How Often Should You Change Gloves During a Wound Dressing Change? Protection Status

by Karen Zulkowski DNS, RN, CWS

How often should you change gloves during a dressing change? In the past year I have learned of multiple nursing home facilities being cited for not changing their gloves after a dressing is removed to avoid bacterial cross-contamination during dressing reapplication. I have looked at the evidence and there is nothing out there, based on my research, that supports or denies this claim. The closest information found was on handwashing from the CDC and WHO. If you are from a facility that has been cited, please post what happened.

Bacteria is present on everyone’s skin. Basically, there are transient bacteria that you can wash off and resident bacteria that you always have. In the patient’s case this bacteria may be shed onto the bed and surrounding areas. This bacteria is also present in the patient’s wound—especially in the edges of the wound. Even after you wash the wound the bacteria is still going to return around the edges.

The idea is to prevent the bacteria present from being transmitted to another patient. Keep in mind that the amount and virulence of bacteria are mediated by the patient’s immune response. When a patient is immunocompromised, any bacteria can become problematic. Look at how all staff is washing their hands after patient contact. How long do they wash and is hand sanitizer available and being applied? Look around and post where you think your facility could improve their hand hygiene practices and tell us your suggestions for how they can be accomplished.

Later this year I am doing a pilot study on wound and hand bacteria. I will let you know what I find! In the meantime, I welcome hearing about your experiences. Feel free to post a comment on this blog.

About The Author
Karen Zulkowski DNS, RN, CWS is an Associate Professor with Montana State University-Bozeman, teaches an online wound course for Excelsior College, and is a consultant for Mountain Pacific Quality Improvement Organization. She has served as a Research Consultant with Billings Clinic Center on Aging, and was the Associate Director for Yale University’s Program for the Advancement of Chronic Wound Care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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I have been doing wound care for more than 8 years, and I am aware that wounds, no matter how much we clean them, bacteria will always be there. However, I use a pair of glove when I remove wound dressings, but I have to change my gloves before I apply the new dressings. I always imagine that even though I know that wounds are always contaminated, the amount of contamination will be reduced when I changed into a clean pair of gloves before applying the new wound dressings. I do this especially when wounds are MRSA positive and draining quite a bit.

I also change my gloves when I have forgotten something in the middle of dressing removal or change. I reach into the drawer or cabinet without my gloves on to get what I need then don on another pair of clean gloves.

By doing this, I am not only protecting myself, but I am also protecting the patient I am attending to and the next patient who will use the treatment room. Of course I still have to wash my hands after removing the pair of gloves before I leave the room, and also at the beginning of the dressing change before I touch the patient.

Thanks. I think this is a very important topic and I also think that this should be talked about more often as I observed some nurses and doctors who do not wash their hands as often as they should.

As a Wound Care Nurse for about 15 years, I relied on my basic nursing education to guide my practice. Back in the day, it was taught to change gloves when the dressing was removed and if you forgot something. I also sanitize in between glove changes. This is a perfect area for research - how often do we need to change gloves?

I was always taught that you change your gloves at least three times when performing a dressing change. Wash hands and apply gloves to remove the soiled dressing. Wash hands and apply gloves to clean the wound. Wash hands and apply gloves to apply the new dressing.

In My Ohio region, the surveyors have been very rigid with infection control, especially hand washing and gloving.

Their expectation is that gloves need to be changed & hands washed/sanitized every time you go from dirty to clean during a dressing change. I had one facility get cited for this, causing me to revise our corporate infection control policy to accommodate the multiple glove changes.

Their expectation is as follows: wash hands when entering the resident's room and don gloves. Remove dressing, remove gloves, sanitize hands, don gloves, clean wound, remove gloves, sanitize hands, don gloves, apply new dressing, remove gloves & wash hands.

I also incorporated into the policy to place a trash can beside the bed or an unused garbage bag on the bed for soiled items as well as the need to clean shared equipment being used with a bleach wipe prior to and after use. We did this step in front of the surveyor so there wouldn't be any questions regarding the sharing of equipment. Staff also needs to make sure they are placing items that are going to be taken back out of the room on a barrier and wax paper is a cheap effective barrier for this purpose.

Had a state man watching me do two changes yesterday, he was doing a lot of writing. I will soon find out if he thought I changed and washed my hands enough times while doing wound care.

CMS is here this week at our hospital. One of the surveyors observed a staff member changing a dressing. She performed hand hygiene, put on gloves, performed the dressing change, removed the gloves, donned clean gloves, but did not perform hand hygiene and the surveyor cited us as a breach. Has anyone ever contested this, and what references did you cite if so? I am not able to find anything yet, but my Executive Director has me on a search to find anything that might speak to it. Thanks

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