It Ain’t Necessarily So – 15: The uses and misuses of personal protective equipment
Caring Times. April 2014
With JOHN BURTON
For a visitor, one of the most common sights in many care homes must be protective gloves. A member of staff with gloved hands pushing a resident in a wheelchair; someone walking along a corridor with gloves sticking out of their pocket; a pair of gloves hanging incongruously over a handrail. Look in a toilet and there’s a box of gloves on the window sill. Plastic aprons are also common because staff have been told that whenever they wear gloves they should also wear an appropriate apron.
So, that care worker pushing the wheelchair is probably also wearing a plastic apron. At 10.30am the staff put on blue aprons to serve out the coffee and biscuits, and at lunchtime there they are again in aprons and some are even wearing blue gloves! The regular visitor, the staff, the residents . . . the manager? . . . get used to it.
If the visitor remains curious about this particular feature of care home life and asks, they may be told that PPE, personal protective equipment (for that is what gloves and aprons are officially known as) is a requirement whenever “personal care” is being given or “delivered”.
The really curious visitor may ponder on this answer: “Surely, I haven’t – nor should I – see personal care being given, and is serving food and drinks personal care?” Infection control and the use of personal protective equipment is mandatory training for care staff, yet they come out of the training possibly even more inclined to don gloves and aprons at the drop of a hair net.
The principles are simple but in practice they are forgotten. Could it really be that PPE, far from preventing the spread of infection, is all too often the cause of infection? As I understand them, the principles are that gloves and aprons (and other protective equipment) are for one time use only, and that in private. Their purpose is to protect both the carer and the resident from infection and contamination.
They should be used only when there is a risk of infection and contamination. The carer goes into the room, puts on a new pair of gloves and an apron; carries out the personal care task; disposes of any contaminated items including the gloves and apron in a new sealable bag (which remains clean on the outside); washes their hands and then leaves the room (probably with the sealed bag to dispose of in the clinical waste) in the same way – without gloves or apron – in which they entered. No one but the carer and the resident should see the gloves and apron. And as for the dining room? Would you like to be served food at home or in a restaurant by someone wearing blue gloves and a plastic apron? It’s surreal.
We found a different way: Caring Times readers tell their stories
Relative, the Midlands: My mother lives in a very nice home and I visit her at least twice a week. She’s happy and well looked after, and she and I get on with the staff and the manager very well. She has dementia but doesn’t need what’s called personal care. She just needs reminding about things. She enjoys the life in the home and the routine helps her a lot. She has good friends she eats with in the dining room and she particularly likes the bird table and the garden.
I don’t want to identify the home because in nearly every way it’s a lovely place. But, the one thing that really upsets me is the way the staff use rubber – or are they vinyl? – gloves and horrible plastic aprons. It looks so impersonal, as if my mother is dirty and untouchable. She’s not. It makes her feel bad. Her room has a box of gloves on the dressing table. And I see staff walking up and down in gloves and aprons. Why? I asked the staff about it and they say it’s “health and safety” and “infection control”.
Apparently they have to wear this stuff. I’ve asked the manager as well – not aggressively – and she gives roughly the same answer, saying that it’s a requirement, and if the inspector caught staff not using protective clothing the home would be in trouble. It just doesn’t make sense to me. (I see Caring Times at the home and thought it would be good to have a relative’s angle on this subject.)
Nurse in a care home in the South East: Staff don’t realise that they can be the main source of infection. The residents live here but the staff are in and out, bringing with them a rich variety of viruses and bacteria from public transport, home, shops etc. So first, they need to have good personal hygiene including basic hand washing which minimises the risk of most infection. However, often they see the residents as the source of infection that they should be protected from. This makes them very keen on PPE.
But I ask, is it necessary and how is it being used? The first answer I get from my group of staff is that it’s how they’ve been trained and they have to protect themselves. But they are not using this equipment properly. I see them in the corridor wearing gloves and aprons. They go from one resident to another with the same gloves and aprons. I’m forever asking why staff wear gloves to give someone a shower or to comb their hair. I see them wearing gloves and putting their hands to their own hair or even their face. I believe that the easy availability of this equipment has stopped people thinking, reduces hand washing, and has increased the risk of cross infection.