent cleaning of high touch objects in hospitals (Boyce, 2016, Murphy et al., 2011). In combination these factors create the "perfect storm" for organism reservoirs and transmission of potentially pathogenic microbes via either HCWs' hands or contaminated surfaces.

Loveday's work also explored the specific stages during healthcare delivery when HCWs were most glove noncompliant. This included in disciplinary variations and how underlying beliefs impacted HCWs' choices regarding how they use gloves, Consistent with hand hygiene evidence, Loveday's research showed that nurses (45%) were more glove compliant than medical and allied health staff (24% it also mirrored the findings of hand hygiene research which has repeatedly shown that HCWs tend to value self-protection more than patient protection.

Loveday concluded the following are commonly occurring themes that emerged from her work. HCWs:

Timing of glove use and removal is an important aspect of infection prevention. So too is selection of a glove appropriate for the task. The wide variety of tasks typically required of HCWS range from specific grasping situations, handling of power tools, rapid donning in emergencies, palpation of skin, the need to determine surface temperature and contact with rough and jagged edges of either equipment or bone shards. There are many other tasks requiring different features of gloves. Whilst the clinical situations are diverse the range and performance attributes of commonly available gloves are comparatively limited. Typically, HCWs select gloves according to their fit, elasticity, tactility and ease of donning Comfort is of special significance to HCWs including surgeons, who typically are required to wear gloves for extended periods, Glove fit and avoiding hand fatigue are critically important in these cases as is the durability of the glove and its ability to withstand operating conditions without tearing, breaking or leaking (Mylon, Lewis, Carre, Martin, & Brown 2014). Torn or broken gloves are inefficient barriers and potentially predispose the transfer of infectious agents from or to the HCW's hand or the patient or touched surfaces.

Mylon highlights the importance of ensuring that gloves are comfortable recognizing that uncomfortable gloves can cause HCWs to lose or have lapses in concentration.

This can also increase the potential for them to make errors during care delivery which may inadvertently affect the patient's or their own safety. Accidental sharps injury and subsequent exposure to an infectious agent is one such example (Mylon et al 2014) Moylan's work also recognizes that glove design is most often generic in that size varies in half inch increments with no standard options differentiating between male and female hands and limited combinations of hand breadth and length.

Glove thickness is also on important consideration in selection. Some clinicians require gloves that enable them to maintain good child ability such as that required to assess skin temperature or to palpate during vascular access or fine surgical procedures. The ideal glove is of

a thickness that is protective and durable but does not limit the HCW's ability to perform tactile-dependent tasks. Choosing the correct glove is a critical component of using gloves as a barrier to prevent transmission of infection. It can also be a complex process. Clearly there is no "one size fits all" solution to glove selection and wearers may have to choose between tear and puncture resistance vs dexterity and tactile sensitivity. This section details a variety of HCW considerations and glove characteristics that need to be taken into account when selecting either examination or surgical gloves. Understanding glove quality and being able to assess it are equally important. They are determined by a combination of national, international and manufacturer standards including acceptable quality levels (AQLs) that are discussed in the next sections of this newsletter.

Additional Resources:

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