title: Is hand hygiene before putting on nonsterile gloves in the intensive care unit a waste of health care worker time?--a randomized controlled trial.
abstract: BACKGROUND
  Hand hygiene (HH) is recognized as a basic effective measure in prevention of nosocomial infections. However, the importance of HH before donning nonsterile gloves is unknown, and few published studies address this issue. Despite the lack of evidence, the World Health Organization and other leading bodies recommend this practice. The aim of this study was to assess the utility of HH before donning nonsterile gloves prior to patient contact.
  
  
  METHODS
  A prospective, randomized, controlled trial of health care workers entering Contact Isolation rooms in intensive care units was performed. Baseline finger and palm prints were made from dominant hands onto agar plates. Health care workers were then randomized to directly don nonsterile gloves or perform HH and then don nonsterile gloves. Postgloving finger and palm prints were then made from the gloved hands. Plates were incubated and colony-forming units (CFU) of bacteria were counted.
  
  
  RESULTS
  Total bacterial colony counts of gloved hands did not differ between the 2 groups (6.9 vs 8.1 CFU, respectively, P = .52). Staphylococcus aureus was identified from gloves (once in "hand hygiene prior to gloving" group, twice in "direct gloving" group). All other organisms were expected commensal flora.
  
  
  CONCLUSIONS
  HH before donning nonsterile gloves does not decrease already low bacterial counts on gloves. The utility of HH before donning nonsterile gloves may be unnecessary.
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD. Electronic address: Crock@umm.edu.
authors.forename: Clare
authors.initials: C
authors.lastname: Rock
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harris
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Reich
authors.forename: J Kristie
authors.initials: JK
authors.lastname: Johnson
authors.forename: Kerri A
authors.initials: KA
authors.lastname: Thom
mesh_terms: D001419:Bacteria / Q000302:isolation & purification; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000517:prevention & control*; D005932:Gloves, Surgical / Q000706:statistics & numerical data*; D006225:Hand / Q000382:microbiology*; D063373:Hand Hygiene / Q000379:methods*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D011446:Prospective Studies
keywords: Alcohol hand rub; Handwashing; Health care-associated infection; Infection control; Nosocomial infection
references.citation: Ann Intern Med. 1988 Sep 1;109(5):394-8
references.pmid: 3136685
references.citation: J Hosp Infect. 2007 Sep;67(1):9-21
references.pmid: 17719685
references.citation: Curr Opin Infect Dis. 1998 Aug;11(4):457-60
references.pmid: 17033411
references.citation: Arch Intern Med. 1999 Apr 26;159(8):821-6
references.pmid: 10219927
references.citation: Surgery. 2003 Aug;134(2):180-8
references.pmid: 12947316
references.citation: Infect Control Hosp Epidemiol. 2004 Mar;25(3):192-7
references.pmid: 15061408
references.citation: Crit Care Med. 1995 Jul;23(7):1211-6
references.pmid: 7600829
references.citation: Infect Control Hosp Epidemiol. 2013 Jan;34(1):69-73
references.pmid: 23221195