Direct-gloving strategy without prior hand hygiene by healthcare professionals better for infection prevention: JAMA

A recent study published in Journal of American Medical Association challenges the current guidelines for hand hygiene in healthcare settings. The study involved 3,790 healthcare personnel across 13 hospital units, investigated the impact of a "direct-gloving" policy, which allows medical professionals to don nonsterile gloves without prior hand hygiene.

The results of this mixed-method, cluster-randomized clinical trial, conducted from January 2016 to November 2017, and analyzed through April 2019, have the potential to reshape infection prevention practices in hospitals.

The primary finding of this study suggests that direct gloving, which omits the requirement for hand hygiene before wearing gloves, led to significantly higher adherence to expected infection prevention practices compared to traditional protocols. In the units that implemented direct gloving, adherence reached an impressive 87%, while units following the standard guidelines achieved only 41%.

These results held true even when controlling for factors such as baseline hand hygiene rates, unit type, and universal gloving policies. The increased glove use was particularly pronounced when entering contact precautions rooms.

The findings raise important questions about the necessity of the current hand hygiene guidelines in healthcare settings. It challenges the convention that strict hand hygiene compliance before donning gloves is always the most effective method for preventing infection.

However, it's important to note that the study did identify a potential downside to the direct-gloving strategy. It was associated with increased total bacteria colony counts and greater detection of pathogenic bacteria in the emergency department. In contrast, colony counts decreased in pediatrics units. These findings suggest that the impact of direct gloving could vary depending on the specific healthcare context.

The implications of this research are significant. It opens the door for healthcare facilities to reconsider their hand hygiene policies, potentially adopting a direct-gloving approach in certain situations. However, the study also highlights the need for further research and the importance of tailoring infection prevention practices to the specific needs of different hospital units.

Source:

Thom, K. A., Rock, C., Robinson, G. L., Reisinger, H. S., Baloh, J., Li, S., Diekema, D. J., Herwaldt, L. A., Johnson, J. K., Harris, A. D., & Perencevich, E. N. (2023). Direct Gloving vs Hand Hygiene Before Donning Gloves in Adherence to Hospital Infection Control Practices. In JAMA Network Open (Vol. 6, Issue 10, p. e2336758). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2023.36758