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Slight of Hand?
When it comes to selecting gloves, rubs and scrubs, be sure to pamper the hands that care for your patients.
Dottie Borton
Publish Date: February 9, 2008   |  Tags:   Infection Prevention

The comfort and condition of your staff's hands should be a real concern. They're the ones applying scrubs and rubs, washing with soap and water and donning gloves, over and over and over again during a full day of surgery. Dry, cracked skin — never mind the constant reminders (or is it harping?) from someone like myself about the importance of hand hygiene — can make protecting and disinfecting hands feel like a punishment. You want staff and surgeons to clean and protect their hands because it's the right thing to do. Providing them with gloves and hand hygiene products that make their hands feel good will help that cause.

What's the rub?
There's no shortage of hand hygiene products, including soaps, brushless and water-aided scrubs and waterless alcohol-based rubs. Alcohol-based rubs come in liquids, gels and foams. Yes, you have to select products that meet guidelines for efficacy — 60 percent to 95 percent ethanol, plus ingredients to extend the life of the kill — but there's more to picking the right rub or scrub than buying the first one that meets your budgetary needs and the FDA's guidelines for safety and efficacy. Remember: Hand hygiene products have to feel good when applied. While the active "on paper" ingredients are important to consider, what ultimately works best for the end user will drive hand hygiene compliance.

Alcohol in and of itself is extremely drying. Some members of your clinical staff might tolerate constant applications of alcohol-based rubs. But the wear and tear your staff's hands endure — especially the potentially abrasive actions of scrubbing with soap and water — can strip away the natural barrier against harmful bacteria that skin provides.

Chapped, cracked skin is not only uncomfortable and difficult for staff to endure; it harbors the growth of dangerous pathogens. So using alcohol-based rubs and scrub products that incorporate emollients into their formulations will make your staff's hand feel good while, more importantly, helping to keep the skin barrier intact. By warding off the ill effects of dry skin, the additives can increase staff acceptance of your hand hygiene protocols.

The amount and type of emollients added to a rub or scrub depends on the product's formulation. Some products have a thicker consistency than others. Also consider that you have to control the amount of hand hygiene product your staff applies. Judge this as closely as you would the formulation, as it could pose a safety hazard or deter usage. Be sure the dispensing method is easy to control (so users don't get too little or too much).

Applying hand hygiene products in excess means the products will take longer than clinically necessary to dry, resulting in buildup — on still-wet hands — that might make it more difficult for staff to don gloves. That's not necessarily a bad thing — it means staff are complying with hand hygiene protocols — but difficulty in donning gloves because of residue can be a detriment to employee acceptance of the product.

Also consider choosing a scrub or rub with a neutral fragrance. Complying with hand hygiene is not gender-specific, but women typically use hand creams and lotions outside of your facility more than men do. Many male physicians and staff have especially negative reactions to something that smells like flowers. We once trialed a scrub that had a soft babypowder scent. It didn't go over well. A little bit of fragrance is nice in some respects, because it masks the alcohol scent. But it's a good idea to ask your staff to review a product's smell when you consider that it might factor into its acceptance and usage.

Buying Gloves Is a Balancing Act: Fit, Comfort, Allergies, Cost

For staff and surgeons, the fit and comfort of surgical gloves are paramount. They often sound like Goldilocks when telling you what they want: Gloves should fit just right, not too loose and not too tight. You also need to consider how your staff's hands react to wearing gloves during a busy day of surgery. Talk about a balancing act.

Allergic reactions to latex are well documented. Linda MacGaffin, RN, BSN, CNOR, the materials manager at Glasgow Medical Center in Newark, Del., hasn't yet transitioned to latex-free gloves, although she's finding that her staff is gradually moving toward a universal preference for powder-free models.

A manufacturer's removal of powder from gloves demands a second step during production, says Ms. MacGaffin, making the gloves about three times more expensive than powdered options. But she says you must consider the indirect costs you'll incur when staff miss days or are unable to scrub for surgery because of severely cracked and bleeding hands. That statement isn't intended to be overdramatic; one of Ms. MacGaffin's nurses was close to missing time recently with badly damaged hands before her switch to powder-free gloves solved the problem.

It's a fine line between protecting staff and providing them with gloves that they feel comfortable wearing, at a price your facility can afford. Ms. MacGaffin has trialed aloe-treated gloves at annual nursing conferences. You know the drill: You wear the gloves around the expo hall for a half-hour and check back with the manufacturer to analyze the condition of your hands once you peel off the glove. Ms. MacGaffin says her hands felt nice after the trial and believes moisturizing your hands while you work isn't a bad thing.

But as a cost-conscious freestanding surgery center, the aloe-coated gloves don't make financial sense for her at this time. They might, however, for larger hospital systems with greater buying power. That doesn't mean Ms. MacGaffin won't consider aloe-treated gloves in the future. She says finding the right balance between controlling costs and satisfying staff calls for standardizing gloves whenever possible and constantly re-evaluating product development and trends.

— Daniel Cook

Feel the glove
My hospital is part of a large health system, so we have to consider the needs of many departments and their clinical responsibilities when purchasing gloves. We use powder-free gloves facilitywide, but both latex and vinyl are available in bulk at our general clinical areas. Our hospital's value analysis committee recently discussed making a shift to nitrile, a latex-free synthetic.

We discovered that our hospital's staff was not ready to focus on a single product and the additional expense of the nitrile gloves made the move cost prohibitive. It just wasn't the right time. We're preparing to re-address the issue now that synthetic glove prices have become more competitive and because many healthcare workers and patients continue to be at risk for latex allergy.

Your staff will look for gloves that form to the shape and size of their hands. Matching a bulk glove's fit to various finger lengths and palms of different lengths and widths can be daunting task. That's where latex gloves hold a big advantage over other model types. Latex gloves are strong, pliable and provide excellent tactile sensation. One size doesn't always fit all, but latex gloves come close.

Vinyl gloves don't stretch and mold to the shape of the hand as well as latex models. Look to the synthetics — nitrile and others — for a blend of the ergonomic benefits of latex gloves with a reduced risk for latex allergy. They typically have a more forgiving fit, form snugly to the hand — particularly against the fingertips — and provide adequate tactile sensation.

Considering non-latex gloves in order to eliminate possible negative reactions to latex is the first step in ensuring your staff and surgeons work in comfort. Allergic reactions can escalate into respiratory distress, but don't ignore the possibility of more mild reactions that could include sore, red, dry or chapped skin.

In response to caring for sensitive hands and ease of donning concerns, synthetic glove manufacturers are adding therapeutic agents to the inner linings of gloves. Aloe-treated gloves soothe your staff's hands while protecting them. The additional cost of these gloves may be worth it to your staff, who are of course concerned about a glove's protective properties, but may also be just as interested in its comfort factors.

Ask around
Provide your clinical team with products that protect without causing additional harm to their hands and balance those concerns with a price your facility's purchasing director can live with. Gather staff feedback. Do they like the feel of a glove? Can they perform the tasks they need to perform when wearing them? How does a rub feel after it's applied? What don't they like about products you're considering? When adding or changing the products that protect your staff's hands, be sure you consider how good they feel to use.

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