Leading change

The Lead Nurse for Infection Prevention and Control and two Lead Practice Educators at Great Ormond Street Hospital NHS Foundation Trust (GOSH) addressed the over-use of non-sterile gloves through education and training. This has improved patient safety and experience and staff are now following evidence-based practice rather than wearing gloves out of habit.

Where to look

Completed audits highlighted unwarranted variation in the adherence to the ‘Five Moments of Hand Hygiene’ and that overuse of non-sterile gloves was a key reason for this. It was identified that gloves were also being worn for the preparation of all intravenous medications.

What to change

The use of non-sterile gloves has been associated with a significant potential for cross-contamination and transmission of healthcare-associated infections (HAIs). This is because they are often used when they aren’t needed, put on too early, taken off too late or not changed at critical points (Wilson, Loveday, 2017).  Research shows that patients often feel uncomfortable with inappropriate use of gloves for personal tasks (Wilson, Bak et al, 2017).

The Lead Nurse and Lead Practice Educators developed the ‘Gloves are off’ campaign, which aims to improve patient safety by ensuring that patients and their families are seen by staff with clean hands. The aims of the project were to:

• reduce hospital acquired infections and central venous line (CVL) infection rate and
• improve hand hygiene compliance
• reduce the level of dermatitis in staff due to the overuse of gloves
• improve environmental impact.

Baseline data was collected for hand hygiene audits, infection rates, soap and hand sanitiser usage, glove usage, dermatitis levels in staff, qualitative data from patients and families surrounding glove usage, and financial and environmental measurements.

How to change

Firstly, the Lead Nurse and Lead Practice Educators gained support from GOSH Nursing Board to set up a working group to develop an educational awareness programme for staff. This included an updated educational package for when gloves should be worn generally in practice and a risk assessment strategy for use of gloves when preparing intravenous medication.

Guidelines were updated and training and resources developed for multiple staff groups which included a risk assessment matrix for medications.

Staff were asked to risk assess when they would wear gloves for giving medication. Gloves were only needed for:

• any medication where you could be in contact with a bodily fluid. e.g. eye drops, nose drops
• any therapeutically active cream
• any liquid hormones or cytotoxic medications.

And to risk assess if they were going to come into contact with blood or bodily fluid. Gloves were only needed if they risk assessed that this was certain or highly likely.

Engagement took place with patients and parents, educational resources developed and a trust-wide communication strategy put in place. This included, a frequently asked questions sheet, webpages, screensavers, posters, presentations and a hand hygiene event in May 2018.

Adding value

The education programme for the project began in April 2018 and the campaign launched on 5 May 2018.

Better outcomes – There has been a reduction in staff attendances to occupational health for hand or skin related problems. The CVL infection rate remains within normal parameters and there has been no adverse rise in hospital acquired infections including Vancomycin-resistant Enterococci (VRE), viral respiratory and enteric infections.

Better experience – The father of a child with learning disabilities gave feedback that his child is hospital and gloves phobic and the project has improved the quality of their life.

The main focus of the project was to provide education and training so that staff felt empowered to risk assess when they used gloves, which has been achieved.

Better use of resources – There has been a significant reduction in the amount of gloves ordered into the hospital. The most recent mean for gloves ordered is 163,125 per week, which is taken from the baseline period between the weeks beginning 15 April 2018 and 29 July 2018, which is a significant reduction on the previous mean of 199,733 units per week a difference of 36,608.

The outcomes of the project are continuing to be monitored and are reported quarterly to staff across the Trust and Nursing Board.

Challenges and lessons learnt for implementation

• The key was perseverance and thinking outside the box. One of the most successful engagement methods was holding a stand in the hospital canteen. The nurses chatted to staff, patients and carers, had give-aways and quizzes, as well as the educational material, and visits to the ward also took place
• Initial engagement in the project and changing practice was not easy.

Find out more

For more information contact:

• Amy Leonard, Lead Practice Educator, Amy.leonard@gosh.nhs.uk