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For Primary Care| View from the ground

‘Gloves Off’ in General Practice

View from the Ground, by Dr Vasumathy Sivarajasingam

Medical gloves are a crucial element of personal protective equipment (PPE) and are readily accessible in healthcare settings. It is recommended that they are used in many procedures as a standard precaution to prevent the transmission of infection between patients and healthcare professionals (HCPs),1 such as during contact with mucous membranes, broken skin, harmful drugs, or chemicals.2 Categorised as either examination (sterile or nonsterile) or surgical (sterile), medical gloves are made of different materials, and come in various colours, thicknesses, and sizes.1 Powder-free and nitrile gloves are among the types of medical glove most frequently used in healthcare.1

The use of gloves by HCPs has increased exponentially,3 but there are hidden costs to this, both environmentally and financially speaking. Medical gloves are one of the single-use plastic items most commonly used in the health service; in England alone, around 5.5 billion gloves were used in NHS and social care settings between 25 February 2020 and 24 February 2021.2 The environmental costs of the manufacture and transport of medical gloves are compounded by the production of waste associated with their use.2,3 Therefore, there is a need to reduce glove use in healthcare—and, in particular, inappropriate glove use.2,3

Staff may feel unable to challenge excessive glove use in healthcare, despite reassurance that hand hygiene is a highly effective way of protecting oneself from contagions such as HIV or COVID-19.2,3 However, members of the primary care team sometimes wear gloves unnecessarily—for instance, when working on computers or completing administrative tasks.3 In fact, there are many activities for which glove use is not necessary—for example, giving a vaccination or holding a patient’s hand.3

Inappropriate use of gloves can be harmful, especially if they are worn for long periods of time.3Glove use can increase the risk of dermatitis for the wearer—according to a Royal College of Nursing (RCN) survey published in 2020, 93% of nurses had reported at least one symptom of hand dermatitis in the preceding 12 months.3 Glove use may also put patients at an elevated risk of infection by preventing hand hygiene.2

In 2018, the RCN launched ‘Glove Awareness Week’ to emphasise the importance of appropriate glove use and good skin health.2,3 The campaign highlighted the negative environmental effects of—and provided nursing staff with clear actions to reduce—inappropriate glove use.2 The benefits of such campaigns are evident in the ‘Gloves Off’ campaign launched by Great Ormond Street Hospital (GOSH) in 2018, which asked staff to perform a risk assessment before choosing whether or not to wear gloves;3,4 through this approach, GOSH staff saved 21 tonnes of plastic and £90,000 by reducing unnecessary glove use.5

Primary care has a huge part to play in raising awareness of the importance of good hand hygiene, the purpose of gloves, and the planetary, public, and financial impacts of incorrect glove use. We need to reiterate to all of our staff the merits of methodical hand hygiene using soap and water or alcohol-based hand gel before and after every patient contact—either with or without gloves, and on removing gloves. To achieve this, buy-in is needed from the top down, as empowering individuals to make long-lasting behavioural changes requires the support of the whole organisation.2

This initiative may also represent a valuable quality-improvement opportunity for HCPs, as it will highlight the burden of inappropriate use of not only gloves, but also other PPE (for example, plastic aprons and disposable masks) on practice finances and the wider NHS.