Glove utilization in the prevention of cross transmission: a systematic review

BACKGROUND: Gloves are worn to protect hands from contamination from microorganisms and to reduce the risks of transmission of microorganisms from healthcare workers to patients and vice versa. However, gloves should be changed between patient contacts and hand washing is necessary before putting on gloves and immediately after removing gloves. OBJECTIVE: The objective of this review was to evaluate and synthesize the best available research evidence that investigates clinical use of gloves in the prevention of cross transmission. TYPES OF PARTICIPANTS: Health care workers.Types of intervention(s): Glove use intervention. Types of outcomes: Contamination of healthcare workers' hands, transmission of infections, adherence to glove usage, inappropriate uses of gloves, and adherence to hand hygiene. Types of studies: Quasi-experimental studies and descriptive studies. SEARCH STRATEGY: The search sought to find published and unpublished studies. The time period of the search covered articles published from 2000 to 2012 in English and Thai. The databases searched included: MEDLINE, CINAHL, EMBASE, The Cochrane Library, PubMed, Science Direct, Current Content Connect, Blackwell synergy, Thai Nursing Research Database, Thai thesis database, Digital Library of Thailand Research Fund, Research of National Research Council of Thailand, and Database of Office of Higher Education. METHODOLOGICAL QUALITY: Studies selected for retrieval were assessed by two independent reviewers for methodological quality using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument software. DATA COLLECTION: Data extraction was performed using the standardized data extraction tool from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument software. DATA SYNTHESIS: A meta-synthesis was not possible due to the methodological heterogeneity of the included papers. The evidence was thus presented as a narrative summary. RESULTS: Twenty-three studies were included in this review. The results indicated that contamination of a healthcare worker's gloves with bacteria during routine care activities is common. The use of gloves can protect the hands of healthcare workers from bacterial contamination, but the protection afforded by the gloves was incomplete. Adherence to glove utilization among healthcare workers was suboptimal. Gloves were overused and often misused. The major break in compliance with glove use was failure to change gloves between procedures on the same patient. Inappropriate glove use can increase the risk of cross transmission. It is unclear if modifications in glove use alter compliance with hand hygiene among healthcare workers. CONCLUSION: Gloving can reduce acquisition of microorganisms on the hands. However, gloving does not completely prevent contamination of the hands. Compliance with glove use among healthcare workers is poor. Gloves were also overused and often misused. Inappropriate glove use can increase the risk of cross transmission via contaminated gloved hands. There is still not enough evidence to prove the influence of glove use on adherence to hand hygiene. IMPLICATIONS FOR PRACTICE: This review strengthens the recent suggestion on the use of gloves to reduce bacterial contamination. However, gloving does not completely prevent contamination, thus emphasizing the need for hand antisepsis before and after patient contact. Intervention to improve the use of gloves and hand hygiene compliance after gloving in the healthcare settings should be implemented. IMPLICATIONS FOR RESEARCH: Further studies should target poor compliers with glove use and promote strategies that can be evaluated.