2. Proper Glove Use is a Doctoral Level Skill: Challenges in Developing a Glove Use Surveillance Tool Nothing to Disclose Deb Patterson Burdsall MSN, RN-BC, CIC 2009-2011 NHCGNE Patricia G. Archbold Scholar Doctoral Candidate The University of Iowa College of Nursing Infection Preventionist: Lutheran Home / Lutheran Life Communities Arlington Heights, IL

3. Proper Glove Use is a Doctoral Level Skill: Challenges in Developing a Glove Use Surveillance Tool Nothing to Disclose Deb Patterson Burdsall MSN, RN-BC, CIC 2009-2011 NHCGNE Patricia G. Archbold Scholar Doctoral Candidate The University of Iowa College of Nursing Infection Preventionist: Lutheran Home / Lutheran Life Communities Arlington Heights, IL

4. Learning Objectives Identify reasons healthcare workers use gloves when they care for patients Discuss current glove-use literature as it relates to glove use and the transmission of pathogens and contamination of the healthcare environment Recognize why it is important that we understand how gloves are being used in the sequence of patient care Describe the challenges related to surveillance tool development

5. Overview Clean gloves are a useful tool that can protect both healthcare workers and patients. When gloves are misused, they may be a source of cross contamination and transmission. This session will discuss the development of a tool that may help describe how gloves are actually being used by healthcare workers.

6. Why Study Glove Use? As IP you are told you must do hand hygiene surveillance You must have high rates of hand hygiene compliance Single most important infection prevention and control measure There is an extreme focus on hand hygiene in Healthcare “Are there barriers to hand hygiene during the sequence of patient care?” Loreen Herwaldt MD, 2010

7. From Bare Hands to Gloves Shift from bare handed care to care with gloves and other PPE in the 1980s in response to Human Immunodeficiency Virus and Hepatitis B Virus 1 Glove use can protect hands from contamination 2 Glove use can control outbreaks and has been shown to decrease transmission of multidrug- resistant organisms 3 1 CDC, 1988; Lynch, Jackson, Cummings & Stamm, 1987; OSHA, 1991; Larson, 1988; Larson & Kreutzer, 1995; Larson, 1996 2 Johnson et al., 1988; McFarland, Mulligan and Karok, 1989 Jury et al., 2011 Guerrero et al., 2012 3 Patterson et al., 1991; Berthelot et al., 2001; CDC/HICPAC, 2007

8. Definition 4 Moments for Glove Changes Change gloves and perform hand hygiene 1.After contact with blood or body fluids or if gloves are soiled 2.After completing a patient care task 3.Before moving from a contaminated to a clean site 4.Between patients (WHO, CDC, CMS, OSHA )

10. Patient Care Event

11. New Employee Orientation Slide from 2008 Gloves are useful when used correctly Gloves can be a nightmare when used in the wrong way 1 pair of gloves for 1 job!! Proper Glove use is a PhD level skill Photo: Medline.com

12. Challenges in developing a practical glove use surveillance tool (GUST) Development time Research tool or surveillance tool, or training tool? Practical? How to simplify without losing richness and usefulness of information

13. After Expert Review

14. Two Week Pilot Trained over 100 observers (1 hour with video and 2 practice sessions) <iframe width="560" height="315" src="//www.youtube.com/embed/hpQnTc_F_NI?rel=0" frameborder="0" allowfullscreen> Five Units (34-42 patients/residents each) One observation per unit per shift (2 per day) 14 days 140 possible patient care event observations Usual standard of practice / Hand Hygiene surveillance – “barriers to hand hygiene” Assent from HCW and resident/patient No identifying information collected on observed HCW – observer identified only for clarification

15. Scenario You are a nurses’ aide healthcare worker (HCW) Mrs. Smith had a BM and needs help with hygiene and adjusting her brief and her clothes. She has a bad hemorrhoids She uses a standing lift, but has pain in her arms, and can only hold on to the lift for short periods You have been told year after year that blood and body fluids are dangerous, and that “everyone” has MRSA or some other dread organism that can make you and your family very sick

16. When is hand hygiene necessary and practical? Does hand hygiene become a barrier to proper glove use during patient care events (Intra-series events)? Patient Care Event ?? ??? Intra-series events (Eveillard, 2011) Extra-series events (Eveillard, 2011) Intra-series events (Eveillard, 2011) (Rock, et al., 2013)

17. Implications for Practice Consistent with prior studies Gloves are used when the are not necessary – Human touch? Gloves were not changed when they needed to be Staff frequently expressed “I wear gloves to protect myself” Hand hygiene during the sequence of patient care when changing gloves was described as “difficult, time consuming, and a barrier to glove changes” (Rock et al., 2013)

18. Infection Prevention and Control is a Human issue Infections have personal costs, they have economic costs, and they have cultural costs, but what is the cost of the loss of human touch? HUMAN Spiritual Psychological Biological Social

19. Future Directions Glove use is a barrier to hand hygiene Hand hygiene may be a barrier to proper glove use Complete analysis of collected data Further refine and test GUST incorporate lessons learned from pilots and from expert input Goal: Valid and reliable tool Goal: Quantify glove use, create teaching tool