The changing face of hand protection - Home Study Program - Statistical Data Included

AORN Journal,  August, 2002  by Peter B. Graves,  Carolyn L. Twomey

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Why the resistance to change? One study found that health care workers needed time to evaluate how to double glove. (40) In tests, preferences of wearing one-half size larger gloves on the inside, versus one-half size larger gloves on the outside, versus the same size gloves on both the inside and outside were divided evenly among study participants. The most common reason for not double gloving, however, is loss of tactile sensitivity. The same study found that it0 takes time for the cortex of the brain to adjust to sensory changes from the fingers (ie, cortical remapping). Based on these findings, a single attempt to double glove may not be sufficient to allow the brain to remap its senses, and it may not allow a practitioner to become comfortable with a change in the most intimate of surgical tools--the sterile surgical glove. As in all aspects of change, adapting takes patience and time.

The stress placed on surgical gloves, including the length of procedures, heavy and sharp instrumentation, and surgical chemicals, makes it imperative that barrier protection is ensured. The benefits of protection from pathogen exposure and the decreased potential for surgical site infection far outweigh the time and tedium of adjusting to change.

CAN BARRIER PROTECTION EXIST UNDER YOUR GLOVE?

In addition to the previous factors about the barrier protection of gloves, consider the barrier protection of the scrub or hand wash used in daily practice. What scrub do health care workers choose--and why do they choose it--as they step up to the sink each day?

The success of infection control depends on the attention each individual pays to decreasing the spread of pathogens and thus preventing nosocomial infections. It has been documented extensively that hand antisepsis results in significant reduction in patient morbidity and mortality from nosocomial infection. (41) The Association of Professionals in Infection Control and Epidemiology asserts that gloves should be used as an adjunct to and not a substitute for handwashing. (42) The most important thing perioperative nurses and other health care workers can do to prevent nosocomial infections in patients is to appropriately choose and use a hand hygiene product.

AORN's Standards, Recommended Practices, and Guidelines states that the purpose of a surgical hand scrub is to

* remove debris and transient microorganisms from the nails, hands, and forearms;

* reduce the resident microbial count to a minimum; and

* inhibit rapid rebound growth of microorganisms. (43) It also states that an effective antimicrobial surgical hand scrub agent should

* significantly reduce microorganisms on intact skin,

* contain a nonirritating antimicrobial preparation,

* be broad spectrum,

* be fast acting, and

* have a residual effect. (44)

A residual effect is defined as a persistent activity on the skin. (45) Some antiseptic agents have the ability to bind to skin's corneum stratum resulting in a significant persistent activity. (46) Such persistence may help enhance continued antimicrobial activity. (47) Use of the following five antimicrobial ingredients is well documented in the clinical literature. (48)