Sepsis

Glove use

Infection Prevention Solutions

Non sterile, powder-free latex or synthetic latex e.g. nitrile and vinyl gloves should be worn whenever contact with body fluids, contaminated equipment, non-intact skin or mucous membranes is anticipated.

Sterile, non-powdered, latex or synthetic latex e.g. nitrile gloves which provide greater dexterity and tactility should be available in a range of sizes for surgical and other invasive procedures requiring sterile gloves.

For the majority of routine clinical tasks good quality vinyl/nitryl gloves provide adequate protection and should be the glove product of choice.

Gloves are not required when handling unsoiled articles or for contact with intact skin in the absence of body fluids.

Gloves must be removed at the end of each individual procedure/care activity, and hands washed thoroughly.

It is essential to keep the time of wearing gloves to a minimum to avoid skin sensitisation and irritation. Staff experiencing skin conditions, which may be exacerbated by glove wearing, should contact Occupational Health or their GP for further advice / assessment.

Double gloving

Healthcare workers should only double‐glove when undertaking exposure‐prone procedures (EPPs) not as routine practice. Double gloving may be considered for particular procedures where the perforation of gloves may be anticipated, e.g. orthopaedic surgery, cardiac surgery

An EPP is defined as an activity ‘where there is a risk that injury to the healthcare worker may result in exposure of the patient’s open tissue, to the blood of the healthcare worker’ (DOH, 1998).

The use of double gloves is advocated to protect surgeons from blood borne viruses. The Department of Health also advocate double‐gloving to reduce the likelihood of percutaneous exposure during surgical procedures on patients with blood borne infections.

Double gloving provides an extra layer of protection and has been shown to reduce the number of perforations to inner gloves in all types of surgery. Double gloves may be worn for high risk cases if deemed appropriate. It is known, however, that double gloving reduces hand dexterity and sensitivity.

Sterile double‐gloving systems have been introduced which helps reveal any outer glove puncture. The system consists of two pairs of gloves; a green under‐glove and a standard outer glove. If the outer glove is punctured the inner glove changes colour thus alerting the wearer.

Infection Prevention Solutions

Disposable plastic aprons

The purpose of wearing a disposable plastic apron is to protect firstly the service user who may be susceptible to infection and secondly the wearer from contamination as well as protecting staff uniform / clothing from contamination with body fluids (exception of sweat) or chemicals (NICE 2012, Epic 3 2014). This may include:

• decontaminating equipment and during environmental cleaning • emptying waste bags • close contact patient care related activities with potential for exposure to body fluids • any invasive diagnostic procedure • undertaking activities using Aseptic Non-Touch Technique (ANTT)

Always remove the apron at the end of each care-giving procedure, discard into a waste bag, and wash and dry hands to reduce the likelihood of transferring microorganisms to another site.

The same apron must not be worn between different care-giving procedures or between service users.

Full Body Surgical Gowns

All surgical gowns are classified as medical devices and are controlled by standard EN 13795 (European Committee for Standardisation 2002).

This standard requires that gowns are able to withstand the user performing all that is required from the surgical procedure without compromising the sterile field, and to be resistant to liquid and microbial penetration, with minimal release of particles.

All gowns used in theatres must comply with the specification outlined and should be the wrap around style.

Theatre staff must understand the gown specification, how the gown is unpacked, how the gown is donned and the area of sterility afforded to the wearer once donned.

During Minimal Access Interventions (MAIs) and some minor surgical procedures (where a sterile device is being implanted) or when there is a risk of significant postprocedure infection then it is recommended that a sterile (water repellent) full body gown is worn to minimise the risk of surgical site contamination (Humphreys H., Coia J.E. et al (2012) Guidelines on the facilities required for minor surgical procedures and minimal access interventions Journal of Hospital Infection 80 103 – 109).

Non-sterile full body long-sleeved gowns may, on occasions be required when disposable aprons provide inadequate cover for the procedure or task being performed. For example, when performing a respiratory aerosol generating procedure on someone who may have a respiratory infection such as COVID-19 or Influenza. Gowns must be removed on completion of a specific procedure / task as per plastic aprons.