Children’s Hospital of the King’s Daughters, Norfolk, VA

The conundrum is a frustrating one for hospital purchasing professionals. Here at Children’s Hospital of The King’s Daughters, Norfolk, VA, we’ve tried a number of remedies, none of which produced the desired results. Finally, however, a product committee has selected and put into use a glove that is simultaneously helping to protect staff members from diseases, improving staff members’ hand health — and having a positive impact on the hospital’s bottom-line.

Hand health hitches
Wearing gloves to protect from disease while at the same time keeping hands healthy certainly appears to be a losing proposition. Gloves are by design occlusive – made to be impervious to body fluids and hazardous substances. Ironically, however, the same occlusive properties that make gloves effective barriers against external contaminants also trap substances such as water and soap residue on hands, which can lead to conditions such as irritant contact  dermatitis.

What’s more, the repeated use of hand scrubs and hand-washing products, as recommended in the Centers for Disease Control and Prevention’s "Guideline for Hand Hygiene in the Healthcare Setting," 1 can expose clinicians to substances such as iodophors, chlorhexidine, PCMX, triclosan and alcohol-based products – all of which are commonly reported irritants.

The result? Clinicians who must wash their hands and change gloves between every patient or procedure become particularly susceptible not only to dry skin, but also to skin irritations such as acute or chronic contact irritant dermatitis.

These irritations amount to much more than a simple annoyance. In addition to the increased risk of transferring infection to patients, broken skin puts employees at additional risk of exposure to infectious organisms such as hepatitis B or C or even HIV. Damaged skin also provides a more direct route for contact organisms such as staphylococcus aureus and e.coli to enter the bloodstream.

Plus, the problem stretches beyond health issues to the hospital’s bottom-line. Irritant and allergic dermatitis combined accounts for 15 percent to 20 percent of occupational diseases and costs more than $1 billion a year, according to the National Institute of Occupational Safety and Health.2 A full 75 percent of these cases can be classified as irritations, and contact irritant dermatitis is one of the top concerns in the healthcare setting.

Less than satisfactory solutions
Here, at King’s Daughters, we have, for some time, struggled to find a way to address this problem. Finding a solution that protects clinicians from diseases, enhances hand health and improves the hospital’s bottom-line, however, has been difficult.

Over the years, we have tried a number of options. For example, we had changed from latex to powder-free to nitrile gloves. Each change proved beneficial to some extent, but none was truly effective in protecting clinician’s hands.

The problem eventually became so worrisome that we even tried to stock different gloves for different staff members. For example, the surgery department alone at one point stocked eight different types of gloves in an attempt to meet everyone’s needs. Aside from the expense of buying multiple gloves, the department had to find separate places to store the gloves so only those who needed them would use them.

Because none of these changes offered exactly what we needed – a product that would help staff steer clear of diseases while maintaining hand health. As a result, staff members were increasingly turning to the use of unapproved lotions and emollients to treat their irritated hands, creating yet another hand health hazard.

While these consumer products could offer relief, some ingredients in consumer cosmetic and skin-care products either are not as efficacious as promised or are incompatible with some antiseptics and some types of gloves. Aloe, for example, has been reported to cause both contact irritation and allergy, and aloe vera gel has been shown to be only a fair humectant.

So, I formed a product committee that would seek to tackle this hard-to-handle problem. Our mission? Find a glove that would protect clinician’s hands, reduce the incidence of contact dermatitis and eliminate the need for the use of over-the-counter moisturizers and lotions.

It was quite a tall order for our committee – especially when considering the fact that clinical staff are resistant to changes in gloves, masks, gowns and hats – the personal protective apparel in which people develop proprietary interest. While committee members wholeheartedly supported any equipment change that would benefit workers, members were reluctant to introduce a new product if it would create dissension.

A suitable solution
After researching the market, the committee decided to test medical gloves that deliver skin protection while they’re being worn. When the gloves, coated with a formulation of Provitamin B5, glycerin, gluconolactone and chitosan that was created especially for healthcare workers, were submitted to the hospital’s products committee for consideration, members were skeptical.

But from a scientific standpoint, the Esteem gloves with Neu-Thera™ looked like the right solution. In addition, the gloves had been subjected to extensive controlled, qualitative and quantitative studies overseen by a board-certified dermatologist at the California Skin Research Institute (see table above).

As the first step in a full assessment, product committee members tried the gloves on. Even after only a few minutes of wear, they could feel a difference. The coating left what felt like a protective layer on hands without feeling greasy or powdery.

That was enough to convince the committee that the gloves were worth trying in several departments – including surgery and PACU. Trials would indicate whether staff would be resistant to a full-scale change, but also whether the gloves would justify the additional expense.

The gloves were offered for general use in the trial departments. Some were provided at bedsides; others at nursing stations. Although all nurses, surgical assistants and scrub techs in the surgical department were encouraged to try the gloves (and most did), some staff whose hands were particularly troublesome were specifically asked to participate in the one-month trials.

The gloves earned positive reviews. Within a day, managers were hearing positive comments; within a week they were seeing improved skin conditions and by the end of the month, 28 of the 32 people who completed post-trial surveys said their hands felt moisturized, smoother and less flaky.

"People were coming to me and saying they really liked these new gloves," says Joan Brooks, R.N., nursing manager. "Within a week, they noticed an improvement, and then it was just constant steady improvement after that."

Some of those whose hands had been in the poorest condition asked that the new gloves be made a permanent addition to hospital supplies.

Hand health, however, is only one measure of a glove’s effectiveness. The product committee also had to make sure that the gloves stood up to other criteria. Outside the OR, testers were asked to rate the gloves for fit, durability, tactile sensitivity, ease of donning and grip properties. Staff members rated the gloves good or excellent in three of these categories and acceptable in two. The gloves did not receive any poor ratings.

The response was so positive that the exam gloves now are used hospital-wide, and the surgical gloves are the primary product in the OR.What’s especially encouraging is the fact that none of the resistance normally associated with product changes has surfaced. Neither department managers nor I have heard complaints about the gloves.

Although our committee addressed cost when selecting these gloves, we also realized that choosing products based solely on cost can be an expensive proposition. Not only can the cost of even a few nosocomial infections match the budget for hand-hygiene products supplied for patient care areas, one severe infection can result in expenses that exceed the budget for antiseptic agents.

Aside from the potential costs of noncompliance with hand hygiene procedures, if staff won’t use a product or it doesn’t work, any initial savings will be lost. Finally, quality products are a signal to employees that the hospital appreciates them and cares about their welfare, even if monetary rewards aren’t always possible. Products that improve employees’ health also improve morale, which helps reduce turnover.

The shift to coated gloves is expected to save money by eliminating much of the need for different types of gloves, decreasing referrals to occupational health and improving hand hygiene compliance by making it more comfortable for people to wash their hands.

In addition, using the gloves may even reduce the need for lotion, as some nurses have reported that the skin protection provided by the gloves has been sufficient for them to stop using the lotion after every hand washing.

Although it took some time to come up with a solution, Children’s Hospital of the King’s Daughters was able to successfully address the hand health problem while maintaining effective infection control standards and preserving, if not improving, the bottom-line by selecting coated gloves based on a review of the formulation and efficacy of the ingredients in the coating and examining the test data that demonstrates the benefits claimed by manufacturers.

Tom Berry is the materials management director at Children’s Hospital of the King’s Daughters, a 186-licensed-bed pediatric hospital in Norfolk, VA. The hospital staff performs more than 40 surgical procedures a day on patients from newborn to young adults.