Gloves: Barriers of Infection
The need for hand gloves arises at various critical areas in the hospital which include patient examination, operation, dealing with blood, etc. Dr Sunayana Jangla (Nanaware), Microbiologist, warns that hand gloves are effective tools of infection control provided –
• Reduce the chance of organism from the personnel hand getting transmitted to the patients;
• Reduce the likelihood that hands of personnel contaminated with organism from a patient or fomite can transmit organisms to another patient; and
• Protect the skin from hazardous substances like chemicals, solvents, etc.
In order to ensure the effective use of gloves in infection prevention, Dr Dipti Dhanwate, Consultant Microbiologist, SL Raheja Hospital (A Fortis Associate), suggests procedures that should be adopted. They include:
“Firstly, hands must be washed and cleaned thoroughly before donning gloves. Secondly, depending on the duration that the process will take, one has to decide on the number of gloves to be worn. For example, if you are going to operate or do procedures requiring hours together then double gloves should be donned. The World Health Organization has laid guidelines of how, when to use and what to use. I do recommend the same at my organization.”
There are various kinds of gloves in the market. Dr Sunayana lists the following:
“I would recommend Latex gloves because of its properties of flexibility and durability, even though there are cases of allergic reactions to it. There are also examination gloves made of low protein powder-free or powder-smooth which are good for examination purpose like Phelbotomy and non-critical areas,” explains Dr Dipti.
“Sterile latex (powder free) is ideal for surgery. Surgical gloves are of different thickness and therefore can be donned for longer duration of time,” adds Dr Dipti.
About 6% of the population is allergic to Latex; such individuals are candidates for vinyl /synthetic gloves or nitrile gloves. According to various polls, 82.5% of the users prefer nitrile gloves over latex due to latex sensitivities. The non-immunologic cutaneous response manifests as dry, crusted, fissuring lesions on glove-exposed areas. Sweating under the gloves, mechanical friction caused from ill-fitting gloves, glove powder and chemical additives may cause irritant reactions.
Gloves made of natural rubber latex are found to be a suitable solution against allergy. The American College of Osteopathic Dermatology has recommended the use of plastic or vinyl powder-free gloves for people with sensitive skin.
“Earlier, vinyl gloves were not allowed to be used in highly infectious areas and while handling chemotherapy drugs. With the progress in various technologies, vinyl is now being recommended for hospital use,” says Dr Dipti.
“There will always be issues, but gloves are the means of preventing spread of diseases to self and patients. If used wisely and as per recommended standards gloves can help keep infection at bay.” – Dr Dipti Dhanwate
“Nitrile gloves are known for maximum protection against chemicals. This totally depends on technology used in manufacturing gloves. The material used and the thickness of gloves matters. Presently, the nitrile gloves available in market are of three to five mils thickness. Before recommending nitrile gloves, one should check with the manufacturer the details of tests conducted and data about chemo-protection,” adds Dr Dipti.
These gloves are available in different colours like purple, green, pink, black, etc. Nitrile gloves are recommended to be used in critical and noncritical care units, emergency rooms, labour and delivery wards, laboratories, phlebotomy, pharmacy and oncology departments.
Walking around with gloves on from one department to other or within the organisation or answering phone calls with gloves on, not performing hand hygiene after removing gloves… are some of the wrong practices leading to contamination.
Lack of knowledge about when to change gloves and the myth that hand washing is a substitute for gloves is a hurdle in infection control practices.” – Dr Sunayana Jangla
Glove use is appropriate for situations when contact with body fluids is anticipated or when patients are to be managed with contact precautions. However, use of gloves should not be considered a substitute for effective hand hygiene practices taking place before and after patient contact. Although gloves can reduce the number of germs transmitted to the hands, germs can sometimes still get through latex. Hands can also be contaminated by “back spray” when gloves are removed after contact with body fluids.
Healthcare workers wearing gloves, rely too much on the ability to prevent transmission, as they clean their hands before and after patient contact less frequently. This failure of basic hand hygiene may be viewed as one of causes of spread of infection. This is simply stated a case of “dirty hands in the latex glove” as coined by Dr Sheldon Stone of the Royal Free Hospital NHS Trust, UK. In his study, he found that compliance to hand hygiene practices was just over 41% in cases of healthcare workers who wore gloves. In India, there is much graver problem in public hospitals – availability of gloves, says Dr Sunayana. There are prevalent cases of defective gloves and disposed gloves being reused in many hospitals.
“One of the main reasons for biohazard problems, arising due to reuse of gloves are inappropriate disposal,” states Dr Sunayana. As per the BioMedical Waste Disposal rule, the user is supposed to mutilate gloves before discarding. “Reuse of discarded gloves spreads various diseases from MRSA to HIV. Due to incorrect disposal, ragpickers collect them and sell them in the secondary market leading to malpractices,” laments Dr Sunayana. Further improper removal of gloves could be dangerous. “Are we not exposing ourselves while cutting, tearing such infected gloves?” queries Dr Dipti.
“Cutting with scissors may lead to injury to healthcare worker, while tearing with hand may lead to splash of infected materials/liquid to conjuctiva/ skin of healthcare worker. We are presently using examination gloves (Rakshak, Trikasafe) and sterile gloves (Kanam, Surgicare). Nitrile gloves are recommended for Chemotherapy patients,” says Dr Dipti.