COMMENTARY

Hand Hygiene Before Gloving: Needed or Needless?

Mark E. Rupp, MD

Disclosures

January 03, 2014

Editorial Collaboration

Medscape &

Is Hand Hygiene Before Putting on Nonsterile Gloves in the Intensive Care Unit a Waste of Health Care Worker Time? -- A Randomized Controlled Trial

Rock C, Harris AD, Reich MG, Johnson JK, Thom KA
Am J Infect Control. 2013;41:994-996.

Yes, It's a Waste of Time

That is the conclusion from a prospective, randomized trial performed by investigators at the University of Maryland Hospital. In brief, 115 healthcare providers preparing to enter contact isolation rooms in intensive care units (ICUs) were randomly assigned to perform routine hand hygiene with an alcohol-based gel just before donning nonsterile gloves, while an equally sized group donned gloves without first performing hand hygiene. Hand cultures were taken from both groups at baseline and after donning gloves.

The results showed that at baseline, hand colonization was similar in the hand hygiene group vs direct gloving group (131 vs 148 colony-forming units [CFU], respectively), and after gloving, there was no significant difference in the average CFU on the surface of the gloves (6.9 vs 8.1 CFU, respectively). It took an average of 31.5 extra seconds to perform hand hygiene before donning gloves, which equates to about 20 minutes of extra time for the average ICU nurse caring for a patient in contact isolation during a 12-hour shift.

Viewpoint

This study has a few limitations. First, the study did not examine conditions with heavy hand contamination, and perhaps additional information could be gained from artificially "spiking" the hands of the nurses before they don gloves. Also, the fingertips and palmar surfaces of the gloves were sampled -- not the cuff. One would expect the cuff or wrist surface to potentially be more heavily contaminated in the group not performing hand hygiene because the cuff is manipulated more extensively as one pulls on a pair of gloves. Thus, although questions remain, the generally recommended practice of performing hand hygiene before donning nonsterile gloves when caring for a patient in contact isolation may be unnecessary, inefficient, and wasteful.

Abstract

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