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How many pairs of disposable gloves do you get through a day? And have you ever thought about what happens to them when they are discarded into clinical waste?
Use of gloves is a contentious issue in clinical practice. Looking back to when I trained, non-sterile gloves were used sparingly for procedures such as rectal administration of medicines and mouth care.
“Attitudes to the use of non-sterile gloves have changed significantly over the years”
No one would have dreamed of using them to administer IM or IV medicines unless there was an identified risk. Physical care such as washing and dressing was delivered without gloves and we never used them to help patients to eat and drink.
Attitudes to the use of non-sterile gloves have changed significantly over the years and it is now accepted that they are overused and, as a consequence, patients are routinely receiving care that is not evidence-based. There is also evidence that when healthcare staff use gloves to protect themselves, they wear them for multiples procedures and fail to decontaminate their hands between tasks, which puts patients at risk.
Each year the Gloves Off campaign hosted by the RCN aims to raise awareness of when gloves should and should not be worn in healthcare. One of the issues raised by the campaign is the environmental impact of the millions of non-sterile gloves used inappropriately.
In a post to mark this year’s campaign, the Healthcare Infection Society noted that the majority of gloves used in healthcare are not biodegradable and end up in landfill. So how do we change ingrained practice and reduce waste?
The Gloves Off: Safer in our Hands project at Great Ormond Street Hospital has addressed this issue by creating an educational awareness programme for staff. Audits show it has changed practice; staff now use gloves at the right time and, as a consequence, they are used less frequently.
Orders for non-sterile gloves fell from 11.1 million in the 12 months before the project to 7.4 million in the 12 months after, resulting in cost savings of over £90,000.
In environmental terms, gloves created around 55 tonnes of waste a year before the project; this reduced by around 18 tonnes after implementation.
We all have to acknowledge that healthcare has a huge impact on the environment. In 2012 a King’s Fund report on sustainable health and social care noted that NHS carbon dioxide emissions in England were greater than the total emissions from all aircraft departing from Heathrow Airport.
It is clear from the work by the Sustainable Development Unit that the solutions need to be wide-ranging, from the obvious – improved energy efficiency in healthcare buildings – to rethinking how and where we deliver care.
Individual trusts are also working to improve sustainability and some are achieving amazing results. For example Guy’s and St Thomas’ Hospital NHS Foundation Trust has reduced its carbon footprint per patient by 65% through a series of initiatives including improved energy saving, waste management and changes in procurement. The trust also notes the importance of staff engagement and changing everyday work culture.
“Following evidence-based guidance on non-sterile glove use protects patients, saves money and reduces waste”
This issue of staff engagement is important. Tackling the impact of healthcare on the environment requires a whole-system approach but as with all change staff need to be motivated to do so, and that means they must be aware of the issue and involved in discussions around how their individual choices can make a difference.
It would be naive to think that changing the way we use non-sterile gloves will save the planet but following evidence-based guidance on non-sterile glove use protects patients, saves money and reduces waste. These are the small changes that contribute to the overall drive to building a sustainable healthcare for future generations.