1. NUR 113 : SKILL 8-3 STERILE GLOVING

2. STERILE GLOVING - INTRODUCTION
Sterile gloves help prevent the transmission of pathogens by direct and indirect contact.
Nurses apply sterile gloves before performing sterile procedures such as inserting urinary catheters or applying sterile dressings.
It is important to select the proper size glove.
The gloves should not stretch so tightly over the fingers that they can easily tear, yet they need to be tight enough that object can be picked up easily.
Sterile gloves are available in various sizes (e.g., 6, 6 ½, 7).
They are also available in “one size fits all” style or in “small”, “medium” and “large”.
Always remember that sterile gloves do not replace hand hygiene.

3. INTRODUCTION – CONT’D
It is important to choose not only the right size glove, but also the correct material.
Many patients and health care workers are allergic to latex, the natural rubber used in most gloves and other medical products (Church & Bjerke, 2009).
The powder that is used to make latex gloves slip on easily is a carrier of the latex proteins.
When you apply or remove gloves, the powder particles become airborne and can remain so for hours.

4. INTRODUCTION – CONT’D
The latex can then be inhaled or settle on clothing, skin, or mucous membranes.
Reaction to latex are mild to severe.
For individuals at high risk or with suspected sensitivity to latex, it is important to choose latex-free or synthetic gloves.
More health care agencies are implementing latex-safe environments for workers.

5. INTRODUCTION – CONT’D
If only sterile latex gloves are available, don a pair of synthetic gloves first because these provide a barrier between the skin and the latex gloves.
Once you apply gloves, always be conscious of the position of your hands during procedures.
If a sterile glove touches a clean, contaminated, or questionably contaminated object, it becomes unsterile, and a new sterile glove must be applied.

6. INTRODUCTION – CONT’D
It is helpful to interlock the fingers and hold the hands together in front of the body and above waist level while waiting to handle sterile items.
If a tear develops in a sterile glove, apply a new glove immediately.
Once gloved, keep your hands clasped about 30 cm (12 inches) in front of your body, above waist level and below the shoulders, until you are ready to perform the procedure GERMS

7. INDIVIDUALS AT RISK FOR LATEX ALLERGY
Spina Bifida
Congenital or urogenital defects
History of indwelling catheters or repeated catheterizations
History of using condom catheters
High latex exposure (e.g., health care workers, housekeepers, food handlers, tire manufacturers, workers in industries that use gloves routinely).
History of multiple childhood surgeries
History of food allergies

8. LEVELS OF LATEX REACTIONS
The three types of common latex reactions (in order of severity) are:
1. Irritant Dermatitis: A non-allergic response characterized by skin redness and itching.
2. Type IV hypersensitivity: Cell-mediated allergic reaction to chemicals used in latex processing. Reaction, including redness, itching, and hives, can be delayed up to 48 hours. Localized swelling, red and itch or runny eyes and nose, and coughing may develop.
3. Type I allergic reaction: A true latex allergy that can be life-threatening. Reactions vary based on type of latex protein and degree of individual sensitivity, including local and systemic. Symptoms include hives, generalized edema, itching, rash, wheezing, bronchospasm, difficulty breathing, laryngeal edema, diarrhea, nausea, hypotension, tachycardia, and respiratory or cardiac arrest.

9. ASSESSMENT
1. Consider the type of procedure to be performed and consult agency policy on use of sterile gloves.
Ensures proper use of sterile gloves when needed.
2. Consider patient’s risk for infection (e.g., a preexisting condition and size or extent of area being treated).
Directs you to follow added precautions (e.g., use of additional protective barriers) if necessary.
3. Select correct size and type of gloves and then examine glove package to determine if it is dry and intact with not water stains.
Torn or wet package is considered contaminated. Signs of water stains on package indicate previous contamination by water.

10. Assessment – cont’d
4. Inspect condition of hands for cuts, hangnails, open lesions, or abrasions. In some settings you are allowed to cover any open lesion with a sterile, impervious transparent dressing (check agency policy). In some cases presence of such lesions may prevent you from participating in a procedure.
Cuts, abrasions, and hangnails tend to ooze serum, which possibly contains pathogens. Breaks in skin integrity permit microorganisms to enter and increase the risk for infection for both patient and nurse (AORN, 2011).

11. ASSESSMENT – CONT’D
5. Assess patient for the following risk factors before applying latex gloves:
A. Previous reaction to the following items within hours of exposure; adhesive tape, dental or face mask, golf club grip, ostomy bag, rubber band, balloon, bandage, elastic underwear, intravenous (IV) tubing, rubber gloves, condom.
B. Personal history of asthma, contact dermatitis, eczema, urticarial, rhinitis.
C. History of food allergies, especially avocado, banana, peach, chestnut, raw potato, kiwi, tomato, papaya.
D. Previous history of adverse reaction during surgery or dental procedure.
E. Previous reaction to latex product.
Suggests allergic response.

12. planning 1. Expected outcomes following completion of procedure:
Patient does not develop signs or symptoms of infection after procedure.
Indicates that microorganisms are not introduced into sterile body cavities or sites (such as skin or urinary tract).
Patient does not develop latex sensitivity or latex allergy reaction.
Patient at risk for latex allergy is not exposed to latex proteins.
Clinical Decision Point: Synthetic non-latex gloves are necessary for patients at risk or if nurse has sensitivity or allergy to latex.

13. IMPLEMENTATION 1. Apply sterile gloves:
A. Perform thorough hand hygiene. Place glove package near work area.
Reduces number of bacteria on skin surfaces and transmission of infection. Ensures availability before procedure.
B. Remove outer glove package wrapper carefully separating and peeling apart sides.
Prevents inner glove package from accidentally opening and touching contaminated objects.
C. Grasp inner package and lay on clean, dry, flat surface at waist level. Open package keeping gloves on inside surface of wrapper.
Sterile object held below waist is contaminated. Inner surface of glove package is sterile.

14. Implementation – cont’d
D. Identify right and left glove. Each glove has a cuff approximately 5 cm (2 inches) wide. Glove dominant hand first.
Proper identification of gloves prevents contamination by improper fit. Gloving of dominant hand first improves dexterity.
E. With thumb and first two fingers of non-dominant hand, grasp glove for dominant hand by touching only inside surface.
Inner edge of cuff will lie against skin and thus is not sterile.

15. IMPLEMENTATION – CONT’D
F. Carefully pull glove over dominant hand, leaving a cuff and being sure that cuff does not roll up wrist. Be sure that thumb and fingers are in proper spaces.
If outer surface of glove touches hand or wrist, it is contaminated.
G. With gloved dominant hand, slip fingers underneath cuff or second glove.
Cuff protects gloves fingers. Sterile touching prevents glove contamination.
H. Carefully pull second glove over non- dominant hand.
Contact of gloved hand with exposed hand results in contamination.

16. IMPLEMENTATION – CONT’D
Clinical Decision Point: Do not allow fingers and thumb of gloved dominant hand to touch any part of exposed non-dominant hand. Keep thumb of dominant hand abducted back.
I. After second glove is on, interlock hands together above waist level. The cuffs usually fall down after application. Be sure to touch only sterile sides.
Ensures smooth fit over fingers.

17. IMPLEMENTATION – CONT’D
2. Remove gloves:
A. Grasp outside of one cuff with other gloved hand, avoid touching wrist.
B. Pull glove off, turning it inside out, and place it in gloved hand.
C. Take fingers of bare hand and tuck inside remaining glove cuff. Peel glove off inside out and over previously removed glove. Discard both gloves in receptacle.
D. Perform hand hygiene.
Protects health care worker from contamination resulting from any unseen tears or pinholes in gloves; also removes powder from hands to prevent skin irritation.

18. evaluation
1. Assess patient for signs of infection, focusing on area treated.
Improper technique contributes to development of an infections.
2. Evaluate patient for signs of latex allergy.
Establishes baseline for patient’s reaction to latex.

19. Unexpected outcomes
1. Patient develops signs of infection (e.g., urine becomes cloudy or odorous; wound becomes painful, edematous, or reddened with purulent drainage).
Contact health care provider and implement appropriate treatments as ordered.
2. Patient develops systemic signs of infection (e.g., fever, malaise, increased white blood cell count).

20. Unexpected outcomes – cont’d
3. Patient develops allergic reaction to latex.
Immediately remove source of latex.
Bring emergency equipment to bedside.
Have epinephrine injection ready for administration, and be prepared to initiate IV fluids and oxygen.

21. Recording & reporting
It is not necessary to record application of gloves.
Record specific procedure performed and patient’s response and status.
In the event of a latex allergy reaction, record patient’s response in nurses’ notes, EHR, and vital sign flow sheet.
Note type of response and patient’s reaction to emergency treatment.

22. Special consideration - teaching
Nurse or patient with a known latex allergy should wear a medical alert bracelet or tag and carry a wallet card stating “latex allergy.”
Individuals with known latex allergies should carry a quick- acting oral antihistamine and an epinephrine auto-injector at all times

23. End of skill This is the end of your skill.
Your book has provided a video for this and the link is below:
Elsevier: Perry-Potter: Clinical Nursing Skills and Techniques, 8e Sterile Gloving