title: Improved hand hygiene compliance after eliminating mandatory glove use from contact precautions-Is less more?
abstract: Guidelines recommend that health care personnel (HCP) wear gloves for all interactions with patients on contact precautions. We aimed to assess hand hygiene (HH) compliance during contact precautions before and after eliminating mandatory glove use.
  
  
  
  We assessed HH compliance of HCP in the care of patients on contact precautions in 50 series before (2009) and 6 months after (2012) eliminating mandatory glove use and compared these results with the hospital-wide HH compliance.
  
  
  
  We assessed 426 HH indications before and 492 indications after the policy change. Compared with 2009, we observed a significantly higher HH compliance in patients on contact precautions in 2012 (52%; 95% confidence interval [95% CI], 47-57) vs 85%; 95% CI, 82-88; P < .001). During the same period, hospital-wide HH compliance also increased from 63% (95% CI, 61-65) to 81% (95% CI 80-83) (P < .001). However, the relative improvement (RI) of HH compliance during contact precautions was significantly higher than the hospital-wide relative improvement (RI, 1.6; 95% CI, 1.49-1.81 vs 1.29; 95% CI, 1.25-1.34), with a relative improvement ratio of 1.27 (95% CI, 1.15-1.41).
  
  
  
  Eliminating mandatory glove use in the care of patients on contact precautions increased HH compliance in our institution, particularly before invasive procedures and before patient contacts. Further studies on the effect on pathogen transmission are needed before revisiting the current official guidelines on the topic.
authors.affiliation: Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Bern, Bern, Switzerland. Electronic address: alexia.cusini@insel.ch.
authors.forename: Alexia
authors.initials: A
authors.lastname: Cusini
authors.affiliation: Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Bern, Bern, Switzerland.
authors.forename: Doris
authors.initials: D
authors.lastname: Nydegger
authors.affiliation: Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Bern, Bern, Switzerland.
authors.forename: Tanja
authors.initials: T
authors.lastname: Kaspar
authors.affiliation: Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Bern, Bern, Switzerland.
authors.forename: Alexander
authors.initials: A
authors.lastname: Schweiger
authors.affiliation: Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Bern, Bern, Switzerland; Clinic of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Rolf
authors.initials: R
authors.lastname: Kuhn
authors.affiliation: Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Bern, Bern, Switzerland.
authors.forename: Jonas
authors.initials: J
authors.lastname: Marschall
mesh_terms: D003428:Cross Infection / Q000517:prevention & control*; D017575:Gloves, Protective; D019983:Guideline Adherence; D006235:Hand Disinfection / Q000592:standards; D063373:Hand Hygiene / Q000592:standards*; D006282:Health Personnel; D006761:Hospitals; D006801:Humans
keywords: Contact precautions; Glove use; Hand hygiene