Applying human factors ergonomics to the misuse of non-sterile clinical gloves in acute care

Background: Healthcare workers (HCW) are recommended to wear non-sterile clinical gloves (NSCG) for direct contact with blood and body fluids to reduce transmission of healthcare associated infections (HCAI). However, there is evidence that inappropriate NSCG-use increases the risk of transmission. Methods: A mixed methods study comprising observation of NSCG-use during episodes of care in two acute hospitals and semi-structured interviews with HCW. Qualitative data were categorised using thematic analysis. Findings were mapped to the Systems Engineering Initiative for Patient Safety (SEIPS) model and used to develop a strategy for improving NSCG-use. Results: 278 procedures performed in 178 episodes of care involved the use of NSCG. NSCG were inappropriate for 59% (165/278) procedures; risk of cross-contamination occurred in 49% (87/178) episodes. 26 HCW were interviewed; emotion and socialisation were key factors influencing decisions to use NSCG. Data from observation and thematic analysis were mapped to six interacting components of the SEIPS work-system. Interventions targeting each component were identified to inform quality improvement strategies Conclusions: Despite more than a decade of intense promotion of hand hygiene as the key measure to protect patients from HCAI, NSCG dominate routine clinical practice and potential cross-contamination occurs in half of care episodes where they are used. Such practice is associated with significant environmental and financial costs and adversely affects patient safety. The application of HFE to the complex social, professional and emotional drivers of inappropriate NSCG behaviour may be more effective than conventional approaches of education and policy in achieving the goal of preventing HAI and improving patient safety

A prevalence survey of patients with indwelling urinary catheters on district nursing caseloads in the United Kingdom: the community urinary catheter management (CCaMa) study

Background: Catheter-associated urinary tract infection (CAUTI) is common in both hospitals and the community. Aim: To investigate the prevalence of indwelling urinary catheters on district nursing caseloads in the United Kingdom (UK). Method: Participants were recruited through the Infection Prevention Society (IPS). An electronic survey was undertaken on a single day between November 2017 and January 2018. Data were analysed using descriptive statistics. Findings: 49,575 patients were included in the survey of whom 5352 had an indwelling urinary catheter. This gave a point prevalence of 10.8% [95%CI 10.53-11.07], which varied between organisations, ranging from 2.36% [95% CI 2.05-2.73] to 22.02% [95% CI 20.12-24.05]. 5% of catheters were newly-placed (within four weeks). Of these, most (77%) had a documented indication for insertion. Only half of patients with a newly-placed catheter had a plan for its removal. This varied between organisations from 20% to 96%. Only 13% of patients had a patient held management plan or ‘catheter passport’ but these patients were significantly more likely to also have an active removal plan (28/36, 78% vs 106/231, 46%, p< 0.0001). Alternative bladder management strategies had been considered for 70/267 (26%) patients. Discussion: The management of patients with an indwelling urinary catheter represents a significant component of district nursing caseloads. Given the high proportion of newly-catheterised patients without an active management plan for removal of the catheter, the establishment of an optimal management pathway should be the focus of future prevention efforts

O003: the misuse of clinical gloves: risk of cross-infection and factors influencing the decision of healthcare workers to wear gloves

Clinical gloves are routinely used in the delivery of patient care but unless integrated with the ‘5 moments of hand hygiene’ have the potential to increase the risk of HCAI transmission

Does glove use increase the risk of infection?

There is clear evidence that gloves are often misused in clinical practice, which puts patients at increased risk of infection. New evidence suggests there are two main influences on health professionals’ to wear gloves: socialisation, reflecting the expectations of peers, or the ; and emotion, the response to a sense of disgust and need for self-protection. This article explores the extent of glove misuse why they are misused, and suggests to address the problem

A comparison of the nationally important infection prevention and control documents in NHS England and NHS Scotland

Background: The devolution of health to Scotland in 1999, led for the first time in the NHS to different priorities and success indicators for infection prevention and control (IPC). This project sought to understand, compare and evaluate the national IPC priorities and available indicators of success. Aim: To identify the national infection prevention and control priorities alongside national indicators of success. Methods: Critical analysis of nationally produced documents and publicly available infection related data up to March 2018. Findings: For both NHS Scotland and England the local and national infection prevention and control priorities are evidenced by: a) People being cared for in an IPC safe environment, b) Staff following IPC safe procedures and c) organisations continuously striving not just to attain standards, but to improve on them. If national agencies that produce data were also charged with using a Continuous Quality Improvement (CQI) model, then there would be further opportunities to detect and improve on successes

Public perceptions of the use of gloves by healthcare workers and comparison with perceptions of student nurses

Introduction: There is emerging evidence that non-sterile clinical gloves (NSCG) are over-used by healthcare workers (HCW) and associated with a risk of cross contamination because they are put on too early and removed too late. The purpose of this study was to determine student nurses’ approach to their use and the perceptions and preferences of the public. Methods: A cohort of third-year student nurses were asked to complete a questionnaire and indicate for which of 46 clinical tasks they would routinely wear gloves and what influenced their decision to use them. Factor analysis was used to explore correlations between tasks. Members of the pubic were asked to complete the online survey aiming to explore their recent experiences of healthcare and their attitudes towards HCW wearing gloves. Results: A total of 67 student nurses completed the questionnaire. Inconsistencies in responses were observed and gloves were reported being routinely worn for procedures with a low risk of contact with blood and body fluid. The exploratory factor analysis identified correlations related to four factors – procedures perceived to be risky, definitive indications, procedures related to personal hygiene and some low risk procedures. Most students (94%) indicated their own judgment influenced their decision to wear NSCG. The public survey was completed by 142 people. Many were uncomfortable with HCW using gloves for personal tasks but 94% preferred their use for washing ‘private parts’. Responses were broadly comparable with those of student nurses. 29% had observed inappropriate use of gloves during a recent episode of healthcare treatment and 20% had challenged a HCW about their glove use. Conclusions: Student nurses reported using NSCG appropriately for procedures involving a risk of contact with BBF, however a significant proportion also routinely used NSCG for a wide range of low risk tasks and procedures for which they are neither required nor recommended. Members of the public feel uncomfortable with HCW wearing gloves for some personal care but strongly prefer their use for contact with ‘private parts’ such as the genitals

Scoping the role and education needs of practice nurses in London

Aims: To identify education priorities for practice nursing across eight London Clinical Commissioning Groups (CCGs); to identify the education, training, development and support needs of practice nurses in undertaking current and future roles. Background: The education needs of practice nurses have long been recognised but their employment status means that accessing education requires the support of their GP employer. This study scopes the educational requirements of the practice nurse workforce and working with educational providers and commissioners describes a coherent educational pathway for practice nurses. Method: A survey of practice nurses to scope their educational attainment needs was undertaken. Focus groups were carried out which identified the education, training, development and support needs of practice nurses to fulfil current and future roles. Findings: 272 respondents completed the survey. Practice nurses took part in three focus groups (n=34) and one workshop (n=39). Findings from this research indicate a practice nurse workforce which lacked career progression, role autonomy or a coherent educational framework. Practice nurses recognised the strength of their role in building relationship-centred care with patients over an extended period of time. They valued this aspect of their role and would welcome opportunities to develop this to benefit patients. Conclusion: This paper demonstrates an appetite for more advanced education among practice nurses, a leadership role by the CCGs in working across the whole system to address the education needs of practice nurses, and a willingness on the part of NHS education commissioners to commission education which meets the education needs of the practice nurse workforce. Evidence is still required, however, to inform the scope of the practice nurse role within an integrated system of care and to identify the impact of practice nursing on improving health outcomes and care of local populations

The misuse and overuse of non-sterile gloves: application of an audit tool to define the problem

Background: The use of non-sterile gloves (NSG) has become routine in the delivery of health care, often for procedures for which they are not required; their use may increase the risk of cross contamination and is generally not integrated into hand hygiene audit. This paper describes a small-scale application and validation of an observational audit tool devised to identify inappropriate use of NSG and potential for cross contamination. Methods: Two observers simultaneously observed the use of NSG during episodes of care in an acute hospital setting. The inter-rater reliability (IRR) of the audit tool was measured corrected for chance agreement using Kappa. Results: A total of 22 episodes of care using NSG were observed. In 68.6% (24/35) of procedures there was no contact with blood/body fluid; in 54.3% (19/35) NSG-use was inappropriate. The IRR was 100% for eight of 12 components of the tool. For hand hygiene before and after NSG removal it was 82% (Kappa = 0.72) and 95% (Kappa = 0.87). Conclusions: In this small-scale application of a glove-use audit tool we demonstrated over-use and misuse of NSG and potential for cross transmission on gloved hands. The audit tool provides an effective mechanism for integrating glove use into the audit of hand hygiene behaviour

Using a multi-modal strategy to improve patient hand hygiene

Objective The role of healthcare worker hand hygiene in preventing healthcare associated infections (HCAI) is well established. There is less emphasis on the hand hygiene of hospitalised patients; in the context of COVID-19 mechanisms to support it are particularly important. The purpose of this study was to establish if providing patient hand wipes, and a defined protocol for encouraging their use, was effective in improving the frequency of patient hand hygiene (PHH). Design Before and after study Setting General Hospital, United Kingdom. Participants All adult patients admitted to six acute elderly care/rehabilitation hospital wards between July and October 2018. Methods Baseline audit of PHH opportunities conducted over 6 weeks. Focus group with staff and survey of the public informed the development of a PHH bundle. Effect of bundle on PHH monitored by structured observation of HH opportunities over 12 weeks. Results During baseline 303 opportunities for PHH were observed; compliance with PHH was 13.2% (40/303; 95%CI 9.9-7.5). In the evaluation of PHH bundle 526 PHH opportunities were observed with HH occurring in 58.9% (310/526); an increase of 45.7% vs. baseline (95%CI 39.7–51.0%; p<0.001). Conclusion Providing patients with multi-wipe packs of handwipes is a simple, cost-effective approach to increasing patient hand hygiene and reducing the risk of HCAI in hospital. Healthcare workers play an essential role in encouraging PHH