Nursing home workers often fail to change gloves, risking spread of infection: new study


Arlington, VA, September 11, 2017

The failure to change gloves is common among certified nursing assistants, and may be a significant cause of the spread of dangerous pathogens in nursing homes and long-term healthcare settings, according to a new study published in the September issue of the American Journal of Infection Control, the journal of the Association for Professionals in Infection Control and Epidemiology (APIC).

Certified nursing assistants (CNAs) are often the main providers of care in long-term care facilities (LTCFs), with significant patient contact. If a CNA uses gloves incorrectly, pathogens can easily be spread to patients and the environment, leading to healthcare-associated infections (HAIs). Researchers estimate that between 1.6 million and 3.8 million infections occur in LTCFs annually. Infections in LTCFs cause approximately 388,000 deaths per year and cost between $673 million and $2 billion annually.

“Gloves are an essential component of standard precautions, and proper use of gloves is a critical component of best practices to prevent HAIs,” said Linda Greene, RN, MPS, CIC, FAPIC, 2017 APIC president. “This is especially important in long-term care, where residents are more vulnerable to infection and stay for extended periods. Facilities must continually educate healthcare providers about the importance of appropriate glove use to prevent infection and monitor adherence to this practice.”

In the first-of-its-kind prospective study by Deborah Patterson Burdsall, PhD, RN-BC, CIC, of the University of Iowa College of Nursing, researchers examined the degree of inappropriate glove use in a random sample of 74 CNAs performing toileting and perineal care at one LTCF. Inappropriate glove use -- defined as a failure to change gloves, and when surfaces were touched with contaminated gloves -- was frequently observed in this study.

The Centers for Disease Control and Prevention (CDC) recommends standard precautions requiring all CNAs to wear personal protective equipment, especially gloves, to avoid contact with blood, secretions, excretions, or other potentially infectious materials that may contain pathogens. CNAs must change gloves as a standard precaution at the following glove change points during patient care: when the gloves have touched blood or body fluids; after the CNA completes a patient task; after the gloves touch a potentially contaminated site; and in between patients.

“Glove use behavior is as important as hand washing when it comes to infection prevention,” said lead study author Deborah Patterson Burdsall. “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.”

While CNAs wore gloves for 80 percent of touch points, they failed to change gloves at 66 percent of glove change points. More than 44 percent of the gloved touch points were observed as contaminated, with all contaminated touches being with gloved hands. Of note, gloves were readily available on all units in public areas, shower rooms, patient rooms, and patient bathrooms to enhance availability and workflow.

To measure inappropriate glove use, the PI developed and validated the glove use surveillance tool (GUST), allowing them to record the type of surface, the sequence in which they touched surfaces during a patient care event, whether they wore gloves, and whether they changed gloves.

The frequency of contaminated gloved touches illustrates the significant potential for cross-contamination between patients and the healthcare environment from inappropriate glove use. This study supports the findings of earlier studies that describe inappropriate glove use by healthcare personnel. Based on information from such studies, infection prevention staff and educators should develop training programs using adult learning principles and evidence-based instructional methods to improve glove use.

Visit www.apic.org for more resources on proper hand hygiene and glove use.

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Notes for Editors
The article is “Exploring inappropriate certified nursing assistant glove use in long-term care,” Deborah Patterson Burdsall, Sue E. Gardner, Thomas Cox, Marin Schweizer, Kennith R. Culp, Victoria M. Steelman, and Loreen A. Herwaldt (http://dx.doi.org/10.1016/j.ajic.2017.02.017). It appears in the American Journal of Infection Control, volume 45, issue 9 (September 2017) published by Elsevier.

Authors:
Deborah Patterson Burdsall, PhD, RN-BC, CIC (Corresponding author)
The University of Iowa College of Nursing, Iowa City, IA

Sue E. Gardner, PhD, RN
The University of Iowa College of Nursing, Iowa City, IA

Thomas Cox, PhD, RN, MSW
Iowa City VA Health Care System, Iowa City, IA
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA

Marin Schweizer, PhD
Iowa City VA Health Care System, Iowa City, IA
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA

Kennith R. Culp PhD, RN
The University of Iowa College of Nursing, Iowa City, IA

Victoria M. Steelman, PhD, RN, CNOR
The University of Iowa College of Nursing, Iowa City, IA

Loreen A. Herwaldt, MD
Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA

About AJIC: American Journal of Infection Control
AJIC: American Journal of Infection Control covers key topics and issues in infection control and epidemiology. Infection preventionists, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of APIC, AJIC is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. AJIC also publishes infection control guidelines from APIC and the CDC. Published by Elsevier, AJIC is included in MEDLINE and CINAHL. www.ajicjournal.org

About APIC
APIC’s mission is to create a safer world through prevention of infection. The association’s more than 15,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization. Visit APIC online at www.apic.org. Follow APIC on Twitter: www.twitter.com/apic and Facebook: www.facebook.com/APICInfectionPreventionandYou. For information on what patients and families can do, visit APIC’s Infection Prevention and You website at www.apic.org/infectionpreventionandyou.

About Elsevier
Elsevier is a global information analytics business that helps institutions and professionals progress science, advance healthcare and improve performance for the benefit of humanity. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, more than 35,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX Group, a global provider of information and analytics for professionals and business customers across industries. www.elsevier.com