To glove, or not to glove, that is the question

Recently I’ve noticed in some other renal support groups that home haemodialysis (HHD) patients state they are wearing gloves. The home environment is different from a clinical setting and I began to question why these patients were wearing gloves. Firstly let us look at the reasons clinicians wear gloves:

Rationale for using medical gloves:

Medical gloves are recommended to be worn for two main reasons:
1. To reduce the risk of contamination of health-care workers hands with blood and other body fluids.
2. To reduce the risk of germ dissemination to the environment and of transmission from the health-care worker to the patient and vice versa, as well as from one patient to another. (World Health Organisation 2009)

Since in the home environment we are in contact with our own micro organisms and the risk of cross contamination is minimal there is little need to wear gloves. The only exception to this is if we have a care partner and/or we have a central venous catheter (CVC).

Studies have shown that there is an increased risk of infection with a CVC, 84.8% compared to 15.2% with an arteriovenous access http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921710/#R29

Prior to commencing HHD it was ensured I had adopted the correct hand washing technique. I was also taught the ANTT (Antiseptic Non Touch Technique). This involves not touching any of the ‘key parts’ at the preparation, duration and end of dialysis. ‘Key parts’ are ends of connectors, syringes, needles etc that if contaminated are most likely to cause infection. Syringes, needles etc are opened onto a sterile pack which should not be touched where they are placed.

I also noted some patients were advised to wear non sterile gloves following hand washing. This rather defeats the object of hand washing and could potentially increase infection if ‘key parts’ are accidentally touched. Patients in some instances were also applying hand gel to gloves. This again could increase infection as “Any practice of glove washing, decontamination or reprocessing is not recommended as it may damage the material integrity and jeopardize the glove’s protective function” (WHO 2009). If hand gel is applied to gloves it isn’t able to work effectively as it is works by evaporating on hands. Something it cannot do on gloved hands. In addition the slippiness of the gloves is more likely to increase potential touching of ‘key parts’ as dexterity is compromised. Furthermore the wearing of gloves has the potential for needles to become displaced when self cannulating as tape sticks to it. It is also not necessary to use a nail brush as this could cause breaks in the skin, a lovely warm moist environment for bacteria to cause infection. Also a nail brush at home is not a single use disposable item like the surgical team would use. Surgical teams no longer use the outdated ‘scrub’ brush for hand washing and now it is advocated they only use the brush on the nails. “Nail brush use, other than directly to nails, is not recommended” http://www.afpp.org.uk/filegrab/surgical-hand-antisepsis-poster-final.pdf?ref=1908

Some studies have shown that wearing gloves in the clinical setting can potentially increase the risk of contamination. http://www.nursingtimes.net/download?ac=1288583

It appears that some clinicians and patients are often misguided that glove use can prevent cross contamination.

Provided correct hand washing technique is adopted and ANTT, the use of hand gel on clinically clean non soiled hands is effective for dialysis in the home environment.

All views are the author’s own and patients should follow their clinicians advise and local Trust policies.