Standardization is typically thought of as a good thing among hospital and health system leaders. By standardizing purchasing and other processing, hospitals can reduce costs and increase optimizations. However, for some supplies in hospitals, excess standardization can lead to major risks.
Medical exam gloves are the first line of defense for clinicians. At some hospitals, nurses and physicians are only given one option for exam gloves. While the hospital may have made this decision to cut costs and improve efficiency, limiting selection to, most commonly, the thinnest exam glove can cause clinicians to feel undervalued.
Take for example a facility that standardized to one thin nitrile exam glove, which was used in all areas and all floors of the hospital, according to RoseMarie Squeo, RN, a senior consultant of clinical operations at Cardinal Health. Since the adoption of the single glove, clinicians have complained of feeling marginalized over the facility’s decision. Beyond feeling undervalued, clinicians began reporting tearing in the gloves that lead to exposure of bacteria, bloodborne pathogens and common chemicals.
In the intensive care unit, clinicians also experienced tears exposing them to human waste. One of the nurses that experienced the exposure had to be put on antibiotics, Ms. Squeo said. When the clinician returned to work, she expressed anxiety over the exposure.
These are just a few examples of how excess standardization of exam gloves puts clinicians at pathological and psychological risks. Additionally, hospitals can face financial burdens from excess standardization.
During a June 12 webinar sponsored by Cardinal Health and presented by Becker’s Hospital Review, Samantha Hoye, global vice president of Exam Gloves and Medical Essentials at Cardinal Health, Ms. Squeo and Jane Lacovara, a clinical nurse specialist at Banner University, explained the consequences and unknown risks hospitals can bring upon themselves when limiting exam glove options.
Pathological risks
Although hospitals don’t expect clinicians or staff to be exposed to unsafe conditions, exposures can happen.
A market research study conducted by Key Group on behalf of Cardinal Health in May of 2019 found that 20.3 percent of clinicians have been exposed to sharp objects because of exam glove failures. Around 23.7 percent said they believe they could have been exposed to MRSA because of tears, punctures or leaks with exam gloves.
“It’s agreed upon that exam gloves are used to protect the hands that they hold,” Ms. Hoye said. "Clinicians use their hands every day and they can’t afford for their hands not to be at their best. When clinicians know they have the right protection for each setting, their minds can be rest assured and they can focus on what matters — the patient care. Excess standardization can compromise that peace of mind.”
There isn't a one-size-fits-all solution when it comes to exam gloves. When exposures do happen because of problems with medical exam gloves, nurses and other hospital staff can then feel skeptical or worried about their safety.
Psychological risks
After an exam glove tear, clinicians report feeling apprehensive. A survey of clinicians funded by the Centers for Disease Control and Prevention and NIOSH in December of 2000 found that 53 percent had anxiety following an exposure incident. Eighteen percent of hospital staff said they suffered from insomnia after an exposure and 13 percent reported to have depression.
The risk of glove failures is a reality. The May 2019 market research by Key Group reported that 88.5 percent of clinicians have had glove failures and 50 percent have had torn cuffs. The anxiety that follows an exposure or failed glove is also real. The same independent market research showed 85 percent of clinicians experienced stress because of a glove failure and 18 percent had high or extreme stress.
Due to the constant worrying, clinicians turn to other options to stay protected, including double gloving. The Key Group survey also showed that 76 percent of clinicians double-glove some of the time.
“Many intensive care unit nurses have made it their practice to double glove because they do not trust their gloves will protect them,” Ms. Squeo said. “I believe there has been an increase in double gloving because of excess standardization and not having the appropriate gloves for the tasks at hand.”
Excess standardization is a real concern for clinicians. In the same Key Group survey, sixty-six percent said the standardization could put them at risk and 62 percent said it puts the patient at risk, Ms. Hoye said. Additionally, excess standardization can cause a lack of control in decision making and can lead to increased costs due to hospital-acquired infections.
Financial risks
A few of the diseases that clinicians can be exposed to if exam gloves fail include C. diff, MRSA, Hepatitis B and C and HIV. If contracted, these exposures can be very costly for hospitals. A 2016 meta-analysis and modelling study published in BMC Infectious Diseases found the average C. diff case management and C. diff attributable costs were $63,700 per case.
Financial impacts should also not be limited to just glove failures.
“It doesn’t take an actual glove failure to cost money,” said Ms. Lacovara. “Just the threat of a glove failure is costly. Think back to the number of physicians who double glove because of the anxiety they have. Imagine the number of times exam gloves are needed in a hospital setting every day and then how many more gloves are actually used by doubling or tripling. The double or triple gloving can really add up financially over time.”
A hidden financial risk that can be overlooked is the cost of employees. Clinicians who have been exposed to an infection or feel limited in their glove choice, may choose to leave a specific hospital. The costs of hiring and training new employees as well as the disruption in patient care can be significant.
Conclusion
According to the Centers for Disease Control and Prevention, exam gloves should aim to protect both patients and healthcare workers from exposure to infectious materials that can be carried by hand. Clinicians have preferences when it comes to exam gloves. To accommodate for clinicians and safety, hospital should have a risk-adjusted glove mix, Ms. Hoye said. By providing clinicians access to other high use and specialty gloves for each patient engagement, hospitals can increase safety and satisfaction.
To learn more about Cardinal Health, click here.
To learn more about Exam Gloves, click here.
To view the webinar, click here.