Impact of single-use gloves on the five indications for hand hygiene

Background Hand disinfection at the correct indications is generally considered to be one of the most important measures in the prevention of nosocomial infections. The COVID-19 pandemic has led to changes in the hygiene behaviour of healthcare workers, including an increased desire for self-protection, which is likely to have led to increased and inappropriate use of gloves as a substitute for hand disinfection. Aim To investigate the effect of glove use on hand hygiene compliance using the WHO Five Moments model. Methods Direct observations were made in one ICU, one IMC and one normal ward in a university hospital over a period of six months. For documentation, the WHO five moments model was extended to include glove use and contamination, and a measure of uncertainty to assess which moments could not be fully observed. Findings A total of 852 hand disinfection indications were observed. Overall compliance for all indications was 63% when uncertain or incomplete observations were included and 68% when only complete observations were considered. Gloves were worn in 32% of cases. The lowest compliance (40%) was observed before aseptic procedures, where gloves were frequently worn (77%) and frequently contaminated (24%). Glove use increased the risk to not perform a hand disinfection before an aseptic procedure (OR 4.97, CI95% 2.24; 12.48). Conclusion As both, indicated and non-indicated glove use influence hand hygiene compliance, observations of hand hygiene compliance should be extended to include observations of glove use. As glove use is frequent and often non-compliant before aseptic procedures, the most important indication for infection prevention, this phenomenon requires immediate attention from researchers and educators. When including incompletely observable hand hygiene moments hand disinfection compliance (HDC) was 5% points lower than HDC obtained by the classical WHO observation model.