Modified glove removal technique to prevent hand contamination in routine phlebotomy

Abstract

The World Health Organization and the Centers for Disease Control and Prevention (CDC) have established guidelines recommending the performance of hand hygiene routines for healthcare workers following glove removal. However, the completion of frequent hygiene routines can cause allergic and adverse skin reactions. This double-blind, randomized study aimed to address this concern by developing and evaluating a modified glove removal technique that minimizes contamination risk during routine phlebotomy procedures. Furthermore, this study used fluorescent detection to compare the frequency of contamination associated with the CDC-recommended technique and the modified technique using fluorescent detection. One hundred healthcare personnel were enrolled and divided into two groups: one group followed the CDC technique, while the other group implemented the modified technique. Participants received instructional videos and practiced under supervision. They subsequently performed blood collection using a simulation arm covered with fluorescent cream as a contamination marker. After removing gloves, hand contamination was assessed under a black light. The median time required for glove removal in the modified group was four seconds longer than that in the group that followed the CDC technique (p < 0.001). Contamination was observed in 2% (1/50) of subjects using the CDC-recommended technique, while no contamination was detected with the modified technique (p ≥ 0.05). Both the group that followed the CDC technique and the group that used modified glove removal techniques demonstrated the potential to prevent contamination during phlebotomy, thereby reducing the need for hand hygiene and the occurrence of contamination and adverse skin reactions. These findings prompt further exploration into whether proper glove removal can reduce the frequency of completing a hand hygiene routine after each glove removal, specifically within the context of phlebotomy. However, it is essential to note that hand hygiene following glove removal is still recommended to prevent contamination. Further research is warranted to validate these findings.

Keywords:

• Adverse skin reactions
• CDC-recommended technique
• contamination prevention
• hand hygiene
• fluorescent detection
• safety practices

Acknowledgments

The authors extend their sincere gratitude to Ms. Nerisa Thornsri, MSc (Applied Statistics), from the Clinical Epidemiology Division, Research and Development, Faculty of Medicine Siriraj Hospital, for conducting the statistical analysis. We would also like to express our appreciation to Associate Professor Preechaya Wongkrajang, MD, from the Department of Clinical Pathology, Faculty of Medicine Siriraj Hospital, for providing the data on glove testing at the Bureau of Radiation and Medical Devices, Department of Medical Sciences, Ministry of Public Health.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Disclosure statement

The authors declare that there are no conflicts of competing interest.

Additional information

Funding

This work was supported by the Department of Clinical Pathology Fund, Siriraj Foundation. BP and PT each received a Chalermprakiat Grant from the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. The funding organizations played no role in any aspect of the study.