Gloves Off! Clean hands, safe for all

Non-sterile gloves (NSGs) are over-used in the healthcare sector, contributing to poor hand hygiene, and financial and environmental waste. Published research on hand hygiene in healthcare indicates that NSGs are commonly worn when they are not required and that inappropriate glove use is often associated with lower compliance with the 5 Moments for Hand Hygiene.

It is estimated that Hunter New England Local Health District (HNELHD) uses almost 30 million gloves annually at a cost of $1.5million, producing 100 tonnes of waste and a carbon footprint of 1000 tonnes CO₂e. ¹ Similar Gloves Off! interventions have been conducted by Great Ormond St Hospital (UK)^2,3 and the Mater Hospital in Queensland. ⁴ These centres reduced glove use by 30% and 9%, respectively. The Gloves Off! project took place on two trial wards at John Hunter Hospital, aiming to improve hand hygiene and reduce unnecessary non-sterile glove use through the implementation of a targeted hand hygiene education program.

Using dynamic engaging strategies to reach staff

The project team implemented quasi-experimental before and after study in two acute surgical John Hunter Hospital wards and delivered multi-modal education package to clinical staff (nurses, doctors, and allied health). The education intervention aimed to improve staff capabilities in performing risk assessments as per standard precautions, based on Clinical Excellence Commission guidelines. This included:

• formal education sessions delivered by the infection prevention clinical nurse consultant
• point-of-use educational posters with glove use guidelines placed next to glove dispensers
• informal reminders in staff huddles and the development of a survey tool
• novel engagement strategies, including the development of a web page featuring evidence-based guidelines.

A suite of engagement strategies was employed, including recognisable logos on badges, posters and banners, staff newsletters, glove-themed baking, and a custom music video, written and performed by HNELHD staff. The multidisciplinary team had active representation from HNELHD’s Infection Prevention Service, Sustainability Unit, ward staff, surgery staff, and allied health. Outcome measures included appropriate glove use, hand hygiene compliance, carbon footprint, glove waste, costs, staff knowledge and attitudes regarding appropriate use of NSGs.

Unnecessary glove use reduced to 23%

The project was successful in improving staff capability in performing standard precautions risk assessments, improving patient care, saving money, reducing waste and minimising HNELHD’s carbon footprint. Unnecessary glove use reduced from 60% pre-intervention to 31% post-intervention and 23% at six-month follow-up. Observational audits conducted for over 700 hand hygiene moments compared hand hygiene compliance before and after the education intervention and after six months. Hand hygiene compliance improved from 59% pre-intervention to 69% post-intervention and 83% at six-month follow-up.

Ward glove purchase numbers reduced by 21%. The project resulted in cost savings which can be sustained without requirement for additional funding. Estimated annual savings for one ward were approximately $3,774 for glove purchase (excluding waste disposal cost savings). The project achieved a waste reduction of 260kg and carbon savings of 2,566 kgCO₂e, which equates to an equivalent carbon footprint of driving a fuel-efficient petrol car 7,000km (approximately halfway around Australia).

The project is well-suited for use in other health services. It can be implemented using current resources and generates a reduction in healthcare costs. The HNELHD Gloves Off! webpage includes a comprehensive guide with  the resources required for other units to replicate the project or implement a similar project. Leadership from the Infection Prevention Service (IPS) was crucial, as staff trusted information presented by IPS. The nurse unit manager's active involvement was a strong influence on staff behaviour, with innovative and fun education elements increasing staff engagement. Inconsistent availability of alcohol-based hand rub at point of care was a barrier for staff performing hand hygiene. Strategies are needed to ensure hand rub is easily available.

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