The Covid-19 pandemic pushed the NHS to its functional limits. In the face of mounting pressure caused by increased hospitalisations, many processes had to be rapidly adapted and implemented.
This case study will focus on the importance of improved hygiene procedures, looking at the ‘Gloves are Off’ campaign, and how new procedures came into effect.
The Gloves are Off
Even after 18 months, there are still a lot of unknowns about Covid-19, especially with the emergence of multiple strains and variants.
However, what became clear very early on in the pandemic was that maintaining good hygiene was of the utmost importance in curbing the spread of the virus.
Washing your hands regularly with soap and hot water quickly became prominent in the messaging to the public. Internally, the NHS had a slightly different issue on their hands, gloves.
Much of the literature on disposable gloves shows that they do make up part of the best practice for when dealing directly with bodily fluids, non-intact skin, or mucous membranes, there is significant potential for cross-contamination.
Some reasons for this are because they are often used when they are not needed, put on too early, taken off too late, or not changed at critical points.
Earlier research into the use of disposable gloves found that they were being worn without any certainty of them being sterile, and nonsterile gloves could be contaminated with a wide range of bacteria and spore-forming agents.
Helen Dunn, Consultant Nurse and Director of Infection Prevention and Control, alongside Kate Harkus, Lead Practice Educator for Infection Prevention and Control at Great Ormond Street carried out a hand hygiene audit, which included a review into their disposable glove usage at the beginning of the pandemic.
One of their immediate findings was that staff would use gloves in place of good hand hygiene, such as regular washing and sanitising.
There were multiple cases of staff having sore, red hands, some with contact dermatitis, due to the use of gloves rather than regular washing.
As well as this, the review highlighted that the overuse of gloves for tasks that did not require their use was having a significant effect on the hospital’s environmental impact.
Research has also shown that patients, particularly those who are incapable of washing themselves, don’t want to be washed by a gloved hand and would rather experience touch for a more human feeling.
Taking an Educational Approach
To tackle the issues raised by their findings, some measures were quickly agreed and introduced. These included:
- Carrying out hand hygiene audits
- Increasing soap & hand sanitiser outlets
- Measuring dermatitis levels in staff
- Monitoring environmental factors
- Collecting qualitative data from patients and families
- Measuring the cost to the trust
- Analysing infection rates
The trust also asked all staff to carry out risk assessments when using gloves and aprons, considering whether it was necessary, making sure proper protocols were followed regarding disposal.
Alongside this, not using gloves for IV preparation and administration was promoted. This was also risk assessed as each case can provide unique challenges, but the overall aim was to minimise wastage.
The trust adopted an educational approach and standardised the training to be delivered in all clinical areas.
They updated their webpage with resources for staff on hand hygiene, and which procedures to follow if in doubt of whether gloves were necessary or not.
There was a ‘Hand Hygiene Day’ event in May, which sought to clearly explain the importance of good practice and layout the clinical and environmental problems with glove misuse.
The content team produced information posters, pamphlets, and screensavers that were distributed trust-wide to reinforce the messaging.
In the 12 months prior to the Gloves Off campaign launching, 11.1 million pairs of disposable gloves were ordered. This cost the trust £289,599.32.
In the year following the Gloves Off campaign, orders have decreased by 3.7 million pairs.
This resulted in only 7.4 million pairs of disposable gloves being ordered, saving over £90,000 and using 18 tonnes less plastic than prior to the campaign.
The trust also introduced ‘Break-the-Chain’ week. This focused on breaking the chain of infection by educating staff around the trust, with every ward having a Break-the-Chain Champion delivering the training.
The training took a two-pronged attack, showing best practices for Covid-19 patient management and PPE guidance, with being glove aware coupled with the initial messaging.
The overwhelming result of the campaigns have been that the reduction in glove use has led to an improvement in hand hygiene.
There has been no adverse impact on infection rates, and staff have given feedback that they feel more empowered to make better clinical decisions.
Dunn, Helen. Harkus, Kate. 2021. Infection Prevention & Control, Great Ormond Street Hospital. The Gloves are Off: Safer in our Hands.