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Hi all
Please find our latest publication on safe removal of gloves for dry contact with patients under contact precautions (link below)Jain S, Clezy K, McLaws ML. Safe removal of gloves from contact precautions: The role of hand hygiene.
Am J Infect Control. July 2018 Volume 46, Issue 7, Pages 764-767 pii: S0196-6553(18)30034-8. doi: 10.1016/j.ajic.2018.01.013
Kind regards
Susan Jain
Clinical Nurse Consultant CHESS, Conjoint Lecturer UNSW
Level 2, High street
Prince of Wales Hospital, Randwick, NSW 2031
phone: 02 9382 1877 fax: 02 9382 2084 page:44241
E: susan.jain@health.nsw.gov.au
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[Posted on behalf of Susan Jain Moderator]
[NB the original message from Helen Scott was sent to Susan as a personal message, but she has requested the reply to be posted here as she felt it would also be of interest to others – Moderator]Hi Helen
Thank you for your response to our latest research. Please find the answers to your questions below.Hi Michael
We are certain that more people out there will be having similar questions/concerns. Is there any possibility to publish our responses into the AICALIST please?Thank you again and have great weekend
Prof Mary-Louise and Susan Jain
Kind regards
Susan Jain
Clinical Nurse Consultant CHESS, Conjoint Lecturer UNSW
Level 2, High street
Prince of Wales Hospital, Randwick, NSW 2031
phone: 02 9382 1877 fax: 02 9382 2084 page:44241
E: susan.jain@health.nsw.gov.au
G: SESLHD-POWH-InfectionPreventionControl@health.nsw.gov.auHi Susan,
I found your article very interesting.
With respect, I do have a few questions for you if thats ok?One: are the three pumps of ABHR in line with the manufacturers recommendations/SDS?
A: Yes (as per the product label)
I know from previously working for one of these manufacturers, that only one pump is required, and I believe from reading instructions from others, that only one pump is required. Is this off label use then?
A: No, we have followed manufacturers instruction. As you may be aware that the amount and the coverage is the key to appropriate hand disinfection. From our observations HCWs were only using one small pump which will be less than one ml, thats why we wanted to see if two pumps is enough or not which in this case yes if you have average sized hands. As per Dr Pittet study Am J Infect Control. 2016 Dec 1;44(12):1689-1691. doi: 10.1016/j.ajic.2016.07.006. Epub 2016 Aug 24 ABHR volume and hand size matters.
This also depends on the size of the HCWs hands, as three pumps might be too much for smaller hands and vice versa for larger hands.
A:Yes it can be, thats why we tried 2 pumps and 3 pumps
Therefore, I was wondering where the use of three came from?
A: The 3 pumps came from the product manufacturers instructions we used to conduct the study.
And as two of your plates grew an MRO after only two pumps, would this lead people to think that in fact, despite manufacturers instructions, we do in fact require three pumps of ABHR or handwash to achieve desired results?
A: No, we have explained in our results section that we the HCW with positive plates tested negative on retesting, using 2 pumps of ABHR. Both of our HCWs had large sized hands, so by using 2 full pumps they managed to disinfect their hands reiterating the fact that volume and hands size matters.
Two: was the ABHR/handwash a gel, foam, cream or liquid, or did you use several different types?
A: foamThree: with regards glove use, isnt this part of the the package of standard or additional precautions? For example, if I was to enter a room to give care to a known MRO patient wearing a gown but no gloves, how can I be certain that the dry procedure doesnt turn into an exposure? What if the patient vomits, or sneezes, or coughs? Or something else unexpected? And how then do I as an infection control specialist, ensure compliance with transmission based precautions, especially with inexperienced staff, or non compliant staff?
A: Gloves introduced to HCWs aimed at protecting them from body fluids, regardless of patients MRO status. We should not discriminate between MRO and non-MRO patients body fluids as all body fluids are potentially infectious. When a HCW performs a dry contact, meaning no body fluid contact regardless of patients MRO status, why would we need gloves when our research proved that MRSA and VRE can be successfully removed by appropriate hand hygiene. Your point about an unexpected contact (e.g. vomitus) can be cleansed from our hands with soap and water.
And how do I know when auditing, that the staff member walking into the room wearing a long sleeved gown but no gloves, is intending on performing a dry procedure for this patient, despite having contact precautions signs on their doors? Yes, that point can be clarified afterwards, but surely this is going to change all of our auditing processes, as well as the WHO and therefore HHA protocols on glove use, hand hygiene and in fact, transmission based precautions?
A: We haven’t modified contact precautions around auditing. We understand that the contact precautions sign states that HCWs must don PPE outside the room, I dont know if you have followed a HCW into a single room and closely monitored the items they touch with the same pair of gloves within the same patient zone. In fact we contaminate our patients surroundings with pathogen by using same pair of gloves. Please read this paper Glove: Use for safety or overuse? Am J Infect Control. 2017 Dec 1;45(12):1407-1410 https://doi.org/10.1016/j.ajic.2017.08.029. We have created an educational video to highlight this exact issue.
Four: your conclusion states that this improves patient safety, but didnt say how?
A: Numerous studies alluding to us that we misuse gloves in turn our hand hygiene compliance is between 38-50% when we use gloves. Please refer to following articles to answer this question.
Compliance with hand hygiene and glove change in a general hospital, Mashhad, Iran: an observational study. Am J Infect Control. 2012 Aug;40(6):e221-3. doi: 10.1016/j.ajic.2011.12.012. Epub 2012 Mar 21,
Misuse of gloves: the foundation for poor compliance with hand hygiene and potential for microbial transmission? J Hosp Infect. 2004 Jun;57(2):162-9.
Cusini, Alexia, et al. “Improved hand hygiene compliance after eliminating mandatory glove use from contact precautionsIs less more?.” American journal of infection control 43.9 (2015): 922-927.Is it due to complacency when wearing gloves and our (untrue) perception that gloves protect us from everything?
Is it because glove use is abused and people either dont clean their hands properly before or after glove use, or is it because gloves are sometimes left on and continued to be worn for multiple patients? All of these possibilities are what we have seen during audits.A: Yes, you are right, glove use sends a false sense of security. We have similar experience.
As this article was published in the AJIC, did you have any feedback from the US?-
A: It was peer reviewed and only just published so we are waiting for US based feedback
As I said, these are just musings and mean no disrespect whatsoever, just a curious mind.
We appreciate your time and interest in this very important issue and we love to hear your views and ideas.
Would love to hear others and your own feedback.
Thank you, will let you know if we hear any further.
Kind regards,
Helen Scott.On Fri, 29 Jun 2018 at 7:41 am, Susan Jain (South East Sydney LHD) <Susan.Jain@health.nsw.gov.au> wrote:
Hi all
Please find our latest publication on safe removal of gloves for dry contact with patients under contact precautions (link below)Jain S, Clezy K, McLaws ML. Safe removal of gloves from contact precautions: The role of hand hygiene.
Am J Infect Control. July 2018 Volume 46, Issue 7, Pages 764767 pii: S0196-6553(18)30034-8. doi: 10.1016/j.ajic.2018.01.013
Kind regards
Susan Jain
Clinical Nurse Consultant CHESS, Conjoint Lecturer UNSW
Level 2, High street
Prince of Wales Hospital, Randwick, NSW 2031
phone: 02 9382 1877 fax: 02 9382 2084 page:44241
E: susan.jain@health.nsw.gov.au
G: SESLHD-POWH-InfectionPreventionControl@health.nsw.gov.au______________________________________________________________________
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