Alcohol-based decontamination of gloved hands: A randomized controlled trial

Area of Science:

• Healthcare-associated infections
• Infection control
• Microbiology

Background:

• Standard hand hygiene (HH) protocols require glove removal and re-application between patient care moments.
• A novel strategy involves applying alcohol-based hand rub (ABHR) directly to gloved hands for improved efficiency.

Purpose of the Study:

• To evaluate the efficacy and efficiency of applying ABHR to gloved hands compared to the gold standard and usual care.
• To assess bacterial contamination on gloved hands under different hand hygiene protocols.

Main Methods:

• A mixed-method, multicenter, 3-arm randomized trial was conducted in adult and pediatric intensive care units at 4 hospitals.
• Healthcare personnel (HCP) were randomized into three groups: ABHR on gloved hands, the gold standard HH, or usual care.
• Gloved hands were sampled using direct imprints to quantify bacterial contamination.

Main Results:

• Bacteria were found on gloved hands in 82.8% of observations with ABHR intervention versus 67.4% for the gold standard (P < .01).
• The ABHR intervention required a mean of 14 seconds, significantly less than the gold standard's 28.7 seconds (P < .01).
• Compared to usual care (98.5% contamination), ABHR on gloved hands showed reduced contamination (76.6%, P < .01). Microperforations were noted in 2.9% of gloves in the ABHR arm.

Conclusions:

• Applying ABHR to gloved hands significantly reduced contamination compared to usual care, though it was less effective than the gold standard.
• Given the time savings and microbiological benefits over usual care, and the impracticality of the gold standard, this method warrants consideration.
• Recommendations are made for health organizations to consider advising HCP to use ABHR on gloved hands during single-patient encounters.