Re-evaluating hand hygiene practices!

Reviewed by Cindy Noyes

Thom and colleagues performed a multi-center, cluster randomized trial including 4 academic centers to assess adherence to expected hand hygiene (HH) practice at room entry and exit for contact precaution rooms. Thirteen hospital units were randomized to 1) usual care—HH followed by gloving vs 2) direct gloving (DG) without HH.  3390 HCPs were observed. Adherence to expected practice was greater in direct gloving units (87%) vs usual care units (41%). The association persisted despite controlling for unit type, baseline HH rates, universal gloving policies.  Glove use on entry to contact precaution rooms also increased in DG vs usual practice (87 vs 67%). Random culture of gloved hands from HCP prior to entry into care rooms did not demonstrate significant increase in contamination despite no preceding HH.  The ED was an outlier, with very low rates of glove use and HH in both groups and increase in contamination of hands and gloves. Thus, DG may not work if HH isn’t occurring consistently for other patients.  Although no clinical outcomes were evaluated, and this occurred pre-pandemic, in a time when HCP are understaffed and overworked, could a small reduction in time spent waiting for alcohol-based soap to dry prior to donning gloves be eliminated without increase risk in harm? 

Thom KA, et al. Direct gloving vs hand hygiene before donning gloves in adherence to hospital infection control practices. JAMA Network Open. 2023; 6(10):e2336758.

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