Content uploaded by Linda Nazarko
Author content
All content in this area was uploaded by Linda Nazarko on May 23, 2020
Content may be subject to copyright.
Covid 19 and gloves: When to wear and when not to wear
The first rule of healthcare is to do no harm and some staff working in hospitals and in shops
are wearing blue nitrile gloves. The aim is to protect themselves and people they come into
contact with but is indiscriminate use of gloves part of the problem rather than part of the
solution?
How does Covid 19 spread?
The spread of infection within health care requires three elements:
1. A source of infecting organisms (bacteria, viruses, fungi);
2. A susceptible host;
3. A route of transmission of the organism from one person / site to another. This is
shown in figure one.
Figure one: Spread of infection (author’s own work)
Covid 19 is a coronavirus and it is thought to be transmitted through droplets generated by
coughing and sneezing and through contact with contaminated surfaces (DHSC et. al, 2020).
Droplet transmission: by large droplets during coughing, sneezing, talking and during
procedures which may generate droplets such as suctioning and bronchoscopy. The droplets
are propelled only a short distance through the air.
Airborne transmission: caused by dispersal of smaller micro organisms, e.g. viruses, or
airborne dust particles containing the infectious agent. These organisms can be widely
dispersed by air currents before being inhaled or deposited on the susceptible host, or in the
case of dust particles, onto horizontal surfaces and equipment Many viruses are spread by
airborne or droplet transmission (Rosa et al, 2013)
Standard infection control precautions
Standard infection control precautions are evidence based guidance that aim to provide staff
with evidence based guidance to prevent healthcare associated infections, figure two
illustrates these categories (Loveday et al, 2014).
1
Written for Peter Bradley 26th March 2020
Covid 19 and gloves: When to wear and when not to wear
Figure two: Actions to reduce infection risk
Hand washing
Hands must be washed or decontaminated before each and every episode of direct patient
contact and any activity that could contaminate hands. Alcohol hand rubs should only be
used on hands that are free of dirt and organic material. Cuts should be covered with a
waterproof dressing. Hands and wrists should be free of jewellery. Staff should use hand
creams regularly to protect their hands from the drying effects of frequent washing and
decontamination.
When you must wash your hands
Hands must be washed or decontaminated before each and every episode of direct patient
contact and any activity that could contaminate hands. The World Health Authority (2009) has
produced guidance on hand hygiene. This contains recommendations on when to wash your
hands. Health care workers must also decontaminate their hands before and after all patient
contact and whenever hands are visibly soiled. These recommendations which come from the
work of Sax and colleagues (2007) are shown in table one.
Table one: When to wash your hands
Before After
Each shift Each shift
Eating, drinking or handling food Direct contact with any blood and/or body
fluids
Performing a clinical procedure Using the toilet, blowing their nose,
coughing or sneezing
Before performing an aseptic technique Giving personal care
Providing care to a vulnerable
patients/site
Bed making
Removing protective clothing
Performing a clinical procedure
Any cleaning of the environment or
equipment
2
Written for Peter Bradley 26th March 2020
Covid 19 and gloves: When to wear and when not to wear
The problems associated with inappropriate glove use
The healthcare worker (HCW) who wears gloves inappropriately when not delivering clinical
care may touch a key board, answer a telephone and touch his or her face. The gloves can
provide the HCW with a false sense of security. If the HCW goes around the ward or unit
wearing gloves then the gloves can transmit the virus throughout the ward. Research
indicates that coronaviruses such as Covid 19 can live for extended periods on hard surfaces
(Otter et. al, 2016). A research study found that viruses can survive on gloves for 2-4 hours
(Casanova et. al, 2010). It’s unthinkable for an HCW to neglect to wash hands for that length
of time however people who are completing paperwork may wear gloves for considerable
amounts of time. It is important that staff remove gloves with care to avoid
contaminating their hands. Staff should wash their hands after removing gloves.
At present staff are using more gloves than ever before and there have been reports of delays
in obtaining supplies. Using gloves inappropriately can lead to a shortage of essential
equipment when it is needed to deliver care and that can cost lives.
The use of personal protective equipment
Gloves should be worn for all invasive procedures and all activities that carry a risk of
exposure to blood, body fluids, secretions and excretions including during equipment and
environmental decontamination (DHSC, 2020). Gloves should be worn once only and
changed between patients. Staff who are allergic to latex should use alternative products,
such as nitrile gloves (Loveday et al, 2014). Figure 3 author’s own work) summarises
guidance.
Figure 3: Guidance on glove use (author’s own work)
Additional guidance on the use of gloves when caring for people who have a Covid -19
infection or a suspected infection is shown in table two (DHSC, p 24, 2020)
3
Written for Peter Bradley 26th March 2020
!
"
#
!
"
#
$
$
%
%
Covid 19 and gloves: When to wear and when not to wear
Table two: Additional guidance on glove use when caring for people with Covid 19 infections
or suspected infections.
Activity Entry to cohort
area (only if
necessary)
Within 1 metre of
a patient with
possible/confirme
d
COVID-19
High risk units
where AGPs
are being
conducted eg:
ICU/ITU/HDU
Aerosol
generating
procedures(any
setting)
Gloves
Required
No Yes Yes Yes
Handwashing
Liquid soap products
Washing hands with a liquid soap or detergent will remove dirt, organic material and transient
micro-organisms. This method of hand decontamination is all that is required for most routine
health care related procedures. Bar soap should not be used in clinical areas as it can
harbour some micro-organisms.
Alcohol Hand Rub/Gel (with or without antibacterial additives)
Alcohol hand gel can be used to remove microorganisms from clean hands. . Alcohol hand
gel can also be used between tasks and between patients and is useful where adequate
facilities are not available Alcohol is inactivated in the presence of organic matter and
therefore is not used on soiled, grubby hands.
Antiseptic Detergents (e.g. Chlorhexidine)
An antiseptic detergent may be preferred when caring for a patient known to be colonised or
infected with an antibiotic resistant organism, e.g. MRSA, and prior to performing an aseptic
procedure or minor surgery. Aqueous, antiseptic hand washing agents are used to remove
organic contamination and reduce levels of resident flora, and with repeated use, maintain
low bacterial counts on the skin, e.g. under sterile gloves. Antiseptic products must not be
used routinely for hand washing. Prolonged, repeated use of antiseptic products can damage
skin and lead to an increased number of bacteria on the skin
When to wash your hands
The World Health Organisation’s five moments of hand hygiene provides practical guidance
on when to wash hands
https://www.who.int/infection-prevention/campaigns/clean-hands/5moments/en/
(author’s note can we please add to this article)
How to wash your hands
Some areas of the hands are more frequently missed than the others during hand
decontamination. It is important to pay attention to all areas of the hands, whilst washing, but
paying particular attention to the finger tips and nail area. These are the areas most in
contact with the patient and can be heavily contaminated with micro-organisms. Figure four,
below show areas of the hands most frequently missed.
4
Written for Peter Bradley 26th March 2020
Covid 19 and gloves: When to wear and when not to wear
Six stage handwashing technique
1. Palm to palm 2. Backs of hands
3. Interdigital spaces 4. Fingertips
Wet hands under running water, then apply the recommended amount of hand
cleanser, rub hands together vigorously to make a lather using following technique
(see page ):
Palm to palm (including wrists);
Right palm over left dorsum & left palm over right dorsum;
Palm to palm with fingers interlaced;
Backs of fingers to opposing palms with fingers interlaced;
Rotational rubbing of thumbs with thumbs clasped in opposite palms;
5
Written for Peter Bradley 26th March 2020
Covid 19 and gloves: When to wear and when not to wear
Rotational rubbing of finger tips in palms;
REPEAT EACH STEP 5 TIMES.
Rinse the hands thoroughly under running water;
Turn off taps using elbows or clean paper towels to prevent recontamination, and dry
hands thoroughly with clean paper towels.
If in patient’s home, dry hands first and turn taps off using paper towels or towel.
Dispose of paper towel into a foot operated pedal bin. Do not lift up the lid of the bin
with hands as this will re-contaminate them. If necessary, use hand towels to lift lid.
If in patient’s home, dispose of towels into domestic waste.
Reducing the viral burden
Infection control is a team effort and whilst wards where people who have Covid 19 infections
will have additional cleaning measures in place staff may be required to wipe down surfaces
in frequently touched areas more frequently.
Conclusion
Caring for patients with Covid 19 is a new experience for healthcare workers and our
knowledge of how the virus affects people is still developing. There is a sound body of
evidence that guides practice when dealing with infectious diseases and that includes the
appropriate use of personal protective equipment including gloves.
References
Casanova L, Rutala WA, Weber DJ and Sobsey MD. Coronavirus Survival on Healthcare
Personal Protective Equipment. Infect Control Hosp Epidemiol 2010;31:560-561
https://pubmed.ncbi.nlm.nih.gov/20350196/
DHSC et.al, (2020). COVID-19: Guidance for infection prevention and control in healthcare
settings. Adapted from Pandemic Influenza: Guidance for Infection prevention and control in
healthcare settings. Issued jointly by the Department of Health and Social Care
(DHSC), Public Health Wales(PHW), Public Health Agency(PHA) Northern Ireland, Health
Protection Scotland (HPS) and Public Health England as official guidance.
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_dat
a/file/874316/Infection_prevention_and_control_guidance_for_pandemic_coronavirus.pdf
Loveday HP, Wilson JA, Pratt RJ, Golsorkhi M, Tingle A, Bak A, Browne J, Prieto J, Wilcox M
(2014). epic3: national evidence-based guidelines for preventing healthcare-associated
infections in NHS hospitals in England. J Hosp Infect. 2014 Jan;86 Suppl 1:S1-70
http://www.journalofhospitalinfection.com/article/S0195-6701%2813%2960012-2/fulltext
Otter, J.A. et al (2016). Transmission of SARS and MERS coronaviruses and influenza
virus in healthcare settings: the possible role of dry surface contamination
Journal of Hospital Infection, Volume 92, Issue 3, 235 - 250
https://www.journalofhospitalinfection.com/article/S0195-6701%2815%2900367-9/fulltext
Public Health England (2020). Collection Coronavirus (COVID-19): guidance. Updated 25th
March 2020
https://www.gov.uk/government/collections/coronavirus-covid-19-list-of-guidance
Rosa G, Fratini M, Della Libera S, Iaconelli M, Muscillo M (2013). Viral infections acquired
indoors through airborne, droplet or contact transmission. Ann Ist Super Sanita. 49(2):124-
132.
http://www.scielosp.org/pdf/aiss/v49n2/a04v49n2.pdf
6
Written for Peter Bradley 26th March 2020
Covid 19 and gloves: When to wear and when not to wear
Sax H, Allegranzi B, Uckay I, Larson E Boyce J, Pittet D (2007). My five moments for hand
hygiene: a user-centred design approach to understand, train, monitor and report hand
hygiene. J Hosp Infection: 67:1: 9–21
http://microbiology.mtsinai.on.ca/coreEducModules/hand-hygiene-aug-2007.pdf
7
Written for Peter Bradley 26th March 2020
