How and why do healthcare workers use gloves in two Norwegian nursing homes?

Abstract

Background: Incorrect glove use can cause cross-contamination and healthcare-associated infections. Previous research has identified reasons for this, such as lack of indication, improper changing, and poor hand hygiene post use. Limited research has investigated the reasons behind healthcare workers' glove usage.

Aim: To develop an in-depth understanding of healthcare worker (HCW) attitudes and perceptions of glove use and to explore barriers and facilitators as well as compliance with national guidelines.

Methods: A small-scale convergent-parallel mixed methods study design consisting of observations with focus group interviews (FGIs) by using the Systems Engineering Initiative for Patient Safety model (SEIPS). The study was conducted at two Norwegian municipal nursing homes in Oslo for two weeks in January-February 2023.

Findings: Out of 73 observations, gloves were used in 67 episodes, not worn even if indicated in six observations, and were overused 16 times (21.9%). Lack of hand hygiene after glove removal was observed in 36 out of 67 instances (53.7%). Two FGIs disclosed that glove usage decisions are shaped by habits, knowledge, experience, and emotions linked to patient requirements, tasks, and glove type. Double gloves were used for self-protection and efficiency. Availability of gloves was a facilitator, while poor glove quality posed a barrier.

Conclusion: Despite HCWs' knowledge of glove guidelines, their attitudes did not consistently ensure compliance. This study underscores the need for targeted interventions to improve hand hygiene after glove removal, urging awareness of glove overuse to reduce infections, protect HCWs' skin, and promote sustainability.

Keywords: Behaviour; Gloves; Hand hygiene; Healthcare-associated infections; Infection prevention; Nursing home; Work system.