Certified Nursing Assistants in LTC Facilities Failing to Change Gloves

Over 4 million Americans are admitted to nursing homes or long-term care facilities (LTCFs), according to the Centers for Disease Control and Prevention (CDC), and an estimated 1 to 3 million serious infections occur annually in these facilities; a staggering 380,000 individuals each year die from such infections. In order to prevent the spread of harmful infectious diseases throughout these facilities, certified nursing assistants (CNAs) often wear gloves when caring for their patients.

However, results from a “first-of-its-kind” prospective study published in the American Journal of Infection Control and led by Deborah Patterson Burdsall, PhD, RN-BC, CIC, from the University of Iowa College of Nursing, has found that CNAs working in nursing homes aren’t practicing these precautions nearly as much as they should.

CNAs are in almost constant contact with patients in LTCFs, and “they are often the main providers of care” in such facilities, according to a recent press release issued by the Association for Professionals in Infection Control and Epidemiology. The CDC recommends standard precautions that call for all CNAs to don personal protective equipment—especially gloves—to avoid contact with harmful pathogens via blood, secretions, excretions, etc. Furthermore, according to the press release, CNAs should change their gloves:

• If/when gloves come into contact with bodily fluids or blood
• After completing a patient task
• After the gloves touch a site that may be contaminated
• In between caring for different patients

If gloves are used inappropriately, harmful bacteria can easily be spread throughout the facility, which can result in harmful healthcare-associated infections. Although progress has been made in the fight against HAIs, the CDC still estimates that “on any given day,” one in 25 hospital patients will suffer from at least one HAI. When it comes to LTCFs in particular, it is estimated that 1.6 to 3.8 million infections occur each year, causing around 388,000 deaths and costing anywhere from $673 million to $2 billion. Needless to say, these infections are a severe burden to health care providers and patients alike.

This is why practicing standard precautions is so imperative. “Gloves are an essential component of standard precautions, and proper use of gloves is a critical component of best practices to prevent HAIs,” Linda Greene, RN, MPS, CIC, FAPIC, 2017 APIC president stressed in the press release. “This is especially important in long-term care, where residents are more vulnerable to infection and stay for extended periods. Facilities must continually educate health care providers about the importance of appropriate glove use to prevent infection and monitor adherence to this practice.”

For their study, the investigators observed a random sample of 74 CNAs who were “performing toileting and perineal care at one LTCF” to see how many practiced appropriate glove use, and how many did not. They defined inappropriate glove use as “a failure to change gloves, and when surfaces were touched with contaminated gloves,” and unfortunately, they found that it was a frequent occurrence.

Although the CNAs were observed donning gloves for 80% of “touch points,” 66% of the times where they should have changed their gloves (glove change points), they failed to do so. Over 44% of the gloved touch points were considered by the investigators to be contaminated, “with all contaminated touches being with gloved hands,” according to the press release. The investigators note that gloves were easily accessible throughout the facility “to enhance availability and workflow.”

The investigators utilized a glove use surveillance tool (GUST) to measure inappropriate glove use in their study. This tool considered each type of surface involved, the sequence of touching surfaces while providing care for each patient, if they wore gloves at all, and if they changed them.

“Glove use behavior is as important as handwashing when it comes to infection prevention,” Dr. Burdsall stressed. “These findings indicate that glove use behavior should be monitored alongside hand hygiene. The observations should be shared with staff to improve behaviors and reduce the risk of disease transmission.”