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Certified nursing assistants often fail to change gloves in long-term care facility
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Certified nursing assistants frequently failed to change their gloves when moving between patients or after touching contaminated surfaces, possibly contributing to the spread of infections in a long-term care facility, an observational study found.
“Glove use behavior is as important as hand-washing when it comes to infection prevention,” Deborah Burdsall, PhD, RN-BC, CIC, of the University of Iowa College of Nursing, said in a press release. “These findings indicate that glove use behavior should be monitored alongside hand hygiene. The observations should be shared with staff to improve behaviors and reduce the risk of disease transmission.”
The researchers performed a descriptive structured observational study on a random sample of 74 certified nursing assistants (CNAs) working in a long-term care facility. Observers asked the staff members for permission to watch them as they helped patients with using the toilet or delivered perineal care. To minimize the Hawthorne effect, a psychological phenomenon in which individuals change their behavior when they know they are being watched, observers used a “minor deception,” telling workers that they were searching for possible barriers to health care provider hand hygiene.
CNAs wore gloves for 80.2% of touch points but failed to change gloves at 66.4% of points when glove changing was required, such as immediately after touching a potentially contaminated surface or between caring for different patients, Burdsall and colleagues reported. Staff members changed their gloves a median of 2 times per patient care event, and a median of 1 change occurred at a change point.
However, the researchers wrote, the CNAs failed to change their gloves during the appropriate change points a median of 2.5 times per care event. More than three-quarters of patient care events included more than one contaminated touch point (82.4%). Nearly half (n = 782 of 1,774; 44%) of gloved touch points were defined as contaminated, yielding a median eight contaminated touch points per care event. Burdsall and colleagues noted that workers wore gloves for all contaminated touch points, however (P < .001).
The study was limited by the fact that the sample consisted only of CNAs, as well as the fact that the CNAs all knew the investigator who observed them.
“Based on information from such studies, infection prevention staff and educators must develop training programs using adult learning principles and evidence-based instructional methods to improve [health care personnel (HCP)] glove use,” the researchers wrote. – by Andy Polhamus
Disclosures: The authors report no relevant financial disclosures.
Perspective
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The article by Burdsall and colleagues gives a compelling view into the misuse of gloves in a long-term care facility by CNAs. The authors developed a surveillance tool that gave insight into not only whether the CNA donned gloves, but whether the gloves were put on at the correct time, changed between patients and changed when contaminated. The study illustrates how HCP believe they are following the correct process because they are trained to conform to the Occupational Safety and Health Administration (OSHA) regulations, which require HCP to wear gloves if they might be exposed to blood or other potentially infectious materials. However there appears to be a knowledge gap, because staff would often neglect to change gloves when needed, touch patients and surfaces with potentially contaminated gloves and often apply gloves before any expected patient care episode.
It appears that a mind shift has occurred related to glove use because there were no observations of staff providing patient care with bare hands. Staff have adopted the theory that gloves protect them against potentially harmful bacteria or viruses, but the concept that gloves may be harmful to patients needs to be conveyed.
Historically, infection preventionists have focused on hand hygiene and environmental cleaning to decrease health care-associated infections (HAI). This article suggests that attention should also be focused on glove use — not only educating HCP on the correct use of gloves, but that glove use should also be monitored. The authors also propose additional studies on glove use and cross-contamination, to “assess whether inappropriate glove use increases the risk of HAI.”
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