Patient voice

'Some carers don't really know why they wear gloves, they just do'

29 July, 2011

Tony Nicklinson is paralysed and relies on 24-hour care. In his second article for Nursing Times, he suggests that carers should question the use of gloves

Read Tony’s first article: ‘Carers would pet my dog but they wouldn’t touch me without gloves’

It has been just over a year since the carers have been looking after me without wearing gloves and, as expected, nothing untoward has happened to me or them. Actually, it’s not quite true that they have given up gloves, for one carer puts on a glove when wiping and then drying my bottom. I suppose the company would ordinarily wear gloves for this sort of long-term domestic care, but the truth is that I don’t know. I have asked but, as yet, they haven’t told me.

It may be they don’t really know why they wear gloves, they just do. They probably have some vague notion that it is “hygienic”. Given below are some reasons, although the list probably isn’t exhaustive:

Because they can
Because they think gloves are cleaner than clean hands
Because they don’t want to get their hands dirty
Because their competitors do and they don’t want to be different

The central issue is that people don’t appear to ask “why?” before they specify gloves. I believe if they did, gloves would seldom be worn. They could ask questions such as “why do I think wearing gloves is better than not?”, “who benefits?”, “am I trying to stop the worker catching something nasty or vice versa?”, “can I wash my hands instead of wearing gloves?”

I once asked another care provider to justify his glove-wearing and he refused, implying instead that I was a troublemaker and would put my care in doubt if I continued. So much for transparency!

Recently a chiropodist came. She was asked if she would cut my toenails without wearing gloves. She refused and was sent away. She would have been feet away from my en-suite bathroom so what was she worried about?

I recently saw on TV a midwife wearing a glove when giving a patient a scan. Why? I don’t believe that she couldn’t have washed her hands afterwards so was the glove simply a way to avoid having to?

Similarly, I saw a carer preparing food while wearing gloves. Why? Was she avoiding getting food on her hands or avoiding contaminating the food with her hands?

The carer who wears a glove while attending to my bottom obviously doesn’t mind taking risks when wiping his own bottom because he cannot see what he is doing, unlike doing mine; all that happens is that he doesn’t get the glove dirty and he discards it when finished. Why is that not possible without wearing gloves?

The carers who feel they have to wear gloves when giving me a bottle must be pretty incompetent if they think spillage is likely when it is next to impossible. And what does it say about the carers who won’t carry a commode bowl without gloves because it contains faeces or hold a shower without gloves because they are rinsing out said bowl? They are hardly immersing their hands in the stuff, so what’s the problem? Personally, I would be reluctant to employ such a person because their lack of confidence or ability in this aspect of their work could affect other areas.

One can only speculate on the reasons, of course, but I am forced to wonder if the world has gone mad. Have people abandoned common sense in their pursuit of “safety”?

I have shown that wearing gloves for non-clinical use is unnecessary. Someone has to pay for all these gloves and although I don’t know the full cost, I’ll wager it is considerable. At a time when people are protesting about cuts, should we be spending money on something as useless as non-sterile gloves? I don’t think so.

I blame people like Linda Nazarko (in the previous article) for perpetuating the myth that all body fluids are hazardous in all circumstances. Some people drink fresh urine, for goodness sake, so how hazardous is that? Quite obviously there are many situations where gloves are unnecessary when handling body fluids and teachers like Linda should explain what they are.

Linda does make some good points, though, but they appear to go unheeded. Perhaps the nursing profession will try and inject some common sense into the situation but I doubt it because they are as guilty as anybody of promoting the inappropriate use of gloves.

So, stop being delusional and forget reasons like hygiene and modesty and just be honest - admit gloves are worn because you don’t want to get your hands dirty and you are too lazy to wash them. Stop wearing gloves in inappropriate circumstances and wash your hands to save some money.

Readers' comments (26)

mike | 29-Jul-2011 8:36 pm
How insulting and ill informed is this article? I suggest Mr Nicklinson, that it is you that needs to stop being delusional and accept that sometimes gloves ARE worn quite appropriately.

Oh, and for the record, I always wash my hands and wrists after patient contact, even if I have worn gloves. I also wear gloves for ALL clinical tasks, and the majority of personal ones that you have mentioned.

I agree that there are many carers and HCAs (I suppose other health care workers and professionals too) who use gloves inappropriately, ie do not change them between patients etc. (Yes I have seen people do this and reprimanded them!) And yes, I agree that when wearing gloves, we should explain to the patient why we are doing so if they ask us, and yes there probably needs to be a lot more IC training for HCAs and carers, but that does NOT mean we should stop wearing gloves!
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Anonymous | 29-Jul-2011 9:14 pm
Linda Nazarko gave entirely appropriate advice in her response to your last article. Your final paragraph is just insulting. Of course, nurses and carers are just an easy target these days and cheap swipes like yours are ten a penny.
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mike | 30-Jul-2011 1:01 am
A message for the NT moderators, how can an obviously insulting article like this even be allowed onto the site?
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Anonymous | 30-Jul-2011 9:17 am
nobody ever gets their job 100% right although many do their very best. nurses evaluate and do their best to meet the individual needs of the clients/patients within the scope of their working practices which include following the protocols of their employers and their own knowledge, expertise, professional judgement and some personal preferences, and time constraints as well.

although it is more respectful and agreeable for a patient, and also from the psychological point of view, if there is skin contact between the carer and themselves for general care such as washing, carrying out care of the most intimate parts, and especially handling body fluids it is essential to wear gloves for protection from potential infection. The carer may have breaks in the skin on their hands which can be so small as to be imperceptible but where germs can collect and enter the system. they also see several patients a day and, although they may be fairly resistant to most common germs, they need to protect not only themselves but also their other clients, some of whom may be far more vulnerable, from risks of cross infection. People all have different levels of tolerance to germs and as these are invisible general principles of hygiene have to be followed for all to avoid potential problems. Lapses in these rules may result in spread of infection which may not have been detected or serious at source but can become a major health hazard to others.

In response to Mr Nicklinson's statements about urine and faeces: urine is normally sterile but at any one time when carrying out care this cannot be confirmed without microscopic examination that patient's urine is not infected, although its odour can be an indicator. Faeces are very high carriers of different types of germs in large numbers which colonise the gut and notably e-coli which although usually harmless to its host is not necessarily to others.

As for family members and wives carrying out intimate care and the disposal of body fluids, this is personal choice, those living in the same household are probably more immune to each other's germs and they are usually not dealing with other vulnerable patients whose immune systems may be seriously impaired.

Correct hand washing procedures are paramount but may also not be a 100% guarantee against the transmission of infection.

Surely the caring attitudes and skills and competencies of the carer are more important than a dispute over the need for some to wear gloves to comply with their employers regulations or for their own personal preference!

Sensitivity, understanding and social responsibility are required on both sides of the fence and it is better for all concerned to be cared for by someone who feels respected and valued.

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Anonymous | 30-Jul-2011 9:18 am
should read at the end ........respected and valued for their skills and the quality of their work.
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Anonymous | 30-Jul-2011 1:28 pm
any illness and physical or mental loss of function is a tragedy and sad waste of a normal, healthy and productive life. but i find this vindication of healthcare personnel who are there to carry out their duties of caring, helping and supporting this client is extremely sad as well.

Whilst we all like to accommodate the individual needs and wishes of those for whom we care, and aim to understand their physical and psychological needs to the best of our ability, which sometimes involves bending the rules as well, we nevertheless also have to follow certain procedures which have been established for a reason by employers or the nursing and medical organisations for the health and safety, not just of the individual, but for all concerned. nurses and carers should not be coerced or manipulated by their client into changing these rules if they consider this detrimental to themselves and others in any way.

recipients of care have every right to question the care they receive and the motives behind it as have employees to question employers if a directive is unclear to them or seems unreasonable but flexibility to respect and accept some decisions of the carer and their employer are also necessary, and without which their job would become impossible.
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Anonymous | 1-Aug-2011 6:35 pm
I would also like to add, that while healthcare workers should seek to maintain the dignity of their patients at all times, they ought to be forgiven for not wanting someone elses urine or faeces to end up on their hands. Regardless of the germs issue, it is simply not very pleasant. Please don't label us as unsympathetic or bad at our job just because we don't want your bodily fluids on our skin. I think you raised interesting points in your last article (re: the cost of overuse of gloves and the fact there are some jobs that don't require gloves to be worn at all) but you have gone a bit far this time. Please try and see it from our point of view and then perhaps you would moderate your tone somewhat.

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Anonymous | 2-Aug-2011 0:57 am
oooh, I remember the days, when gloves didn't really exist, except fo aseptic techniques, and I am here to tell the tale, and so were my patients. I never gave them MRSA or C Diff, they didn't exist. We are victims of being too clean and too many antiobiotics, and it can only get worse. We used to handwash very very well. We need to keep our natural immune system intact. It's not just this topic, but we are so brainwashed these days.
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Anonymous | 2-Aug-2011 7:12 am
Anonymous | 2-Aug-2011 0:57 am

that is not the argument of this article.

I agree with Anonymous | 1-Aug-2011 6:35 pm

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Anonymous | 2-Aug-2011 9:31 pm
I certainly would not like to wipe someone elses bottom without wearing gloves and to suggest that carers should not because we wipe our own bottoms without wearing gloves is just nonsense.

I do agree that it is not necessary to wear gloves for all procedures but I do because it is my Trust policy for me to wear gloves at all times. I also wash my hands before and after glove wearing most of the time.
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Anonymous | 2-Aug-2011 10:22 pm
Anonymous | 2-Aug-2011 9:31 pm

i agree, Trust policy has to be followed but it must also be up to the carers' discretion if they wish to wear gloves or not for certain procedures whilst also respecting the patient needs and wishes. it requires a balance where over use and unnecessary waste are also considered, of which any responsible carer will be well aware and will respect.

I would wear gloves for any skin infection, for washing intimate areas and handing any body fluids, or obviously not in this case, but if I was caring for a patient for the first time with particularly poor hygiene.

there has to be mutual understanding and respect, flexibility, sensitivity and trust for a therapeutic relationship between carer and patient to be fully effective and in order to provide the highest standards of care and it is the responsibility of the carer to try to establish and maintain this trust by showing that they understand and do their best to fulfil the needs and wishes of their patient, within their professional and personal constraints.
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mike | 2-Aug-2011 11:03 pm
Anonymous | 2-Aug-2011 10:22 pm (and others who have made similar points) very true. I agree. However, why is the onus of responsibility always on the carer? As you say, there has to be MUTUAL understanding and respect, qualities which the writer of this article is showing a dazzling lack of. Of course, the patient can always refuse to be treated with gloves on, just in the same way a carer or Nurse can refuse to treat that said patient.
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Anonymous | 3-Aug-2011 0:46 am
Anonymous | 2-Aug-2011 7:12 am

really?
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Antony Nicklinson | 10-Aug-2011 10:38 am
I’m pleased that the articles have made people think about why they are wearing gloves. It’s a pity, though, that some commentators didn’t read them properly before going into print. Mike (29-Jul), for example, would have read in the first article that I do not object to gloves being worn for clinical, that is appropriate, reasons where they have been shown to be effective. I am only against non-sterile gloves being worn for non-clinical reasons.

He says he washes his hands when he removes his gloves and that he wears gloves contrary to the Nursing Times expert’s advice; anonymous of 02-Aug also does. Apart from wondering why gloves are necessary if they wash their hands anyway, I also wonder how common it is to wash one’s hands after removal of gloves. I have had some experience since my stroke in 2005 and have never seen this done. It isn’t even done by carers whose employer has written it into his procedures that all employees are supposed to follow!

He also said that he has reprimanded staff for wearing the same gloves for two or more patients. Are we to believe that unused gloves are put on for each new patient in a busy A&E unit? Perhaps someone will tell us what actually happens. When medics attend an emergency with multiple victims, do they really use fresh gloves on every patient? Perhaps a member of the Ambulance Service will tell us.

So far, then, so much for hygiene!

I have been told that gloves are worn for modesty (presumably the patient’s). Do you really think that touching a person through gloves contributes one iota to a patient’s dignity when he is already naked in front of strangers? Get real, please.

So much for modesty!

At least anonymous (01-Aug) told us the real reason gloves are worn – to stop hands getting my urine on them – though how a person can have a career looking after people and not expect to encounter some unpleasant substances is beyond me.

I also make it clear from the outset it is in the domestic (a patient’s home, not a care home) situation and it is long-term (years rather than weeks) care where the patient is well known to the carers that I am talking about, points conveniently ignored by some commentators. It may well be appropriate to wear gloves in other circumstances but it is beyond the scope of these articles.

Even your expert Linda Nazarko says that there is no need to wear gloves for simple contact with skin (non-clinical?) so why listen to me? The issue over which we part company is that of body fluids.

For example, the possibility of coming into contact with urine when giving a man a bottle is remote to say the least and if a carer does, so what? As an anonymous commentator (30-Jul) pointed out, fresh urine is sterile (from an uninfected person). If you (anonymous, 01-Aug) find the possibility of getting urine on your hands so distasteful, I despair at the state of the general caring profession now (see the next comment 02-Aug).

Regarding faeces, you don’t ordinarily touch it in a commode bowl and even if it is a source of infection, again, so what? It will probably only be touched if a carer deliberately puts a hand in it (why?). If it’s such a hazardous activity perhaps we should all wear gloves when going to the toilet. Confidence is not engendered by the sight of a carer wearing gloves just to carry a bowl and hold a shower spray even if the bowl’s contents are infectious.

I am intrigued by the idea (anonymous, 30-Jul) that relatives are more immune than strangers and perhaps the anonymous commentator will present scientifically-evaluated and peer-reviewed evidence supporting the statement so sceptics may be convinced.

Thank goodness the Nursing Times is more enlightened than Mike (30-Jul) who apparently advocates censorship for opinions that differ from his own. Where would we be without free speech?

I have never said that carers are anything other than paragons of virtue / angels of mercy who are professional in their work and who are full of good intentions with the patient’s best interests at heart. I have, however, questioned their dexterity and judgement. Anybody who is afraid of a sterile liquid and believes there is a good chance of becoming contaminated when carrying a commode bowl containing some faeces should probably consider another job. That these requirements go unquestioned is also a cause for concern.

It would be nice to have the use of non-sterile gloves used for non-clinical activities justified but, as yet, nobody has done it. Perhaps commentators will provide some explanations. I do not regard the following examples as clinical procedures.

1) Why it is necessary to wear gloves when reading a patient’s notes?
2) Why is it necessary to wear gloves when preparing food?
3) Why would a midwife find it necessary to wear a glove when giving a scan?
4) Why is it necessary to wear gloves when cutting nails, given that the chiropodist could have (should have anyway according to Mike) washed her hands before she left if she wanted to?

It is incumbent upon all employees of the state whose salaries are paid for by the taxpayers to strive to eliminate waste. Sure, you can have your gloves for situations which are merely for your convenience rather than because you are doing something which may endanger your life but you must expect your decision and your judgement questioned. The most useful contribution the RCN can do is to promote an independent investigation into the use of non-sterile gloves and then issue guidelines as to when non-sterile gloves should be worn.

I’m sorry if you are offended or feel insulted by these articles but until the points listed above are satisfactorily answered, I stand by what I have written.
04 August 2011
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Anonymous | 10-Aug-2011 11:02 am
this looks more like a case of psychological 'splitting' than anything to do with gloves.

nurses are as individual as patients and also have their own personal preferences. I think you a very lucky that people have taken the time and made the effort to write their comments here and tried to offer explanations or even look after you at all. I most certainly would not wish to be involved in your care!
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Anonymous | 10-Aug-2011 3:19 pm
this sounds like abuse of the carers caused by rigid thinking, inflexibility and lack of respect for others and possibly projecting anger and blame of a medical condition and resultant helplessness onto others.

Most nurses and carers do their best to provide care and respect the needs and wishes of their patients but equally if they have a personal preference or clinical reasons for wearing gloves this should be respected as well without having to justify every single action.

unless care proves to be negligent, in which case it should be brought up with the employers, tolerance, understanding and flexibility would probably attract better cooperation and more willingness to care which would be more beneficial to all concerned.

Perhaps it would also be more beneficial to find a constructive activity rather than analysing and ruminating over every small detail of the different opinions which have been offered by the good will of the commentators here and playing one against another.
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Anonymous | 10-Aug-2011 3:27 pm
comment from Antony Nicklinson | 10-Aug-2011 10:38 am sent to moderator for attention

I agree with Mike

mike | 30-Jul-2011 1:01 am

in his comment above and why does NT allow these offensive and damning comments to be published.

Nurses do their very best and often go the extra mile to meet the needs of patients but are also human beings with their sensitivities and their rights to respect both from patients and from the editors of NT!
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Antony Nicklinson | 12-Aug-2011 12:27 pm
It is disappointing, though not unexpected, that commentators have failed to justify the use of non-sterile gloves for non-clinical activities in the circumstances I have described despite the considerable intellect of the Nursing Times readership.

They chose instead to accuse me of being many things and to refer me to the moderator for daring to ask some questions (though I haven’t a clue what he will say because everything that I have written, except this piece, was sent to the NT before publication). That doesn’t alter the facts, though. It seems to me that this is a case of shooting the messenger rather than listening to the message.

My carers have shown over the past year that it’s perfectly possible to provide high quality long-term care in the domestic environment without recourse to the carers wearing gloves. As far as I know the carers don’t have to look after me if they don’t want to and in the early days several carers were sent to other clients if they wanted to wear gloves. I don’t force anyone to do anything.

It is still my opinion that the reason gloves are worn is to keep the hands from getting dirty so that the wearer can avoid washing them. This is a legitimate position to adopt if you are miles from the nearest water but this is not the case in the UK. However, I am still puzzled as to why it is a good thing to wash hands after wearing gloves. Surely that’s why you wear gloves in the first place – so that you don’t have to wash your hands.

So, the next time you’re on a demo protesting that the NHS doesn’t have enough money, reflect that you would have more if you didn’t spend some of it on gloves when there is the alternative of just washing your hands.

Finally, I would like to thank the Nursing Times for giving me the opportunity to voice my opinion.

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Irish Nurse | 12-Aug-2011 12:41 pm
I have just completed my infection control training (I work in a nursing home btw so many of our residents are with us for years & I know their history well) and the wearing of gloves for handing/coming into contact with any body fluids is advocated.

The reason coming into contact with ones own (and to some extent your family members) bodily fluids isn't hazardous is because of our resident micro-organisms - we have built up a resistance to their pathogenic properties in many situations (although good hand washing is of course still essential). In a nurse-resident/patient situation this isn't the case and the transient micro-organisms are still potentially harmful.

How would the author feel if one of his carers didn't wear gloves for another client and picked up a 'bug' through contact with their, lets say, faeces which they then passed on to him?

The use of personal protective equipment isn't a UICP (Universal Infection Control Procedure) for fun, it is their to protect both the public & health
care staff.
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Anonymous | 12-Aug-2011 1:12 pm
Antony Nicklinson | 10-Aug-2011 10:38 am

only sees the argument from his perspective and refuses to accept any explanations he has been kindly offered, or respect the choices of his carers therefore this argument has no worth and is not worth pursuing.

as has been previously said the wearing of gloves is based on certain rules of hygiene which also include evidence based microbiology, bacteriology and basic common sense, those laid down by employers and personal preference. Good nurses, assuming clean running water is readily available, will always wash or disinfect their hands before and after care whether gloves have been worn or not and bad nurses will not, but he is unable to accept any of these explanations.

the fact that NT accepted to publish the article does not make them the absolute authority on the subject and they probably, although misguidedly, thought it would be an interesting piece of journalism.
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