The Central Government Health Scheme (CGHS) on 14th December 2017 de-panelled Mata Chanan Devi Hospital Janak Puri Delhi for not being able to explain use of 1600 pairs of gloves and 400 syringes for a 26-day stay in in ICU in one CGHS patient. This case follows the media outcry in the Fortis case in Haryana, where a dengue patient in intensive care was billed for large number of gloves.

If we take this particular instance, 1600 pairs of gloves comes out to be 61 pairs of gloves per day.

In any ICU, there are three shifts of staff and everyone coming in contact with the patient is required to wear non-sterile gloves. Per patient, at least over nine nurses, three technicians, three safai Karamcharis, three resident doctors, three consultants (two treating consultants and the intensive care consultant) are involved in the treatment of that particular patient.

So, if a patient is examined at least three times, as is done with each change in shift duty, a total of 63 pairs of gloves will be a minimum number used in ICU in a day. This number may double or triple, if the patient is on ventilator.

Nosocomial infections constitute the greatest risk the hospital environment poses to patients. Infections are also the most common complication associated with hospitalization. Up to 10% of patients admitted to acute care hospitals acquire at least one infection, with 2 million patients affected per year.

With the rising incidence of antimicrobial resistant pathogens and no new antibiotic in the pipeline, prevention of infections assumes important. Gloves are an essential part of infection control practices.

Gloves in ICU

• Gloves should be worn by healthcare workers in situations in which exposure to blood or body secretions is possible
• Gloves provide a protective barrier for the healthcare worker as well as the patient
• Nonsterile examination gloves are typically used.
• Gloves are also a component of contact precautions. They reduce the likelihood of healthcare worker colonization with microorganisms from a patient who is colonized or infected with pathogenic organisms.
• Wearing gloves does not replace the need for hand hygiene.
• Gloves may have unapparent tears.
• Hands predictably become contaminated during glove removal.
• Gloves should be changed between patient encounters.
• It is necessary to change heavily contaminated gloves while caring for a single patient to prevent cross-contamination of body sites or contamination of medical equipment.

The root of the problem is not the number of gloves used, but the cost involved. Gloves should be included in the National List of Essential Medicines (NLEM) and their price should be capped.

Dr KK Aggarwal

Padma Shri Awardee Vice President CMAAO Group Editor-in-chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA