Tony Nicklinson is paralysed and relies on 24-hour care. Here he questions why carers wear gloves for non-clinical procedures
I’m a 56-year-old civil engineer. I have spent the time since 1994 living and working abroad with my family and a few years in the 80s before that. So when I returned in 2005, I was surprised to find just how risk-averse we had become. It ranged from the wearing of hard hats and safety glasses when there clearly wasn’t a threat to either the head or the eyes, to surface cleaning fluids that kill 99.9% of household germs and kids not being allowed to play outdoors in case they get dirty. I was even told to wear safety glasses at the dentist - naturally, I refused because if water is a problem, I simply close my eyes.
My stroke in the summer of 2005 left me with locked-in syndrome whereby I am unable to speak and am paralysed from the neck down. I therefore need care 24/7. I spent the next two years in hospital and a residential nursing home and in all that time I can’t recall any of the staff ever wearing gloves. When I came home at Christmas 2007, local arrangements were made to provide care.
For two years I didn’t even notice that my day carers wore gloves. It was only when we had a different night carer that gloves came to my attention. Sometimes my heels need elevating and so it was on this particular night. I called the carer and indicated what I wanted. She asked me to wait while she put on some gloves. I was astonished because all she had to do was to lift my shins and put a pillow underneath, which took all of a few seconds. In fact, it took longer to put the gloves on than it took to raise my feet.
Don’t get me wrong, I believe there is a place for gloves in healthcare. It is a good idea for surgeons, for example, and for people who work with blood of unknown origin, but I also think gloves are worn as a substitute for basic hygiene like washing your hands. Who said that wearing gloves was more hygienic than not wearing gloves? As far as I can tell, gloves get just as contaminated as hands - what happens then? Do we wash them or replace them, or perhaps leave them contaminated? If wearing gloves is such a good idea, why is it that our top chefs don’t wear gloves? Do they know something we don’t?
That night I didn’t get any more sleep because I was thinking about gloves. It became clear to me that glove wearing in health care can be split into two categories - clinical and non-clinical. Clinical use is primarily about infection control and is supported by evidence that wearing gloves is effective. Try as I might, I cannot think of a single reason, apart from the convenience of the wearer, why gloves should be worn for non-clinical use. We are talking here specifically about home use, not in a hospital which probably has needs which a home does not, although they may find stuff in this article that makes them re-appraise glove wearing. Perhaps we can be given a reason for wearing gloves that is not about infection control and where the situation cannot be solved by washing hands.
I was getting more and more wound up and by the morning I was in a right old mood. I wrote a strong memo to both sets of carers setting out my objections. The day carers said they couldn’t do much about it because it was a health and safety issue for the workers and anyway it was in line with their health and safety policy in the ‘care environment’ (my home). The night carers just stopped doing it.
I asked the community matron to find a company whose workers wouldn’t insist on wearing gloves. Eventually one was found but it wasn’t all plain sailing during the transition period. I got the existing company to remove the gloves for much of the time but there were some problems with the male carers. They would insist on wearing gloves at all times they were with me and while they were happy enough to pet our dog without gloves, they wouldn’t touch me if they didn’t have gloves on.
This was the last straw – I was regarded less favourably than the dog. Imagine, if you can, how that made me feel. Was it an unintended consequence of a policy which says “Wear gloves at all times when in the presence of the client”? I don’t think so. Any policy which doesn’t allow any discretion is bound to produce an outcome like this. I felt as though I was a leper, unclean and contaminated. The men never came back unless there was absolutely no alternative.
Towards the end of their time, I had to suffer the indignity of being looked after by the male carers. On one occasion his colleague was quite happy to move me from my wheelchair to my armchair without gloves, but he wasn’t. When I wouldn’t co-operate until he removed his gloves, he reluctantly took them off in front of me, making a great show of it, but as soon as he could he put them back on again out of my sight, hoping that I wouldn’t see. By the time I found out that he was again wearing gloves, they had finished. I called in my wife and we proceeded to quiz him.
His excuse was that he had a cut hand. Apart from the same reason being given by another career that morning (if true, rather careless of them don’t you think?) he refused to show it to us - also, hadn’t he heard of a waterproof plaster? It was patently a lie. I wrote to the company explaining what happened, not expecting a reply and the apology I had asked for, and I wasn’t disappointed. Honestly, the lengths some people will go to just to wear gloves.
There was a second incident of note. This concerned the night carer who, apart from the initial incident, had been as good as gold, although my wife and I are curious as to why she feels it necessary to wear gloves when carrying a bowl of soapy water (admittedly it was used to wash my bottom so perhaps that is the reason, but I wonder what she thought she might catch). For some reason she started to wear gloves and when asked why, she cited, among many reasons, “That was the way I was taught.” If that were true then there is something seriously wrong with what we are teaching our new care workers. What do we teach them? Well, it clearly isn’t how and when to wash their hands. Let’s hope a teacher puts this right.
So far the new carers are doing splendidly bare-handed. As is to be expected, nothing harmful has happened to them and nothing is likely to happen to them in the future, either. It just shows how inappropriate gloves are in these circumstances, and I believe that glove wearing is a suitable topic for proper scientific research. However, here are some anomalies. One is when they are adjusting my wedding tackle to get them comfortable, and for some reason they wear a glove. It can’t be for infection control so it’s probably for modesty though whose modesty is open to question. I can tell all carers that they need not bother for me because I have had my genitals exposed since 2005, and all notions of modesty have long since gone. I imagine it is the same situation with many people.
The other time is when I want to use the bottle. My wife does me during the day and she doesn’t wear gloves, she simply washes her hands afterwards. however, the night carers, deem it necessary to wear gloves. Do they not know that urine is sterile if the person is not infectious? Even faeces, though unpleasant, is sterile under these circumstances. She also gets me settled while wearing gloves. If the gloves are contaminated, does that mean I am too? If the gloves are clean, why bother to wear them at all? Anyway, if the worst comes to the worst they can always wash their hands.
Is this another example of being too lazy to follow basic hygiene or perhaps they are taught that wearing gloves solves all problems? So, who is the more hygienic: the carer who wears gloves but doesn’t wash her hands or my wife who doesn’t wear gloves but does wash her hands?
I have one final story. The other day the area chiropodist called to cut my toenails. As a part of her routine she put on some gloves. What did she possibly think she would catch off me? And don’t try and use the cross-infection argument because all she had to do was to wash her hands before she left her previous client, something which she didn’t do before she left mine. Her glove wearing can cause great offence and it certainly did in my case. How would you feel if that happened to you? A chiropodist who won’t touch feet! Whatever next?A hairdresser who won’t touch hair? A masseur who won’t touch flesh? The whole situation is quite absurd.
So, if you object to the inappropriate use of gloves, insist that your views are acknowledged by the carers. If you get nowhere, change companies to one that will work without gloves. We must all resist those people who insist that we must take all possible precautions against harm, no matter how unnecessary such precautions may be. If we followed their advice we would probably end up spending all our lives in bed dressed in a nuclear, chemical and biological suit and breathing filtered air because one is too afraid of real life. Is it daft? Of course it is but sadly, no more daft than our present situation.
In the light of all this, I would suggest a new approach to gloves in the home. First, stop calling it a “care environment”, at least to my face - it’s my home so kindly refer to it as that. Second, allow someone in authority to take into account local circumstances. Let me explain. In an A&E department it is fair enough for staff to wear gloves because they don’t know who they are treating. This is not the case when someone is living at home, so I suggest that within one week of taking on a new client, the company doing the care checks out the house. If the company finds that both the domestic arrangements and personal hygiene are satisfactory, then gloves need not be worn. Up to the inspection, gloves are worn because the client is unknown. Third, the carers must explain why gloves are necessary when they are worn for clinical reasons and ask the client’s permission if they are worn for non-clinical reasons. If the client objects the carers defer to the client’s wishes.
So, to sum up we have carers who are afraid to touch flesh, a chiropodist who is afraid to touch feet and someone who is prepared to lie just to wear gloves – a sorry state of affairs. Something has to be done and I hope that this article will make people think harder about the non-clinical use of gloves in the home and promote discussion within the healthcare profession.
I’ve encountered the practice of healthcare workers using gloves for all contact with those they care for. Healthcare assistants, student nurses and registered nurses of all grades can use gloves inappropriately for all aspects of contact. This practice may be born out of an ungrounded fear of infection or simply a habit.
As Tony Nicklinson says there’s a place for gloves in healthcare. Healthcare workers should wear sterile gloves when caring out aseptic procedures. Non sterile gloves should be worn when providing care that involves exposure to blood and body fluids. The situation that Tony describes involves contact with his skin and does not require the use of gloves. The use of gloves in such circumstances is bad practice.
Using gloves sends the message that Tony or any other human being in similar circumstances is less than human and is somehow unclean. Tony has received this message loud and clear. The carer who insists on wearing gloves is happy to pat the dog ungloved. Virginia Henderson defined nursing as providing care that the patient would provide to him or herself if he or she had the will, strength and knowledge. That includes caring for the person psychologically as well as physically not making the person feel “like a leper”.
- Using gloves is not a substitute for good hand hygiene. It is difficult to put on and remove gloves without contamination. Wearing gloves instead of washing is poor practice.
- Using gloves unnecessarily is a poor use of resources.
- Providing care requires the person needing support care and the person delivering it to develop a partnership - to become partners in care. This partnership should be based on mutual respect and consideration for the other person’s feelings.
- The test for whether we have given the person we’re caring for this respect is to ask: “Would I be happy if I were cared for in this way, or if my loved ones were?”
Linda Nazarko is senior lecturer at South Bank University and King’s College (visiting) and nurse consultant for older people at Richmond and Twickenham PCT