Introduction

A healthcare-associated infection (HAI) is an infection that occurs in a patient receiving health care that was not present or incubating at the time of admission [1]. A HAI can lead to a prolonged hospital stay, an increased risk of long-term disability and death. The prevention of HAIs is therefore of great importance. Approximately one third (and as much as 70%) of all HAIs are considered to be preventable [1,2]. The single most important measure is for healthcare personnel (HCP) to be compliant with hand hygiene measures [3]. The value of hand hygiene is undisputable, but compliance is suboptimal [4,5], especially when gloves are used [6]. The use and misuse of gloves in health care negatively affects the HCP’s compliance with the five moments of hand hygiene [[7], [8], [9]] and subsequently increases the risk of organism transmission [10].

The wearing of personal protective equipment such as non-sterile gloves during some clinical activities is in accordance with standard hygiene precautions. Gloves reduce the risk for hand contamination and limit the risk of organism transmission when used properly in combination with hand disinfection [11]. However, the actual manner in which HCP use gloves is not in accordance with the guidelines. For example, Baloh et al. [6] observed a substantial gap between self-reported compliance with hand hygiene before gloving and an actual observed compliance. The misuse of gloves has been described as an overuse of gloves and a failure to remove the gloves at the appropriate time e.g. directly after a care activity, between procedures and patients or between different measures performed on the same patient [8,10,[12], [13], [14]].

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Raybould [15] concluded 20 years ago that gloves were often misused or not used by HCP at the appropriate time, and by so doing could expose HCP and their patients to HAIs. Recent studies [6,9] have concluded that HCP have an over-reliance on gloves, in that the gloves are often used as a method to protect themselves rather than a method to prevent the transmission of organisms. An international observational study found that HCP used the same gloves continuously at a high rate, and that there were significant differences between the observed countries. The Nordic countries showed that the HCP used the same gloves continuously at a lower rate before patient contact. Of note, was the remarkably high rate of the use of gloves that should have been changed before aseptic or clean procedures in all of the countries [9]. Even in care activities that required strict aseptic precautions, it was observed that one out of five patients were put at risk for organism transmission because the HCP did not change their gloves before the care activity [14]. It has also been found that gloves were used inappropriately in over 50% of the observed episodes of glove use during patient-related activities [8,16]. Not changing possibly contaminated gloves between procedures performed on the same patient is the most common source of possible contamination, and failure to change gloves between patients is also prevalent [13].

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Loveday et al. [8] have shown that HCP commonly touch about three objects with their gloved hands before performing patient-related care activities. The items most often touched are clinical equipment around the patient, patient notes, urine bottles/bedpans and objects on the bedside table. Any hand-touched surface is a potential fomite that can be a route for organism transmission if the surface has been contaminated. [3]. HCP frequently touch clinical equipment such as intravenous drip tubing/machines and blood pressure monitors with their hands [17,18]. Other sites regularly touched include bed rails, call buttons, furniture, light switches and telephones [17].

A limited number of studies have focused on the use of gloves by HCP in relation to the surfaces touched by their potentially contaminated gloved hands. Therefore, this phenomenon needs to be further explored to better understand the glove-use behaviour of HCP and facilitate the prevention of HAIs.

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