Skill List > Use of Apron and Non-sterile Gloves
Clinical Alert
Please note: The information below is for general use of apron and gloves. Additional precautions are required if looking after a patient with suspected or confirmed COVID-19. In particular, hand hygiene should be performed at specific stages of equipment removal. The order for PPE removal is gloves, hand hygiene, apron or gown, eye protection, hand hygiene, surgical face mask or FFP3 respirator, hand hygiene (Public Health England 2020).

New recommendations from 6th April 2020 state that gloves and aprons remain single use only, as per existing Standard Infection Control protocols, with disposal after each patient or resident contact. However, fluid repellent surgical mask and eye protection can be used for a session of work rather than a single patient or resident contact. Similarly, gowns can be worn for a session of work in higher risk areas. Hand hygiene should be practised and extended to exposed forearms, after removing any element of PPE (Public Health England, DHSC et al. 2020). As these are rapidly developing recommendations, the reader is advised to check Public Health England and NICE websites for updates.

Elsevier Clinical Skills covers the principles of this procedure. You must follow local policies and procedures regarding technique, equipment used and documentation.
Authors:
Based on Nicol: Essential Nursing Skills 4E
Adapted by: Professor Maggie Nicol BSc(Hons) MSc(Nursing) PGDipEd RN
Updated by: Janet Hunter MA BSc(Hons) PGCE RN; Karen Rawlings-Anderson BA(Hons) MSc DipNEd RN; Marsh Gelbart BA(Hons) MA PGCert RN
Last updated: April 2020
Learning Objective
After reading the skill overview, watching the video, following up some of the references/web sites and completing the self-test quiz you should be ready to be assessed in practice in the skill of using an apron and gloves to prevent infection.

Introduction

Personal protective equipment (PPE) is used to protect you and your patient from the risks of cross-infection. It includes aprons, gloves, masks, goggles, and visors, and, in areas such as the operating theatre, may also involve the use of gowns and hats (Health Protection Scotland 2015). Body fluids are a major source of micro-organisms associated with healthcare associated infections (HCAIs) and so protective clothing should be worn for any direct contact with body fluids. In order to decide whether eye protection is required, you need to assess the risk of contact with body fluids and the risk of splashing (Health Protection Scotland 2015, National Institute for Health and Care Excellence (NICE) 2012). 
The use of PPE and indeed standard precautions became more widespread and rationalised after the advent of HIV in the 1980s and SARS in 2003 (Brown et al. 2020). Similarly the COVID-19 pandemic of 2019 will lead to revision of how and when PPE will be used in healthcare. Specifically, greater emphasis will be given to Transmission Based Precautions, which supplement standard precautions, when a patient has a known infection (DHSC 2020, Public Health England, DHSC et al. 2020).


Disposable aprons are used to prevent the uniform becoming contaminated. They are also used to provide a clean barrier over your uniform for aseptic techniques such as dressings, urinary catheterisation, etc.

The use of disposable non-sterile gloves for direct contact with body fluids prevents the hands becoming contaminated. Gloves also help to protect healthcare workers from infection if they have cuts or abrasions on their hands (Health Protection Scotland 2015, 2016). Gloves and aprons are part of the personal protective equipment (PPE) that is fundamental to the standard infection precautions (see below) and should be worn in the following situations (Health Protection Scotland 2015, Loveday et al. 2014, NICE 2012):

  • Procedures involving direct contact with mucous membranes (e.g., mouth care, vaginal examination).
  • Any activity where contact with body fluids is possible (e.g., urinalysis, emptying a catheter bag).
  • Where isolation precautions are in place (e.g., patients with MRSA or Clostridium difficile). Gloves and aprons are worn to reduce contamination of the hands and thus reduce the risk of transferring infection to other patients. They must be discarded before leaving the room or attending another patient.

Gloves must be discarded after each procedure, even if it is the same patient. For example, gloves used whe emptying a catheter bag must be changed before removing an intravenous cannula to prevent transfer of micro-organisms from the urinary tract to the cannula site. Because the gloves are likely to be more heavily contaminated than the apron, the gloves should be removed first to prevent contamination of your hair and uniform when removing the apron.

Washing gloves is not safe practice: the gloves may be damaged by soap solution and, if punctured unknowingly, may allow prolonged contact with body fluids (Health Protection Scotland 2015).

Hands must be decontaminated after removal of the gloves. Although gloves significantly reduce the risk of hand contamination, they do not eliminate it entirely (Loveday et al. 2014) and the warm, moist environment under gloves allows micro-organisms to multiply rapidly. Hand hygiene is therefore essential following removal of gloves.

Preparation and safety

  • Gloves should be worn whenever patient care involves dealing with blood or other body fluids. They are for single use only (Health Protection Scotland 2015, Loveday et al. 2014).
  • Gloves may also be required when there is any contact with a patient who has an infection such as hepatitis, methicillin resistant Staphylococcus aureus (MRSA), or Clostridium difficile.
  • Aprons should be worn in all situations where there is direct patient contact or contact with body fluids, bed linen, excreta, clinical waste, etc., or with items that have been in contact with infectious diseases, such as clothes or books.
  • If latex gloves are used, check whether the patient has a latex allergy (Health Protection Scotland 2015, Loveday et al. 2014). Non-latex gloves are now widely available.
  • The use of gloves does not reduce the need for hand hygiene.
  • Hand hygiene must be performed before and after gloves are worn because the hands sweat within the gloves, creating a warm, moist environment that encourages micro-organisms to multiply. Also, gloves may not completely protect the hands; they have been shown to develop tiny punctures that go undetected but allow micro-organisms to pass through (Health Protection Scotland 2015, NICE 2012).
  • The apron should be put on after performing hand hygiene.

Procedure

  1. Perform appropriate hand hygiene. Rationale It is important that your hands are clean before handling the clean apron and gloves.
  2. Place the apron over your head; avoid touching your hair and clothing. Rationale – It is important to make sure your clean hands do not become contaminated by touching your hair or clothing.
  3. Tie the apron loosely at the back to avoid it becoming gathered at the waist. Rationale – So that micro-organisms, body fluids or water splashes will run off easily.
  4. Choose clean gloves that are close fitting. Put on gloves and then hold your gloved hands in front of you; do not let them hang by your sides where they may touch your uniform or contaminated surfaces. Rationale – If your gloves do not fit well you will not be able to perform fine movements.
  5. At the end of patient contact remove the gloves first before removing the apron. Do not touch your wrists or hands with the dirty gloves. Rationale – These are likely to be more heavily contaminated than your apron and you may touch your hair or uniform when breaking the apron ties (step 8).
  6. Using a gloved hand, pinch up the glove of the other hand at the wrist and pull it off, turning it inside out. With your non-gloved hand, slip your fingers into the wrist of the other glove and pull it off, again turning it inside out. Rationale – This technique will enable you to remove your gloves without touching your wrists or hands with the dirty gloves and thus reduce the risk of cross-contamination.
  7. Discard into the clinical waste bin. Rationale – Your gloves will be contaminated and so must be discarded into the clinical waste bin.
  8. To remove the apron, break the neckband and fold the top of the apron down. Then break the waist-ties, and carefully fold the apron in on itself. Avoid touching the front of the apron. Rationale – This technique enables you to remove your apron without shaking organisms into the air or contaminating your uniform and ensures that your hands touch only the ‘clean’ side of the apron (Tomas et al. 2015).
  9. Discard the used apron into the clinical waste bin. Rationale – Your apron will be contaminated and so must be discarded into the clinical waste bin.
  10. Perform appropriate hand hygiene. Rationale – Hand hygiene must be performed after gloves are worn because the hands sweat within the gloves, creating a warm, moist environment that encourages micro-organisms to multiply. Also, gloves may not completely protect the hands; they have been shown to develop tiny punctures that go undetected but allow micro-organisms to pass through (Health Protection Scotland 2015, NICE 2012).

Ongoing care, monitoring and support

  • Your gloves are likely to be more heavily contaminated than your apron. Removing your gloves before the apron reduces the risk of contamination of your clothing when breaking the neckband and waist-ties to remove the apron.
  • Removing your gloves in the way shown avoids contamination of your hands as they touch only the inside of the gloves.
  • Folding the apron carefully as it is removed reduces the risk of shaking organisms into the air, contaminating your uniform, and ensures that your hands touch only the ‘clean’ side of the apron.
  • If a mask is worn, this should be removed after the gloves and apron, but before performing hand hygiene .
  • Hand hygiene must be performed before and after gloves are worn because the hands sweat within the gloves, creating a warm, moist environment that encourages micro-organisms to multiply. Also, gloves may not completely protect the hands; they have been shown to develop tiny punctures that go undetected but allow micro-organisms to pass through (Health Protection Scotland 2015, NICE 2012).

Documentation and reporting

  • Signs may be required to explain to healthcare staff, patients and visitors the importance of hand hygiene and wearing aprons and gloves.
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