title: "The dirty hand in the latex glove": a study of hand hygiene compliance when gloves are worn.
abstract: OBJECTIVE
  Wearing of gloves reduces transmission of organisms by healthcare workers' hands but is not a substitute for hand hygiene. Results of previous studies have varied as to whether hand hygiene is worse when gloves are worn. Most studies have been small and used nonstandardized assessments of glove use and hand hygiene. We sought to observe whether gloves were worn when appropriate and whether hand hygiene compliance differed when gloves were worn.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Healthcare workers in 56 medical or care of the elderly wards and intensive care units in 15 hospitals across England and Wales.
  
  
  METHODS
  We observed hand hygiene and glove usage (7,578 moments for hand hygiene) during 249 one-hour sessions. Observers also recorded whether gloves were or were not worn for individual contacts.
  
  
  RESULTS
  Gloves were used in 1,983 (26.2%) of the 7,578 moments for hand hygiene and in 551 (16.7%) of 3,292 low-risk contacts; gloves were not used in 141 (21.1%) of 669 high-risk contacts. The rate of hand hygiene compliance with glove use was 41.4% (415 of 1,002 moments), and the rate without glove use was 50.0% (1,344 of 2,686 moments). After adjusting for ward, healthcare worker type, contact risk level, and whether the hand hygiene opportunity occurred before or after a patient contact, glove use was strongly associated with lower levels of hand hygiene (adjusted odds ratio, 0.65 [95% confidence interval, 0.54-0.79]; P < .0001).
  
  
  CONCLUSIONS
  The rate of glove usage is lower than previously reported. Gloves are often worn when not indicated and vice versa. The rate of compliance with hand hygiene was significantly lower when gloves were worn. Hand hygiene campaigns should consider placing greater emphasis on the World Health Organization indications for gloving and associated hand hygiene.
  
  
  BACKGROUND
  National Research Register N0256159318.
authors.affiliation: University College London (UCL) Research Department of Infection and Population Health, UCL (Hampstead Campus), Royal Free Hospital, London, United Kingdom. christopher.fuller@ucl.ac.uk
authors.forename: Christopher
authors.initials: C
authors.lastname: Fuller
authors.forename: Joanne
authors.initials: J
authors.lastname: Savage
authors.forename: Sarah
authors.initials: S
authors.lastname: Besser
authors.forename: Andrew
authors.initials: A
authors.lastname: Hayward
authors.forename: Barry
authors.initials: B
authors.lastname: Cookson
authors.forename: Ben
authors.initials: B
authors.lastname: Cooper
authors.forename: Sheldon
authors.initials: S
authors.lastname: Stone
mesh_terms: D003428:Cross Infection / Q000517:prevention & control; D004739:England; D017575:Gloves, Protective / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006225:Hand; D006235:Hand Disinfection / Q000379:methods; D006282:Health Personnel / Q000706:statistics & numerical data; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000706:statistics & numerical data*; D017592:Skin Care; D014852:Wales; D014944:World Health Organization