Hand hygiene vs gloves. Do we know how to use them correctly?

hands

Today I want to talk about hand washing and wearing gloves. You're probably thinking it doesn't have much of a game, because it's as common a subject for us as it is to breathe. I probably won't find out anything new… Or maybe it is?

The reason I'm focusing on this is because a good partner (and great teacher) has shown me that, even on the simplest issues, we continue to do things wrong. It also made me see my own mistakes setting me up and, of course, I sinned as a rookie.

dialogue nursesThe conversation began with techniques we are supposed to do wrong (most toilets) by not looking at recommendations, or by trusting outdated literature slains and/or low scientific evidence. There came the controversy of the patient's complaints to the professional, and I commented on my personal fears for the safety that offers us the legal coverage of institutions such as trade unions, schools, etc. At that point, the dialogue was more or less like this:
My partner said to me: -.Are you afraid of being summed up for putting a drug wrong, which can happen very eventually in your work, and not other everyday things like hygiene?

I said, "What's wrong with hygiene?

.- Look at your hands, you wear the longest nails than you should, you have a watch on one wrist and a rubber on the other, apart from that you have come with tufts of the piglet and you have them on your face.- And it was true, I always wear a watch on my wrist for the hours medication or constant (also to count the respiratory rate of the patient), and that day also the hair gum in case I lost the clamp (which was already a little old and lacked teeth).

Now look at your partner, what's on her wrists?

-. Well, another watch and bracelets.- I responded, and it was true, but who doesn't have things on their wrists, where did I want to go with this?

-. See what I'm saying, and the other partner… look at her face, she wears makeup, and in theory she's not suitable. If you go to the other units and observe the rest of the companions you will be able to write many errors of clothing and hygiene: long nails, painted, bracelets, rings, watches, loose hair, makeup, etc. Are you really worried you won't be reported for something more serious if it turns out that the most basic thing doesn't come true?

ANUNCIO

-. But no one's going to make a claim to you for going with your nails a little longer to take care of you, or with a watch, or with things like that.- I answered with a little bit of a slob, even though I knew you were right.

-. Well, nobody's going to make a claim to you until someone does. I'm going to ask you one very basic thing, how do you interact with a patient like the one we have here today (a bedless patient with no insulation or continuity solutions except for a venous and an arterial channel)?

nitrile glove-. Well, how it's going to be done, with gloves.-"This is a snare question of pure no-brainer" I thought.

My companion arched his eyebrows and put on a surprise face — With gloves, are you sure?

"Ah, no?" was I starting to confuse… -. Well, it's true, first you wash your hands with soap and then put on your gloves.

He kept his face disbelief — Really? … .- My face was also supposed to be a poem, because I no longer knew where to go. He continued — How would you touch me, or the partner, you don't wear gloves or wash your hands with soap.

-. But neither you nor she are patients.

-. No, but you don't have to touch a patient with gloves all the time, nor do you have to touch the material with gloves. Your hands disinfect them with alcohol, not soap. Do you an ECG do it with the gloves on?

-. Look, I do it almost always with gloves, besides the material, I remember that once an emergency service nurse scolded me for purging a serum without gloves, and in between there was neither blood nor organic matter (although that is another story).

-. Well, badly done, if there's no blood or organic matter, the gloves aren't necessary. And the SVA nurse thing doesn't tell me anything, also some of the uniforms that wear the emergency services are not EPIs (individual protective equipment). I repeat, the fact that everyone does something the same doesn't mean they're doing it right.- And with that the conversation ended for the time being, because we had to get on with the tasks.

I was entertaining, doing a few things for nursing control, and my partner asks me to please go take a look at the patient's nasal goggles (the only one we had that day). While the other partner was taking the lady's medication, I approached to see what was happening to the nasal glasses. I look, I look… Nothing. Well laid, at 3 liters per minute, good saturation… Then what? Since I don't understand what you want me to fix, I ask you again. He looks at me, but he expects me to get to the checkpoint, and he says.

A trap, I've fallen into a trap. "But if I haven't touched anything!" I replied a little offended.

WHO Handwashing Poster

.- No, but you've entered the patient's area, don't you remember the five moments of hand washing? I did it to you intentionally, do you see now what I tell you?.- It is true that I had not touched anything of the patient's furniture, and that if I had done I should have washed my hands, but the trap was not ill-thought to make me realize the need of the myds that we sometimes miss.

The conversation then followed about how to wash my hands, with what and at what point, and as I was curious, I decided to investigate more in the WHO manuals, which a few days earlier had been recommended by Juan Pablo Amador (@JuanPabloAmador), a nurse at SUMMA 112 on Twitter. Also in others such as the Murcian Health Service, which seraphim Fernández (@cuidandosfs) recommends in one of his post "10 essential resources for a flying nurse".
I leave you below several bibliographies. However I have found some inconsistencies in them.

In the WHO material, for example, there is a part dedicated to several examples of hand hygiene moments (very exclarecenes, by the way). One such time is the patient's puncture of vaccines, in which he indicates that the use of gloves is NOT necessary. However, if we go to other manuals such as the Asturian Health Service or the Aragonés, we can find that the use of gloves after the correct hand washing IF must be done.
In my modest opinion, and far from disparaging an entity of such relevance as WHO, in the face of discrepancies I prefer to use them.

There are also other differences regarding the use of soap vs a hydroalcoholic solutions, but of less relevance in my view: literatures point to hand washing only when they look visibly dirty or after contact with biological material prefer the use of hydroalcoholic solutions in case soap is not available (emergency services, major disasters, situations that require rapid care…)

hydroalcoholic solutionWhat everyone agrees on is:

  1. Hand hygiene must be performed before touching the patient or performing aseptic tasks.
  2. After coming into contact with the patient, their environment or with body matter/liquids.
  3. It is not necessary to wear gloves if we are going to perform a technique that does not involve an exchange of contaminated material (taking TA, ECG, auscultation, bimanual scanning…).
  4. The use of gloves NEVER exempts from hand hygiene.
  5. Whenever these are stained, we must wash our hands and put on some clean ones.
  6. If we can't wash our hands, we'll use hydroalcoholic solution.

It is a very very brief summary, I would encourage you to read the links of the different bibliographies, and under your personal prism, accept the recommendations that are most truthful to you and apply them to your daily work.

I hope the post has helped you reflect on how important the hygiene of our work tools is both inside and outside the home: our hands. Remember that with a simple wash, we help to minimize the transmission of diseases (especially the nosocomials). I would like to know your opinion on this subject, and how you use the gloves, I'll wait for you next week!

Bibliography:

  1. Ramos Hernández, M. P; Martínez Espín, M.D; Guardiola García, C. USE OF INDIVIDUAL PROTECTION EQUIPMENT. Guide to the use of gloves in health workers. Occupational Risk Prevention Service. Murcian Health Service. Retrieved 17 July 2014. Available in: https://www.murciasalud.es/recursos/ficheros/203071-folleto_guia_guantes.pdf
  2. World Health Organization. Save lives: Clean your hands. Guide to the implementation of who's multimodal strategy for improving hand hygiene. Ministry of Health, Social Policy and Equality. Patient Safety. A World Alliance for Safer Health Care. Retrieved 18 July 2014. Available in: http://apps.who.int/iris/bitstream/10665/102536/1/WHO_IER_PSP_2009.02_spa.pdf?ua=1
  3. World Health Organization. Save lives: Clean your hands. Hand hygiene in outpatient and home care and long-term care. WHO Multimodal Strategy for Improving Hand Hygiene Implementation Guide and the "The Five Moments for Hand Hygiene" model. Ministry of Health, Social Policy and Equality. Retrieved 18 July 2014. Available in: http://apps.who.int/iris/bitstream/10665/84918/1/9789243503370_spa.pdf?ua=1
  4. World Health Organization. Save lives: Clean your hands. Glove Use Information Leaflet. Patient Safety. A World Alliance for Safer Health Care. Retrieved 18 July 2014. Available in: http://www.who.int/gpsc/5may/Glove_Use_Information_Leaflet.pdf?ua=1
  5. Navarro González, A; Cao Fernández, A; Sánchez Fdez, A.M; Fernández González, C; Vega García, F; Alonso Pérez, F. et al. Hand washing protocol and correct use of gloves in Primary Care of Asturias. DIRECTORATE OF HEALTH SERVICES NURSE COORDINATOR AP / AE . Health Service of the Principality of Asturias. Oviedo 2009. Retrieved 17 July 2014. Available in: http://www.asturias.es/Astursalud/Ficheros/AS_SESPA/AS_Gestion%20Clinica/AS_Seguridad%20Paciente/Protocolo%20Lavado%20Manos%20AP.pdf
  6. Gloves: sanitary uses. Types and uses. Marqués de Valdecilla University Hospital. Retrieved 19 July 2014. Available in: http://www.humv.es/index.php?option=com_docman&task=doc_view&gid=1015
  7. Guide to the use of gloves in health workers. Basic occupational hazard prevention unit. Aragonese Health Service. Retrieved 17 July 2014. Available in: file:///C:/Users/Diana/Downloads/Gu%C3%ADa%20de%20uso%20de%20guantes%20en%20trabajadores%20sanitarios.pdf

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