title: Applying human factors and ergonomics to the misuse of nonsterile clinical gloves in acute care.
abstract: BACKGROUND
  Health care workers (HCWs) are recommended to wear nonsterile clinical gloves (NSCG) for direct contact with blood and body fluids. However, there is evidence of extensive inappropriate NSCG use.
  
  
  METHODS
  A mixed-methods study comprising observation of NSCG use in 2 acute hospitals and semistructured HCW interviews. Qualitative data were categorized using thematic analysis. Findings were mapped to the Systems Engineering Initiative for Patient Safety model and used to develop a strategy for improving NSCG use.
  
  
  RESULTS
  Two hundred seventy-eight procedures performed in 178 episodes of care involved the use of NSCG. NSCG were inappropriate for 59% of procedures (165 out of 278). Risk of cross-contamination occurred in 49% (87 out of 178) episodes. Twenty-six HCWs were interviewed; emotion and socialization were key factors influencing decisions to use NSCG. Data from observation and thematic analysis were mapped to 6 interacting components of the Systems Engineering Initiative for Patient Safety work system. Interventions targeting each component informed quality improvement strategies CONCLUSIONS: Despite intense promotion of hand hygiene as the key measure to protect patients from health care-associated infection, NSCG dominate routine clinical practice and potential cross-contamination occurs in 50% of care episodes. Such practice is associated with significant environmental and financial costs and adversely affects patient safety. The application of human factors and ergonomics to the complex drivers of inappropriate NSCG behavior may be more effective than conventional approaches of education and policy in achieving the goal of preventing health care-associated infection and improving patient safety.
authors.affiliation: University of West London, Richard Wells Research Centre, Paragon House, Brentford. Middlesex, London TW8 9GB, UK. Electronic address: Jennie.wilson@uwl.ac.uk.
authors.forename: Jennie
authors.initials: J
authors.lastname: Wilson
authors.affiliation: University of West London, Richard Wells Research Centre, Paragon House, Brentford. Middlesex, London TW8 9GB, UK.
authors.forename: Aggie
authors.initials: A
authors.lastname: Bak
authors.affiliation: University of West London, Richard Wells Research Centre, Paragon House, Brentford. Middlesex, London TW8 9GB, UK.
authors.forename: Heather P
authors.initials: HP
authors.lastname: Loveday
mesh_terms: D001291:Attitude of Health Personnel; D004632:Emergency Medical Services / Q000379:methods*; D006804:Ergonomics; D005260:Female; D005932:Gloves, Surgical / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007407:Interviews as Topic; D008297:Male
keywords: Hand hygiene; Health care-associated infection; Infection control; Quality improvement; Work systems