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Nurses insisted on ditching gloves in favor of intravenous antibiotics
Oct
A scoping review shows that nurses’ routine use of non-sterile gloves when preparing intravenous antibiotics does not provide proven protection and may even undermine infection control, increase costs and harm the planet.
Test: Time to hang up the gloves: a review of the evidence on the use of nonsterile gloves during intravenous preparation and administration of antimicrobials. Photo credit: New Africa/Shutterstock.com
Nurses often wear non-sterile gloves when preparing intravenous antimicrobial injections and administering them to patients. However, this practice is not supported by specific evidence-based guidelines. A recent report published in the journal Journal of Advanced Nursing addresses this critical gap in healthcare procedures.
Entry
Although there are general guidelines for the use of non-sterile gloves, there are no guidelines governing their specific use in this area. The review noted that such glove use is common, but largely habitual and ritualistic rather than evidence-based. Improper use of nonsterile gloves is associated with limited adherence to good hand hygiene practices, which may increase the risk of healthcare-associated infections. It also increases health care costs. Despite this, the practice is common among nurses.
The use of non-sterile gloves became widespread with the need for universal precautions when HIV caused an epidemic. It is now part of standard precautions and is often taught in nursing training as part of routine clinical skills. This practice is partly due to scientific reports stating that wearing non-sterile gloves reduces the risk of transmitting pathogens between health care workers and patients, prevents short-term colonization of hands by microorganisms, and avoids adverse effects such as skin allergy or irritation caused by hazardous or irritating chemicals.
According to the World Health Organization, seven and fifteen percent of hospitalized patients in high- and low- and middle-income countries will have a healthcare-associated infection before discharge from hospital. This usually occurs due to cross-contamination caused by poor hand hygiene and failure to change gloves between patients and procedures.
Hand hygiene has long been recognized as an essential step in preventing and controlling infection. Reduces healthcare-associated infections and antimicrobial resistance. Yet healthcare workers around the world often refuse to follow hand hygiene protocols.
This increases the risk of transmission of microbes between surfaces and patients, between patients, and between healthcare workers and patients, increasing the risk of infection. This increases the risk of complications and death and increases health care costs. It also drives antimicrobial resistance.
Additionally, incorrect use of non-sterile gloves increases the amount of medical waste and impacts the environment at every stage of production and disposal. Vinyl and nitrile gloves are non-biodegradable; therefore, excessive glove use contributes to environmental waste and carbon emissions. Their disposal during incineration releases dangerous chemicals, heavy metals and microplastics into the air, soil and water.
Better hand hygiene, including proper use of nonsterile gloves, can save approximately $16.50 in reduced health care costs for every dollar invested in an IPC (infection prevention and control) program..
World Health Organization
Although WHO estimates are cited in a broader context, they were not included in the data included in the study. However, nurses have no clear reason to use nonsterile gloves for up to half of the time they interact with patients, including when preparing or administering intravenous antimicrobials.
These observations explain the need for ongoing research. Researchers conducted a rigorous scoping review to identify important concepts in the use of nonsterile gloves during the preparation and administration of antimicrobials, identify the types of research conducted in this area, including gray literature, and identify research gaps.
Research results
After searching five major databases and gray literature (through February 2024), researchers found only three relevant studies. Only one of the 24 selected in the preliminary round met the inclusion criteria. All others were either conference abstracts or did not involve glove use.
The other two come from gray literature, which includes various manuals and guidelines from official organizations. None provided direct evidence on how nonsterile gloves would be used in clinical settings for the preparation and administration of intravenous antimicrobials.
One study found that the main situations associated with the use of non-sterile gloves were cleaning, patient mobilization, linen handling, equipment use, toileting, personal hygiene, patient care, and in 5% of cases any other activity. The report found that in 59% of cases, non-sterile gloves were not recommended. Without a doubt, copying the practices of others, misconceptions about glove hygiene versus hand hygiene, and disgust or fear of germs and dirt have led to this use.
WHO described “five moments of hand hygiene” The same study found that cross-contamination occurs in most cases after or before touching a patient, after a procedure, or after exposure to bodily fluids. The report also found that nurses were less likely than other health care workers to wash or disinfect their hands after removing gloves.
Two studies, without any evidence from their own studies, conclude that the use of non-sterile gloves is appropriate only when there is a risk of exposure to body fluids or mucous membranes. One of them clearly stated that gloves should not be used when preparing and administering antibiotics intravenously.
Surprisingly, no original sources were found to support the sparse citations in these studies, even after tracing the citation chain back to 2000. This resulted in eight articles, none of which provided any evidence in this area. Moreover, many of the limited number of articles were written by the same three researchers, indicating that this area has been little researched.
The third study did not discuss the use of non-sterile gloves in the context of preparing and administering antibiotics at all.
Many professional guidelines around the world support this practice in the absence of any supporting evidence. (It is worth noting that many steps in administering intravenous antibiotics involve potential exposure to blood.)
The current ritual practice of wearing non-sterile gloves during intravenous preparation and administration of antimicrobials highlights a significant knowledge gap and lack of high-quality research in this important clinical area.
The review also noted that this limited evidence base is partly due to the small, overlapping group of researchers studying glove use, highlighting the need for broader participation in research.
There is an emerging shift in clinical practice that emphasizes proper hand hygiene and removing gloves between patients to prevent cross-contamination. One study also showed direct financial and environmental benefits from reducing glove use in educational programs.
Application
The study found that improper use of non-sterile gloves for preparing and administering intravenous antimicrobials can hinder good hand hygiene, promoting cross-contamination and healthcare-associated infections and worsening patient health.
The review found no direct studies examining the effects of infection or transmission of microorganisms associated with the use of gloves during intravenous preparation of antimicrobials, highlighting the complete lack of empirical evidence in this area. Additionally, it has raised health care costs and increased health care waste and associated environmental pollution.
“We found no evidence to support the use of nonsterile gloves during intravenous administration of antimicrobials” This key evidence gap highlights the need for urgent research using a rigorous framework to create clear guidelines in this area and the use of non-sterile gloves in general nursing practice. This would strengthen evidence-based clinical practices, improve nursing education, improve patient health, and reduce health care costs and sustainability.
