significant challenge; avoid mass bewilderment
● Enormous and costly efforts to force wholesale change to all teaching materials globally will result in little gain to the bottom line
● Current transmission-based precautions served their purpose well during COVID for healthcare personnel; they are simple and based on high-quality evidence
“ We need high-quality evidence, not opinion-based evidence; for example, saying‘ Let’ s have everyone in universal masking every respiratory season’ is an opinion,” Conly said.“ Instead, let’ s do an RCTto identify high-quality evidence to guide high-quality, evidence-based guidelines. We also must get better at our teaching efforts and precision of execution of guidelines. Why does inadequate PPE, hand hygiene and training keep coming up in the studies? Have we not done a good enough job? And had we done a better job, would we have seen better results? Can we do better? I believe we can. That should be our focus, not changing the terminology.”
HAND HYGIENE Hand hygiene before gloving
In the presentation,“ Is Hand Hygiene Needed Before Gloving?” Eli Perencevich, MD, MS, professor of epidemiology and internal medicine at the University of Iowa, reminded ICPIC attendees that“ Gloves do not replace hand hygiene, and practitioners should be aware of clinicians’ overuse or misuse of gloves.” While current guidelines require hand hygiene before donning nonsterile gloves, evidence to support this requirement is lacking. Perencevich noted that the debate over hand hygiene before gloving is ongoing, with healthcare personnel seemingly driving this discussion over whether the practice is ponderous and unnecessary.
He pointed to the findings of a 2019 study by Baloh and Thom, et al. in which he served as a co-author, where to estimate compliance rates, the gloving and hand hygiene practices of healthcare workers were observed at entry to patient rooms for six months. Interviews were conducted with 25 providers, nurses, and nursing assistants to investigate their beliefs and perceptions of these practices. Observed hand hygiene compliance rates before gloving were 42 percent, yet in the interviews most healthcare personnel reported 100 percent compliance. Observed compliance with gloving before entering contact precaution rooms was 78 percent, although all healthcare workers reported always gloving for standard and contact precautions. Most personnel reported using gloves more often than necessary; they generally use gloves for their own safety and sanitize hands before gloving for patient safety. Numerous barriers to compliance with hand hygiene before gloving were discussed, including beliefs that gloves provide enough protection. The researchers summarized that hand hygiene and glove use are highly intertwined in clinical practice and should be considered jointly in infection prevention improvement efforts.
In a 2023 randomized controlled trial, Thom, et al. evaluated the effectiveness of a direct-gloving policy on adherence to infection prevention practices in a hospital setting. Participants were 3,790 healthcare personnel across 13 hospital units that were randomly assigned to direct gloving, with hand hygiene not required before donning gloves( intervention), or to usual care( hand hygiene before donning nonsterile gloves).
The primary outcome was adherence to the expected practice at room entry and exit. A random sample of healthcare personnel’ s gloved hands were imprinted on agar plates at entry to contact precautions rooms. The intention-to-treat approach was followed, and all analyses were conducted at the level of the participating unit. Primary and secondary outcomes between treatment groups were assessed using generalized estimating equations with an unstructured working correlation matrix to adjust for clustering; multivariate
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nov-dec 2025 • www. healthcarehygienemagazine. com •
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