Use gloves, gowns, and other hospital equipment supplies well

A new study has highlighted the importance of properly donning and doffing hospital equipment supplies such as gloves and gowns. Hospital workers got ersatz bacteria on their skin and clothes almost half the time when removing gowns and gloves, according to the results of the study published in JAMA Internal Medicine. Keep in mind that there was nothing wrong with the gloves and gowns themselves; the problem lies with the removal protocol – or lack thereof. “Most of the participants appeared to be unaware of the high risk for contamination and many reported receiving minimal or no training in putting on and taking off [personal protective equipment],” author Curtis J. Donskey told Reuters.

The Cleveland Veterans Affairs Medical Center’s Donskey, Dr. Myreen Tomas, and colleagues ran 435 simulations (246 by nurses, 72 by doctors, and 117 by phlebotomists, physical therapists, dietitians, radiology technicians, and other assorted health workers) in which volunteers were asked to put on and hospital equipment supplies including “contact isolation gowns” and nitrile gloves, given ½ a millimeter of a fluorescent lotion to represent invisible pathogens. The hospital workers rubbed their gloved hands with the lotion for 15 seconds and then wiped their hands on their gowns. Finally, they removed their gowns and gloves as they have been accustomed to. Black light was then used to check for traces of lotion.

The staff got lotion on their clothes and skin 38% of the times when taking off the gowns and 53% of the time when taking off the gloves. All told, ‘contamination’ occurred 46% of the times when the workers removed their hospital equipment supplies due to such mistakes as not pulling the gloves over the wrist, taking gowns over the head as opposed to pulling them away from the body, putting of the gloves first and the gown second, and touching the outside of a dirty glove when removing it. Moreover, the contamination rate was 30% even when safety procedures were complied with. In response to these findings, Toma’s own hospital launched an initiative to train staff on how to put on and take off gloves and gowns per CDC standards, including a ten-minute video and a twenty-minute practice.

The authors noted that “educational interventions that include practice with immediate visual feedback on skin and clothing contamination can significantly reduce the risk of contamination.” Conversely, they also wrote that “contamination of skin and clothing was reduced by the intervention” from 60% to 19% but “it was not reduced to zero.” The researchers used an innocuous substitute for actual bacteria, but there is a very real connection between hospital equipment supplies and hospital-acquired infections. Previous studies have pointed to the transmission of drug-resistant bacteria such as C. difficile among hospital staff during glove removal. Tomas and her co-authors stressed that training is helpful but not infallible, and suggested disinfecting gloves and gowns with bleach or ultraviolet C light before taking them off. A better long-term solution, however, would be to rethink the design of personal protection gear to allow for easier removal without contamination.

Related: How to put on and remove personal protective equipment