Gloves off!: Environmental and financial impacts of an educational intervention to improve hand hygiene. A quality improvement study

Abstract

Background: Non-sterile gloves are often used inappropriately in clinical care, with associated poorer hand hygiene, and financial and environmental waste.

Methods: This before and after study assessed the impact of an educational intervention on non-sterile glove use, hand hygiene compliance, knowledge and attitudes, and environmental and financial metrics. Participants were clinical staff working in two acute surgical wards of an adult tertiary referral hospital from May 2023 to March 2024. The intervention, 'Gloves Off!', was a multi-modal education intervention delivered during July-August 2023. The main outcome measures were: glove purchase numbers and associated carbon footprint, waste to landfill, financial cost; hand hygiene compliance and unnecessary glove use; staff hand hygiene knowledge and attitudes. Measures were taken at baseline, post-intervention, and seven-month follow-up.

Results: Glove purchase numbers fell by an average of 6.9 gloves per occupied bed day after the intervention. The estimated monthly reduction of 13,020 gloves for two wards equates to reductions in carbon footprint of 443kgCO₂e, waste 44.8 kg and cost AUD$651. Hand hygiene compliance improved from 59 % (151/254) at baseline to 83 % (125/150) at follow-up and unnecessary use glove use fell from 60 % (152/252) at baseline to 23 % (13/56) at follow-up. Survey results showed that after education, staff demonstrated significant improvements in aspects of hand hygiene and glove use knowledge.

Conclusion: A 'Gloves Off!' intervention was successful in improving glove use behaviour and staff hand hygiene, knowledge and attitudes as measured by observational audits, staff surveys, and glove purchase data. Significant cost, waste and carbon footprint reductions were achieved.

Keywords: Education; Environment; Hand hygiene.