Applying human factors and ergonomics to the misuse of non-sterile clinical gloves in acute care

Background: Healthcare workers (HCW) are recommended to wear non-sterile clinical gloves (NSCG) for direct contact with blood and body fluids to reduce transmission of healthcare associated infections (HCAI). However, there is evidence that inappropriate NSCG-use increases the risk of transmission. Methods: A mixed methods study comprising observation of NSCG-use during episodes of care in two acute hospitals and semi-structured interviews with HCW. Qualitative data were categorised using thematic analysis. Findings were mapped to the Systems Engineering Initiative for Patient Safety (SEIPS) model and used to develop a strategy for improving NSCG-use. Results: 278 procedures performed in 178 episodes of care involved the use of NSCG. NSCG were inappropriate for 59% (165/278) procedures; risk of cross-contamination occurred in 49% (87/178) episodes. 26 HCW were interviewed; emotion and socialisation were key factors influencing decisions to use NSCG. Data from observation and thematic analysis were mapped to six interacting components of the SEIPS work-system. Interventions targeting each component were identified to inform quality improvement strategies Conclusions: Despite more than a decade of intense promotion of hand hygiene as the key measure to protect patients from HCAI, NSCG dominate routine clinical practice and potential cross-contamination occurs in half of care episodes where they are used. Such practice is associated with significant environmental and financial costs and adversely affects patient safety. The application of HFE to the complex social, professional and emotional drivers of inappropriate NSCG behaviour may be more effective than conventional approaches of education and policy in achieving the goal of preventing HAI and improving patient safety