Since childhood, we’ve been told to prize quality over quantity. We can all understand the fundamental truth that, often, more isn’t more.
This is a fact worth remembering in the context of glove awareness week, an annual event asking us to be more conscious in our glove usage.
This has never been more important than it has at the moment, as we emerge from a pandemic when consumption has been conflated with achievement, single-use PPE (personal protective equipment) appears analogous with good hygiene and the need to protect our patients has resulted in a ‘better safe than sorry’ approach.
This dates back to the ‘universal precaution’ message that was spread in the early ‘80s at the emergence of the AIDS epidemic. It’s easy enough to see how the donning and doffing of plastic gloves has become second nature.
We can understand the overuse of these materials particularly as we were learning about a virus with uncertainty about whether spread was airborne, by droplets, or could be contracted through skin contact. However, it is still commonplace to see gloves, and for that matter plastic aprons, being donned on a ward round, in a vaccination centre, or just delivering a tray of food.
Of course, there are times when it is necessary to use gloves. They have been demonstrated do protect patients when performing invasive procedures and protecting the wearer during activities that risks exposure to bodily fluids. National Institute for Health and Care Excellence guidance advises on this, as well as proper hand hygiene.
No one would suggest we banish disposable gloves in their entirety: when used appropriately, they can literally save lives. We are simply asking people to consider whether the pair of gloves that we have just donned were necessary. Like anything else, excess or inappropriate glove use is not inherently ‘safe’. It can cause harm to staff, our patients, and the wider environment.
The RCN (Royal College of Nursing) has spoken at length about how wearing gloves for long periods of time is known to increase the risk of hand dermatitis. Although there have been advances in powder composition and acidity of the materials to reduce the risk of dermatitis, a 2020 RCN survey still reported that almost half of its respondents had poor or very poor skin.
93% of survey participants reported ‘at least one skin symptom in the previous 12-month period’. There is no equivalent survey among doctors, however, as we share the PPE requirements as our other healthcare workers, it is reasonable to assume that the impact will be similar. And for many, our hands are the tools of our trade.
The contraction of skin problems can, in turn, impact an individual’s ability to perform good hand hygiene: over half of respondents to the RCN survey had to either limit or stop using hand sanitiser or washing their hands/wrists with soap and water, and 18% had to limit or stop wearing examination or surgical gloves when skin problems developed. Unnecessary overuse of gloves could, in a worst-case scenario, prevent the necessary use of gloves.
Nor is it the only infection control risk associated with the inappropriate wear. There is evidence that gloves worn for protection of the wearer are associated with fewer hand hygiene measures across multiple care interventions. The risk of cross-contamination should not be ignored.
It must be remembered that measures such as the use of hand sanitiser should still be employed between patient contacts in this setting. There are other examples of the use of gloves having a negative impact on patient well-being. The simple act of human contact can have a profound benefit for people with neuro-atypical conditions or infections such as HIV that are still associated with significant stigma.
There are health implications beyond the healthcare setting. Unnecessary consumption in the UK impacts further on people across the globe. In 2021, the BMA published a paper on labour rights abuse in global supply chains for PPE through COVID-19, highlighting the terrible treatment of some factory workers overseas who make the gloves we casually don and doff.
The association’s recommendations focused on the role government and individuals can take to promote fair trade of medical supplies. As we think sceptically about glove use, we should also ask questions about the source of this PPE, and whether its manufacture is ultimately hurting others.
Then there is the issue of waste. As the BMA highlighted in its 2020 paper ‘Climate change and sustainability: The Health Service and Net Zero’, we are working in a plastic-intensive sector.
NHS supply chain have estimated that around a quarter of the NHS’ waste in England and Wales is plastic. While we largely imagine plastic pollution in the context of environmental damage (perhaps imagining a turtle in the ocean, caught in up in a bit of waste), we need to remember that humans live in the environment, and when we hurt our surroundings we may well hurt ourselves.
There is clear in vitro evidence of the harm of microplastics on human cells. Recently, these microplastics have been identified in human blood and tissues, reigniting the debate on the impact of microplastics on our health.
Most plastics are made from fossil fuels, and their manufacture produces huge volumes of greenhouse gasses. The overconsumption of plastic is, accordingly, connected to climate change – one of the greatest threats to global public health, with the World Health Organization estimates that between 2030 and 2050, climate change will be responsible for around 250,000 additional deaths a year.
It is no wonder that a motion was raised at the BMA 2021 annual representative meeting, calling on the BMA to lobby for the trialling and the implementation of reusable and recyclable PPE.
This is not to say we should abandon disposable gloves in their entirety. There are clinical procedures where single use PPE is essential to prevent infection and, in turn, preserve health and life.
Instead, we need to consider why are we wearing them? is it for your protection? Is there a potential protection of your patient? Or is it just for a fear of judgment for going gloveless or unchallenged assumption about efficacy.
There are clear standards for when we should wear gloves; there are similar standards on hand washing. We have the information we need. We simply need to make sure we use it, and encourage others to use it, well beyond the end of glove awareness week.
David Strain is co-chair of the BMA medical academic staff committee