Through my work with NIVAS, I spent quite a bit of time in 2022 talking about glove use in clinical practice. I've had time to reflect on my own practice and practice nationally within the IV therapy and vascular access world. I was at a conference recently where the results of a mixed-methods study were presented. The observational study of non-sterile clinical glove use in two acute UK hospitals showed that nonsterile clinical gloves are often used when they are not needed, put on too early, taken off too late or not changed at critical points (Wilson et al, 2017).
Healthcare workers seem to be constantly observed wearing gloves while making beds, taking observations and providing personal care to patients with the absence of handwashing and changing of gloves between these activities. It is not surprising that the overuse of clinical gloves has been linked to increased risk of infection and cross-contamination of patients, especially those with indwelling devices.
So how do we kick the habit of wearing gloves when they are not required? How do we decide what is appropriate glove use and what is not?
According to epic3, point SP21, gloves must be worn for invasive procedures, contact with sterile sites and non-intact skin or mucous membranes, all activities that have been assessed as carrying a risk of exposure to blood or body fluids, and when handling sharps or contaminated devices (Loveday et al, 2014).
In 2020, the European Centre for Disease Prevention and Control (ECDC) produced guidelines in the context of the COVID-19 pandemic. It recommended the use of medical gloves as part of standard precautions to reduce the risk of contamination of healthcare workers’ hands with blood and other body fluids (ECDC, 2020). It recommended that medical gloves should be worn when undertaking peripheral venous catheter insertion/removal, intubation, cleaning spills of body fluids, emptying emesis basins, handling/cleaning used instruments, handling waste and so on.
There are many other guidelines that say the same thing — wear gloves when there is a risk of exposure to blood or bodily fluids, non-sterile or sterile depending on the activity, and handwashing must be undertaken before and after the procedure when gloves are discarded. Gloves should be single use.
NIVAS's position is clear in terms of vascular access: the use of a non-touch aseptic technique (ANTT) including handwashing and non-sterile glove use for peripheral cannulation and venepuncture is necessary, because there is a risk of exposure to blood. For central device placement a surgical ANTT, handwash and sterile gloves are necessary because of its invasive nature. For care and maintenance of vascular access devices, an ANTT including handwashing and non-sterile gloves is advisable as there may be contact with blood or bodily fluids.
Our position on glove use in IV therapy is less black and white. The Health and Safety Executive (HSE) has published guidance on glove use (HSE, 2022a). Gloves help protect workers from exposure to blood-borne viruses, especially where there is a risk of injury, such as a puncture wound with contaminated sharps. In terms of handling chemicals or IV therapy, things are slightly greyer.
Cytotoxic drugs are hazardous substances, as defined by the Control of Substances Hazardous to Health (COSHH) Regulations (HSE, 2022b) and require the use of personal protective equipment (PPE), including gloves, as well as other measures such as closed system drug transfer devices when handling and administering cytotoxic agents. There are other drugs such as monoclonal antibodies where PPE must be worn, including gloves, to protect the healthcare worker and of course when cleaning equipment with chemicals, PPE must be worn.
The HSE is clear that, when handling chemicals that could be hazardous to health, PPE, including gloves, should be used. The question is what constitutes a hazardous chemical? Does some or all IV therapy fall under this category? As this is not clear it remains the responsibility of individual organisations to define what PPE is required in individual IV therapies. I hope guidance will be clearer in 2023.