When should gloves be worn? WHO guidelines

Author: lic. rat. med. Jerzy A. Kozłows­ki

Rękaw­icz­ki ochronne rotec­tive gloves ensure the safe­ty of patients and health­care work­ers. In Poland, health­care-asso­ci­at­ed infec­tions affect approx­i­mate­ly 700,000 patients annu­al­ly. Hos­pi­tal infec­tions are a sig­nif­i­cant pub­lic health issue, and the WHO esti­mates that their treat­ment costs up to 80 bil­lion dol­lars world­wide each year. There­fore, it is no sur­prise that there is a strong empha­sis on improv­ing the qual­i­ty of infec­tion con­trol sys­tems and the need for the use of per­son­al pro­tec­tive equip­ment.

Not so clear rules for putting on disposable gloves

W teorii kwes­t­ia tego, kiedy zakładamy rękaw­icz­ki jed­no­ra­zowe, jest intu­icyj­na i każdy pra­cown­ik sys­te­mu ochrony zdrowia nie powinien mieć prob­le­mu z odpowiedz­ią na to pytanie – w prak­tyce sytu­ac­ja wcale nie jest oczy­wista. Między inny­mi dlat­ego WHO opra­cow­ało schemat, nazwany „piramidą poma­ga­jącą pode­j­mować decyzję, kiedy należy nosić (lub nie) rękaw­icz­ki”.

First: hand hygiene

Dis­pos­able gloves pro­tect the patient as well as med­ical staff, care­givers, or those pro­vid­ing assis­tance, from the risk of infec­tion and pre­vent the trans­mis­sion of bio­log­i­cal agents through the hands. Hands are the pri­ma­ry source of trans­mis­sion for up to 90% of pathogens. Dłonie są głównym źródłem trans­misji nawet do 90% pato­genów.

Microor­gan­isms can remain on the skin after con­tact with con­t­a­m­i­nat­ed sur­faces. Typ­i­cal­ly, this dura­tion ranges from 2 to 60 min­utes, but for some pathogens, it can be sig­nif­i­cant­ly longer, such as up to 4 hours for rotavirus, over 2.5 hours for Staphy­lo­coc­cus aureus, and up to 90 min­utes for E. coli. Mean­while, the coro­n­avirus SARS-CoV­‑2 can sur­vive up to 3 hours in aerosol form, up to 24 hours on card­board sur­faces, and up to 72 hours on stain­less steel or plas­tic.

Guidelines for Using Single-Use Gloves

The man­date to wear gloves applies to all med­ical staff. Only effec­tive and thor­ough hand hygiene, adher­ence to safe­ty rules, and the use of dis­pos­able pro­tec­tive gloves can min­i­mize the risk of infec­tion or trans­mis­sion of pathogens. The fol­low­ing rules should be observed: work in short-sleeved cloth­ing (with cer­tain excep­tions) and with­out jew­el­ry that could punc­ture the glove; main­tain nail and hand skin hygiene, and use appro­pri­ate­ly select­ed gloves that pro­vide com­fort and an ade­quate lev­el of pro­tec­tion.

Med­ical staff should be trained in the prop­er way to put on and remove gloves, as it turns out that dur­ing their removal, the skin is con­t­a­m­i­nat­ed in near­ly 53% of cas­es (accord­ing to a 2015 Amer­i­can study involv­ing a group of 435 work­ers).

In what situations should we wear protective gloves?

The “pyra­mid to help decide when to wear (or not) gloves,” pro­posed by WHO, helps deter­mine when to put on dis­pos­able gloves, in which sit­u­a­tions ster­ile gloves are required, and when they are not nec­es­sary.

Disposable protective gloves are not required*:

• In cas­es where there is no expo­sure to blood, patient bod­i­ly flu­ids, and con­tact with con­t­a­m­i­nat­ed envi­ron­ments, sur­faces, or objects.
• In the case of direct con­tact with a per­son dur­ing: blood pres­sure mea­sure­ment, pulse mea­sure­ment, bathing and dress­ing the patient, trans­port, care of the eyes and ears (with­out secre­tion), etc. The WHO pyra­mid also indi­cates that there is no need to wear gloves for sub­cu­ta­neous and intra­mus­cu­lar injec­tions, how­ev­er, the nation­al con­sul­tan­t’s posi­tion in epi­demi­o­log­i­cal nurs­ing dif­fers. Impor­tant: These guide­lines do not apply to excep­tion­al sit­u­a­tions such as epi­demics.
• In cas­es of indi­rect con­tact with the patient with­out the risk of con­tact with blood and secre­tions. Such activ­i­ties include admin­is­ter­ing oral med­ica­tions, pro­vid­ing oxy­gen, com­plet­ing med­ical doc­u­men­ta­tion, etc.

*Except in epi­demi­o­log­i­cal sit­u­a­tions, such as dur­ing the COVID-19 pan­dem­ic or oth­ers.

Although gloves are not required in the spec­i­fied sit­u­a­tions, this does not mean that they can­not be worn for per­son­al safe­ty. Addi­tion­al­ly, the above points do not apply to con­tact with patients under con­tact iso­la­tion.

The obligation to wear non-sterile gloves:

• In any sit­u­a­tion where there is a pos­si­bil­i­ty of con­tact with blood, bod­i­ly flu­ids, and secre­tions.
• Dur­ing direct con­tact with blood, mucous mem­branes, dam­aged skin, poten­tial­ly con­t­a­m­i­nat­ed mate­r­i­al dur­ing med­ical and diag­nos­tic pro­ce­dures and exam­i­na­tions.
• Dur­ing indi­rect con­tact with the patient in sit­u­a­tions where the envi­ron­ment may be con­t­a­m­i­nat­ed with secre­tions, blood, or bod­i­ly flu­ids.

The obligation to wear sterile disposable gloves:

• Dis­pos­able ster­ile gloves should always be worn dur­ing sur­gi­cal pro­ce­dures, child­birth, inva­sive radi­o­log­i­cal pro­ce­dures, pro­ce­dures relat­ed to vas­cu­lar access, and the prepa­ra­tion of par­enter­al nutri­tion and chemother­a­py.

Wearing Gloves — Summary

The “pyra­mid to help decide when to wear (or not) gloves” is a clear and rec­om­mend­ed frame­work that, com­ple­ment­ed by prop­er hand hygiene and adher­ence to med­ical pro­ce­dures, can reduce the num­ber of hos­pi­tal infec­tions by half and sig­nif­i­cant­ly increase the safe­ty of the staff itself. Gloves not only reduce the risk of trans­fer­ring bio­log­i­cal agents via hands but also sub­stan­tial­ly lim­it the num­ber of work­er infec­tions, for exam­ple, by mechan­i­cal­ly stop­ping about 50% of bio­log­i­cal mate­r­i­al dur­ing nee­dle sticks.

Addi­tion­al­ly, it is impor­tant to empha­size that not only health­care work­ers, but also, for exam­ple, fam­i­ly mem­bers vis­it­ing a patient in the hos­pi­tal, should at least dis­in­fect their hands, and in cer­tain sit­u­a­tions, also wear dis­pos­able gloves.

 

Bibliography:

1. dr. Bea­ta Ochoc­ka, „Pirami­da stosowa­nia rękaw­iczek ochron­nych WHO – pol­s­ka per­spek­ty­wa; kil­ka uwag i reflek­sji o groźnych infekc­jach”, Mag­a­zyn Pielęg­niar­ki Oper­a­cyjnej, #1(18)/2017 s.7–9;
2. dr n. med. Katarzy­na Maj­da, lek.  Sła­womir Gondek, „Zmniejsze­nie iloś­ci zakażeń szpi­tal­nych poprzez odpowied­ni dobór rękaw­ic”, Skamex Sp. z o.o. Sp.k.;
3. Mate­ri­ały Min­is­terst­wa Zdrowia i NFZ, „Przestrze­ganie higieny chroni przed koron­awirusem”, por­tal inter­ne­towy pacjent.gov.pl (16.03.2020);
4. World Health Hor­gan­i­sa­tion, „Hand Hygiene: Why, How & When?”, por­tal who.int;
5.„Stanowisko Kon­sul­tan­ta Kra­jowego w dziedzinie pielęg­niarst­wa epi­demi­o­log­icznego w spraw­ie uży­wa­nia rękaw­ic ochron­nych do wykony­wa­nia iniekcji pod­skórnych, śród­skórnych i domięśniowych”, por­tal pieleganiarki.info.pl (21.09.2010);
6. Sto­warzysze­nie Epi­demi­ologii Szpi­tal­nej, „Higiena rąk w placówkach medy­cznych na pod­staw­ie rekomen­dacji Świa­towej Ochrony Zdrowia”, Szkole­nie dla pra­cown­ików medy­cznych, por­tal ses.edu.pl;