Reality of glove use and handwashing in a community hospital

Background: Since the advent of universal precautions and body substance isolation, few studies have examined the relationship between glove use and handwashing. Methods: During a 5-month period in 1991, 477 structured observations were conducted on 19 patient care units at a community teaching hospital during each of three shifts. Patient care contacts were defined as either high level or low level according to potential for blood or body fluid contact. Results: Health care workers were potentially exposed to body fluids (high-level contact) on 152 occasions. Eighty-eight percent of all high-level contacts were limited to the hands; 47% of these contacts occurred during the night shift. Handwashing occurred after 32% of high-level contacts. Health-care workers wore gloves in 57% of high-level contacts. Rates of handwashing and glove use varied markedly among patient care units. Correct handwashing (≥ 9 seconds) occurred after 20% of contacts when health care workers wore gloves but after only 3% of high-level contacts when gloves were not used (p = 0.004). Conclusions: Despite universal precautions or body substance isolation, educational efforts, and written policies, rates of handwashing and glove use are inadequate in cases of potential blood and body fluid contact. The perceived need for gloves may encourage handwashing.