1. FUNCTION.
1.1.This procedure has been developed to allow NHS Fife to comply with the requirements of the Personal Protective Equipment at Work Regulations 1992 (as amended), The Control of Substances Hazardous to Health Regulations 2002 (as amended) and the Management of Health and Safety at Work Regulations (1999) as amended.
1.2.The aim is to set out how NHS Fife will ensure correct selection of gloves according to work activity and protection of staff from adverse reactions to protective gloves.
2.LOCATION
2.1.Location
2.1.1.The procedure applies across all areas of NHS Fife and the Fife Health and Social Care Partnership where protective gloves are in use including domiciliary settings.
2.2.Scope
2.2.1.This procedure applies to all NHS Fife and Fife Health and Social Care Partnership staff using protective gloves, including agency and contracted personnel, and any other person who is not an NHS Fife employee, but who is working under the supervision and direction of an NHS Fife employee.
3.RESPONSIBILITY
3.1.NHS Fife will ensure that the health, safety and welfare of employees and patients are not put at risk as a result of inappropriate glove selection. Gloves used within NHS Fife must be obtained via the Procurement Department who will only supply contracted products. If no contracted gloves are suitable, then users must contact The Occupational Health (OH) Department or Infection Prevention and Control Team for advice.
3.2.Senior and Line Managers
3.2.1.Senior and Line Managers will
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ensure all staff are aware of this procedure, understand its content and the content of associated guidance.
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ensure that suitable and sufficient risk assessments for exposure to chemical or biological agents is carried out. This assessment should also include risks associated with any exposure to Latex.
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ensure all staff are given appropriate information, instruction and training on glove selection and use (including training at induction, updates and refresher training when necessary).
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ensure the effectiveness of protective measures is monitored..
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ensure regular skin health surveillance of staff wearing protective gloves is carried out in line with legislative requirements.
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ensure advice received from OH Department regarding glove selection and use and/or skin health is implemented.
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ensure where staff report a skin health concern, that a review of their product and glove use is undertaken and where required, refer the individual to OH Department.
3.3.Staff
3.3.1.Staff must report any adverse reactions associated with exposure to hazardous substances (including adverse reactions to gloves themselves). Any such incidents must be recorded on DATIX as well as being referred to OH Department.
3.3.2.Staff must ensure
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they safeguard their own health, colleagues’ health and the health of patients by following the advice set out in this guidance, in particular use of infection prevention and control precautions and appropriate glove selection [Ref 6.2 Appendix 2, “Glove Selection Flowchart”, Ref 6.5 Appendix 5, “National Infection Prevention and Control Manual”].
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they pay attention to their own skin care to protect against damage. [Ref 6.3 Appendix 3, “Hand Care Guidance for Healthcare Workers”, Ref 6.4 Appendix 4, “Managing Skin Health at Work Guidance”]
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they co-operate with their managers by following guidance and procedures and using the appropriate controls designed for safe use of hazardous substances
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they participate in any skin health surveillance programme that may be identified for them
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they report all incidents involving adverse reactions to hazardous substances including use of protective gloves.
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their manager is aware of any skin condition that results in broken skin including eczema/dermatitis, especially if it is thought to be work-related
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any advice received from OH Department regarding glove use and/or skin health is implemented; and they take part in training designed to meet the requirements of the guidance, as required.
3.4.Occupational Health (OH) Department
3.4.1.Receive referrals from managers or from staff who have concerns about adverse reactions related to exposure to hazardous substances
3.4.2.Record information relating to adverse reactions to hazardous substances in individual staff health records and advise managers accordingly.
3.4.3.Monitor areas of high incidence of adverse reactions and make recommendations to the appropriate manager and Health and Safety staff on remedial action.
3.4.4.Ensure that managers are advised that RIDDOR reports are to be made where appropriate.
3.4.5.Advise the appropriate Health & Safety groups on any trends
3.4.6.Assist in risk assessment when required.
4.OPERATIONAL SYSTEM
4.1.The use of gloves should be based on an assessment of the risk of contact with blood, body fluids, secretions and/or excretions, non-intact skin, mucous membranes, hazardous drugs or chemicals, including cleaning agents. Where such a risk exists, gloves should be worn to protect the healthcare worker and/ or the patient.”;
4.2.Gloves must be;
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worn for any wet or dirty work in line with departmental risk assessment and safe system of work;
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changed immediately after each patient , following completion of a procedure/ task or between patient bed space;
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changed if a perforation or puncture is suspected; and
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appropriate for use, fit for purpose and well fitting to avoid excessive sweating and interference with dexterity.
4.3.Double gloving is recommended during some Exposure Prone Procedures (EPPs) e.g. orthopaedic and gynaecological operations, attending major trauma/road traffic collision.
4.4.The wearing of gloves is not a substitute for thorough hand decontamination. Hands should be decontaminated thoroughly before and after gloves are used.
4.5.Gloves should only be worn when necessary as indicated in Glove Selection Flowchart [Ref 6.2 Appendix 2] and following suitable risk assessment.
4.6.Used gloves should be disposed of appropriately and safely as clinical waste.
4.7.All gloves in use must be non-powdered.
4.8.As far as is reasonably practicable latex gloves must not be used in NHS Fife. Nitrile Gloves are the first glove of choice. Where latex gloves are indicated/ required for use, this must be accompanied by a suitable risk assessment.
4.9.Glove Selection
4.9.1.Before selecting a glove, staff should determine whether gloves are actually necessary. This can be done by referencing the Glove Selection Flowchart [Ref 6.2 Appendix 2].
4.9.2.In addition to considering personal risk, the healthcare worker must consider risks to patients or colleagues with latex sensitivity. Risk assessment must underpin all glove selection. This is the responsibility of the individual undertaking the task.
4.9.3.It is essential that gloves are not used inappropriately and that all gloves used are within their ‘use by’ date.
4.10.Training and education
4.10.1.Training will take several forms and will be delivered by infection prevention and control, health and safety or line managers/supervisors as appropriate;
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at core induction of all new staff to the organisation;
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at local induction for new staff;
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at induction for medical staff;
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as formal or informal teaching undertaken by Health & Safety and Infection Prevention and Control staff;
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as ad hoc teaching on clinical observation of a person undertaking poor practice;
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in response to incident reports;
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in response to ongoing audits to ensure high standards are maintained;
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in response to changes to legislative or professional practice requirements.
4.11.Incident Reporting
4.11.1.In accordance with the NHS Fife Adverse Events Policy, all incidents involving adverse reactions to protective gloves must be reported on the NHS Fife DATIX Incident Reporting System. If more than one person is affected, a separate report must be completed for each individual.
5.RISK MANAGEMENT
5.1.This procedure is a part of NHS Fife’s system for managing risk as described in the NHS Fife Risk Register and Risk Assessment Policy & NHS Fife Adverse Events Policy.
5.2.Monitoring of incidents will be via the Occupational Health referral process, DATIX system and Reporting of Injuries and Dangerous Diseases (RIDDOR) reporting. NHS Fife will review this guidance every two years to take into account new legislation and research findings.
5.2.1.Local statistics and incident reports will be reviewed regularly to monitor the effectiveness of this guidance and associated procedures.
6.RELATED DOCUMENTS
6.1.Appendix 1: Definitions
6.2.Appendix 2: Glove Selection Flowchart
6.3.Appendix 3: NHS Fife Hand Care Guidance for Healthcare workers
6.4.Appendix: 4: NHS Fife Managing Skin Health at Work Guidance
6.5.Appendix 5: National Infection Prevention and Control Manual
7.REFERENCES
7.1.NHS Fife Control of Substances Hazardous to Health Procedure
7.2.NHS Fife Personal Protective Equipment Procedure
7.3.NHS Fife Risk Register and Risk Assessment Policy
7.4.NHS Fife Adverse Events Policy
7.5.The Control of Substances Hazardous to Health Regulations 2002 (as amended)
7.6.SICPs Literature Review- Personal Protective Equipment (Gloves) from National Infection Prevention and Control Manual
8.Appendix 1: Definitions
8.1.Hazardous substance(s): is given the same definition as ‘Substances Hazardous to Health’ as found in the Control of Substances Hazardous to Health regulations 2002 (as amended). For the purposes of this guidance, this means any chemical agent, biological agent, dust or similar.
8.2.Adverse reaction: means itching, swelling, breathing or nasal/ eye problems or anaphylaxis caused by contact with a hazardous substance.
9.
Appendix 2: Glove Selection Flowchart
Glove Selection Flowchart: Selection Notes.
9.1.Note 1
Gloves are NOT required for procedures where there is no or low risk of cross-infection between patients and staff, e.g.
- Basic care procedures where staff will have no contact with blood or body fluids, secretions and/or excretions, non-intact skin or mucous membranes
- Transferring food trays from food trolleys to patient bedside [See Infection Prevention and Control Policy Section 4: Food Safety & Food Hygiene Procedures for Wards and Departments]
- Making uncontaminated beds/changing or removing patient’s uncontaminated clothing
- Taking recordings (BP, temp, pulse)
9.2.Note 2
- Single-use disposable gloves that meet the standard EN374-2 (and EN374-3 if exposure to chemical agents is anticipated) should be worn for communal care equipment and environmental cleaning tasks. Re-usable household (‘Marigold’ type) gloves are not suitable for these tasks due to the risk of cross-infection.
- long cuff nitrile gloves should be worn for cleaning activities which require wet work or use with chemicals
- Non sterile polythene gloves should be used for food handling, preparation and serving.
9.3.Note 3
Use non sterile nitrile or synthetic gloves for tasks where there is a low risk of contamination, non-invasive clinical care, or environmental cleaning e.g.
- Oral care
- Emptying catheter drainage bags
- Emptying urinals/bedpans and suction jars
- Handling low risk specimens
- Clinical cleaning
- Dressing wounds when contact with blood/body fluids is unlikely e.g. gastrostomy dressings
- Endotracheal suction
- Applying creams
- Touching patients with unknown skin rash/scabies/ shingles
- Making beds/changing clothing of patients in With known or suspected infections
Use non sterile nitrile gloves (not synthetic gloves) for procedures involving risk of exposure to blood borne viruses and where high barrier protection is needed e.g.
- Potential exposure to blood/body fluids e.g. blood spillages*, faecal incontinence, blood glucose monitoring, administering enemas/suppositories and rectal examinations
- Handling cytotoxic material
- Handling disinfectants
- Venepunture/cannulation
- Vaginal examination in gynaecology
- Basic care and specimen collection procedures on patients known or suspected to be high risk of BBV
- Non-surgical dentistry/podiatry
- Handling dirty/used instruments
- Processing specimens in a laboratory
- for non-sterile procedures and chronic wound care
*If blood spillage also contains broken glass or other sharps then heavy duty red rubber gloves should be used in accordance with instructions given NHS Scotland National Infection and Prevention & Control Manual
9.4.Note 4
Sterile nitrile examination gloves should be used for procedures which require a sterile field and high barrier protection e.g.:
- Lumbar punctures
- Liver biopsies
- Clinical care to surgical wounds / drain sites
- Procedures for neutropenic patients
- Insertion of urinary catheters
- Vaginal examination in obstetrics
- insertion of vascular access devices such as CVCs
9.5.Note 5
Sterile surgical gloves should be used for all surgical and radiological procedures. These may be manufactured from:
- Elastryn
- Neoprene
- Nitrile
- Non-powdered low protein latex
- Synthetic polyisoprene
- Tactylon