When Great Ormond Street Hospital’s (GOSH) lead nurse for infection control, Helen Dunn investigated hand hygiene, observations revealed a key reason why staff were missing vital opportunities to clean their hands.
Experts agree that hands are the principal route causing cross-infection, with hand hygiene the single most important factor in controlling its spread. “But staff were wearing gloves the whole time they were caring for their patient,” says Helen. “In effect, the gloves had become a barrier to hand hygiene.”
In particular, they noticed that when staff were administering medication - whether oral or intravenous - they wore gloves throughout. “They would be working in one room, preparing the medication, with lots of people around and wearing non-sterile gloves. They would then give the medication to the patient, wearing those same gloves,” Helen explains.
Working with practice educators, she decided to challenge the usual routine, suggesting that staff assessed the risks instead, adopting RCN standards that advise gloves should only be worn when dealing with potentially harmful drugs, such as those used in chemotherapy.
They took their proposals to various staff groups, including those working with renal patients and those who administered drugs to patients at home. “We were seeking their backing,” says Helen. “And after they had talked it through, the feeling was that it made perfect sense. Staff felt it was more important to clean your hands than wear gloves, if there was no risk of blood or bodily fluids.”
Once approval was given from various trust boards and patient safety groups, the ‘Gloves are off’ campaign launched in the spring of 2018, starting with education. “I think that staff had got into the habit of thinking that they had to wear gloves to administer any medication,” says Helen. But the practice educators trained staff locally on the wards, improving their understanding of when gloves were necessary - and when they weren’t. “It became about what was best for our patients,” she adds.
At the outset, Helen admits they hadn’t anticipated environmental reasons would be one of the main factors in persuading staff to ditch the gloves. “But actually, the biggest reason they do is because of plastic,” she says. “We have a young staff here and for them, how we treat our environment is really important. If you can find the selling point, that’s what helps.”
To chart progress statistically, they collected figures on the numbers of gloves used before and after the campaign started. These showed an average reduction of 36,608 pairs of gloves each week, equivalent to a saving of around £1,000. Over a year, this should equate to nine and a half tons less plastic. “When we showed staff the amount we were using, it really helped them to see the bigger picture, which you’re not always aware of when you’re working on a ward,” says Helen.
Audit shows that staff are cleaning their hands more now, using gel-based cleaners when appropriate. Other benefits include improvements in skin for some staff, especially those more sensitive to wearing gloves. In one instance, a staff member was almost at the point of being taken out of clinical practice. “She showed me pictures of how bad her hands were,” says Helen. “Now they’re the best they’ve ever been. It has made a huge difference.”
A key aspect of the project has also been to reassure families about the changes, including talking to the teachers at GOSH’s own school, which provides education to children who are inpatients. “If their students ask why things are being done differently, they can explain,” says Helen. There has also been some feedback that children see gloves as more medicalised, so their anxieties increase when staff put them on, she says.
Looking ahead, they plan to carry on measuring the savings; spreading the message about appropriate glove use to other staff groups, such as porters and cleaners; and updating staff on progress using visual aids. “The best thing that we’ve done is ask staff why they were wearing gloves,” says Helen. “It’s made them think about whether they need them or not.”