Covid-19 Protocol: Is It All a Farce?

For the first time in its 116 years of existence, New York City is shutting down its subway system every night for disinfection. National chains like Applebee’s have created “sanitation specialists” to scrub down surfaces that otherwise wouldn’t be touched, such as menus and window ledges. Hilton now puts a “room seal” on the door to assure guests that no one has entered the room since it was thoroughly cleaned and disinfected. There’s even an app to determine which COVID precautions your favorite restaurants are currently taking.

But are these measures really keeping people safe? Or are they just creating the perception of safety?

The Data

It turns out that although some COVID precautions do mitigate risk, others don’t do all that much at all.

  • Surface Sanitization. At the beginning of the pandemic, experts warned about surface spread and encouraged people to sanitize all surfaces that might contain viral particles. Some early studies showed that the virus could last on surfaces for close to thirty days. These studies were carried out in controlled environments, though, in complete darkness, and at a constant temperature and humidity. Outside of the laboratory, it’s a different story: UV rays, changing temperatures, and fluctuating humidity usually kill microbes on surfaces relatively quickly. Study after study has shown that surface spread is almost never the primary method that this virus spreads.

Obviously wiping down tables and other eating surfaces between customers is a wise idea, and disinfecting surfaces in hospitals just makes sense. But in general, cleaning all surfaces that other people may have touched doesn’t do much to minimize the spread of COVID-19.

  • Temperature Checks. Again, in the early stages of the pandemic, forehead thermometers were a rite of passage whenever you needed to enter a public place, be it a doctor’s office, a store, or a hotel. Unfortunately, forehead thermometers are extremely inaccurate. Many people in the early stages of infection have a very low fever, or no fever at all. And of course, many are asymptomatic entirely. The number of people who would knowingly enter a public location with a tangibly high fever is low, and anyone dishonest enough to do so could easily take a fever-reducing medication to pass the test. That doesn’t mean that temperature checks are completely ineffective, just that their usefulness is relatively low.

These precautions are often disparagingly referred to as “hygiene theater,” because they masquerade as measures that increase the hygiene of an environment, making viral transmission less likely. So which mitigation measures actually do help reduce risk?

  • Ventilation Improvements. Viral particles spread primarily through airborne transmission, which is why proper ventilation is so important. As a business owner, replacing your HVAC system can go a lot farther towards keeping people safe than adding in miles of plexiglass and investing in thousands of antiseptic wipes.
  • Contactless Service and Amenities. Minimizing interaction between people, especially indoors, can also lower risk. For example, hotels that offer in-room dining have a safer risk profile than those where guests must eat in a communal dining area. Contactless check-in at both hotels and airports, as well as other tech solutions to replace face-to-face interactions, can help as well.
  • Improved Employee Policies. When an employee at the Holiday Inn LAX experienced severe headaches and body aches back in July, she was given the day off to test…but was told she had to come back to work until the results came back several days later. By the time her positive results came back, she had come into contact with dozens of guests and potentially infected them. Employers should instead create policies that incentivize employees to report exposures or symptoms, and allow them to take time off to follow COVID protocols. This would go a long way towards creating safer workplaces.
  • Other Mitigation Strategies. Other best practices include swapping out electric hand dryers for disposable paper towels (hand dryers can harbor and spread disease), limiting the number of people in a given indoor location (e.g., a hotel gym), and mandating the use of face masks in areas where social distancing is not possible.

The Benefits of “Hygiene Theater”

If it’s so clear that many of the safety measures companies are taking during the pandemic are virtually ineffective, why are they still taking them?

Keeping those who patronize your business safe is obviously your highest priority. But actually convincing them that your business is safe can be a challenge.

The most helpful mitigation strategies during this pandemic are predominantly invisible to your customers. They are not aware of your quarantine rules, sick leave policies, or air flow mechanics. What they do see are your increased cleaning staff, informational signage, and screening questions. These create an environment that feels safer, even they don’t do much to actually mitigate risk. In fact, 81% of travelers feel more comfortable staying at hotels that have enhanced safety and cleaning protocols.

In 2021, business owners have no choice but to accept that hygiene theater is a necessity. So embrace temperature checks, sanitizing stations, and plexiglass barriers. And after you make changes to your cleaning protocol or social distancing practices, share the news! Put up signs and send out emails explaining those changes. Keep in mind, however, that these are marketing techniques, rather than actual mitigation techniques. So do not forget to take the steps that will truly protect everyone those who patronize your business, as well as yourself and your employees.

PPE and the Covid Response: Was It Really All That Bad?

While COVID-19 shocked the PPE industry along with the rest of the world, many within the industry rose to the challenge. In retrospect, we may likely find a surprising truth – that the overall effect of COVID-19 on the PPE industry will be a net positive.

Civility: The Secret to a Stress-Free Workplace

A culture of incivility is one of the most costly mistakes that a company can make. Your focus on creating a company culture where people feel respected will go a long way towards increasing stability and productivity in your organization.

Reprocessing Disposable Gloves: Is It Really an Option?

Ask any healthcare provider about the most important rules about gloving in a medical setting, and you’ll hear that disposable gloves should never be reused. After all, the very fact that they are disposable means that they are intended for a single use, and those who intend to use gloves multiple times should buy reusable versions instead.

Enter Covid-19.

Suddenly, the demand for disposable gloves has skyrocketed. While the market is attempting to keep up, and officials are begging the public to save masks and gloves for healthcare providers who will need them for the battles ahead, these same providers are left wondering whether there is any way to stretch their current supply.

After all, in an ideal world, disposable gloves should be changed after becoming soiled, between patients, and even between certain procedures when done on the same patient. But providers are wondering whether they can squeeze more life out of these gloves by applying strong hand sanitizers or even by autoclaving them. Will doing so actually eliminate any microorganisms? Will it damage the gloves’ protective properties? What does the research say?

A Brand New Concern?

Surprisingly, this question is not new – at least in some parts of the globe. In many developing countries, medical necessities have always been in short supply. A disposable glove shortage often means that healthcare providers need to look for ways to cut corners, which includes finding ways to reuse their gloves as safely as possible.

Unfortunately, this has led to an underground business in which people illegally recover medical gloves from dumping sites and use questionable methods to “reprocess” them and resell them as recycled gloves.

The upside of this ugly truth? Researchers have done some – not much, but some – investigations into the concept of disposable glove reuse.

Glove Reuse: The Main Concerns

All researchers agree on one indisputable fact: ideally, disposable gloves should not be reused in any form. Any methods used to clean disposable gloves, from washing to decontamination or reprocessing, can compromise the health of both healthcare worker and patient.

When it comes to assessing the efficacy of disposable glove reuse, researchers focus on two main concerns:

  • How effective different cleaning methods are in removing harmful microorganisms from the glove.
  • Whether the cleaning process damages the protective properties of the glove.

Concern #1: Decontamination Effectiveness

There is research that suggests that some cleaning methods may effectively eliminate disease-causing microorganisms – but that others are completely ineffective.

For example, turning gloves inside out is probably the worst “method” of disposable glove reuse. This method transfers any germs on the hands onto the outer surface of the gloves, as well as any germs on the outside of the gloves onto the hands, defeating both purposes of gloving.

Cleaning the gloves with certain types of disinfectants have been studied as well. In one Turkish study, researchers found that liquid soaps containing 4% chlorhexidine and 7.5% povidone-iodine effectively eliminated all harmful microorganisms. Another study, conducted by Johns Hopkins Hospital, found that disposable gloves could be most effectively disinfected using an alcoholic-based chlorhexidine. In fact, some research suggests that disposable gloves can be disinfected up to 9-10 times using these types of solutions.

Concern #2: Effect on Protective Properties

At the same time, gloves can be damaged significantly during the disinfecting process, potentially compromising the protective nature of the glove. The alcohol in many of the disinfecting solutions that have been tested can cause the plastic in many disposable gloves to dissolve. In addition, other techniques such as autoclaving have an even higher failure rate, leading sections of the glove to stick together, and then to tear slightly upon separation. For example, gloves that were autoclaved in Sri Lanka due to financial concerns were discovered to have a perforation rate of 194/654, or 29.6%. Another study found 41% of autoclaved gloves at the Kenyatta National Hospital in Kenya to be substandard. Note that these studies were performed on latex or nitrile gloves, but other types of gloves may be affected differently.

The Bottom Line

Again, in an ideal situation, disposable gloves should never be reprocessed, recycled, or reused in any way. But in a less than ideal situation, when the supply of gloves runs low and a careful evaluation has concluded that glove reprocessing cannot be avoided, what guidelines should be followed?

  • Avoid wasting gloves as much as possible through unnecessary use, by educating healthcare workers in the appropriate use of gloves during specific applications.
  • Develop clear guidelines that discuss any clinical situations that may arise, including when disposable gloves should be reprocessed, when they should definitely be disposed of (e.g., when they are visibly soiled with blood or feces), and when they should be discarded after reprocessing (e.g., if perforations have been detected).
  • Ensure that the donning and doffing of gloves is done properly, to avoid contamination of the inner surface from the outer contaminated surface.
  • Create a system in which it is apparent how many times a set of gloves have been reprocessed, and decide on a number of processes that a glove can go through before it should be discarded.
  • Make sure that all gloves are inspected for defects due to reprocessing. This includes:
    • Inspecting gloves for visible cuts, holes, or openings
    • Inspecting gloves for visible discoloration
    • Inspecting gloves for visible cracking, as well as changes in shape or texture
    • Lightly inflating gloves and then spraying them with a mild and dilute dish soap solution to check for air leakage
  • Gloves should be washed with soap and water and then sanitized while on the hand.
  • Consider double gloving when using reprocessed gloves, if possible.

Disposable medical gloves are intended to be for single use, and can risk transmission and infection if used incorrectly. They are difficult to reprocess adequately without compromising their effectiveness. At a time like this, however, it is important to consider how, under extreme circumstances, disposable glove reprocessing can be done in a way that is most likely to be effective.