In the 1960s and 1970s, nursing students were often taught how to manage contaminated objects with their bare hands. This included cleaning incontinent patients and counting bloody sponges. In surgery, the scrub nurse would hand off a sponge forceps from the active surgical field, complete with biologic contamination, to the barehanded circulating nurse during sponge counts. Hands often came in contact with microbe-laden material, and the answer was simply hand washing. Nonsterile gloves were not readily available for dirty tasks.

Today, gloves of all varieties are available in patient care areas. But gloves are not a panacea for dealing with evolving “super bugs” of the 21st century.

Whether at the surgical site or on the hands of the caregiver, skin is inherently laden with resident and transient flora.^1,2 Inadequate hand hygiene allows opportunistic pathogens in varying life stages to transfer between patients and other surfaces during everyday activities.¹ Studies monitoring handwashing reveal that many people do not wash their hands properly after using the toilet or diapering a baby. This translates into the OR, where body substances abound, and the risk for transference is a serious concern.^2,3 Hand hygiene and skin antisepsis in surgery depend on using products according to the manufacturer’s recommendations. The products must be used correctly and provide microbial kill to be effective.^2-4

Iowa Sate University posted results from hand cultures online (www.extension.iastate.edu/foodsafety/files/Yuckphotos.pdf) that show agar culture plates of the hands of food service personnel. The cultures show the difference in microbial load between washed hands and simply “rinsed” hands. Washing with soap reduced microbial load, but did not eliminate it. Common inanimate environmental objects, such as purse bottoms and countertops, were cultured and grew multiple strains of microorganisms and enormous numbers of bacterial colonies. Other cultures in the Iowa study, such as nonsterile glove boxes (not unlike the exam glove boxes in patient care areas) grew positive results. According to the CDC, 76 million people annually get a fatal food borne disease, such as salmonella and E. coli, which can be attributed to improper hand hygiene. As many as 5,000 die of the illness. Patient illness and death closely match these statistics. (These sources can be viewed online at www.cdc.gov/cleanhands and www.mayoclinic.com/health/handwashing/HQ00407.)

The dirty hands of many people reach into the same box for nonsterile gloves for personal protection and transmit microorganisms to the box and its contents. Caregivers feel a false sense of security when they don gloves and wear them for prolonged periods, performing multiple tasks without changing them.⁴ Moisture and heat builds under the gloves, creating favorable living conditions for bacterial reproduction and endospore reactivation.^5,6 The surface of a glove picks up microorganisms from the environment and deposits them wherever it makes contact. Gloves do not always protect the patient and may, in fact, provide a transfer vehicle for portable pathogens.^4-6

The microbial load on any surface is capable of causing postoperative complications, such as wound dehiscence or systemic morbidity.⁶ Research reveals that prevention of cross-contamination and surgical site infection consists of appropriate skin antisepsis for both the patient and the caregiver.⁶ Hand hygiene and skin antisepsis are not singular processes and are effective only during the moment they are performed.^1,3-5 Each contact with different areas of the patient‘s body and the patient care environment (e.g., bed rails, clothing, stethoscope, and blood pressure cuff) requires cleansing of the hands and device or changing of gloves to prevent deposition of new bacteria. In essence, a caregiver can transfer bacteria from one part of the patient’s body to another because each body part has its own level of bioload. Moving resident flora to another part of the body creates a pathogenic potential for the patient.⁴