This is a tricky question, and as with all questions of this type there is no one answer for everyone. Instead, there are several tradeoffs to consider.


One big consideration is the geographical delivery of the complex care training.  Smaller training companies tend to find delivering face-to-face courses nationwide is more of a challenge than larger training companies.  It is not impossible to find small training companies that can meet a national provider’s needs, but larger training companies tend to have a larger network of trainers that can accommodate a larger training area more easily.  If you work for or own a national healthcare provider a large complex care training company may meet your needs more easily. Alternatively, you can build a list of smaller training providers each covering a complimentary geographical area.  Thankfully, with the technology available today not all courses need to be delivered face-to-face although there are some that we at Actionable Intelligence feel should be, see our previous post on remote vs face-to-face training delivery.

Quality and standardization

Having a list of different companies that provide training in different geographic areas prompts a question about how you ensure quality and standardization of materials and delivery is maintained across training courses.  Employing a larger training company places the bulk of the responsibility for assessing and maintaining quality and standardized material delivery to the training company.  However, the healthcare training industry is structured in a way that many larger training companies’ contract to freelance trainers or smaller training companies to fulfil their contractual obligations making quality control and standardization of training delivered face-to-face a challenge even for large healthcare providers.

For smaller healthcare providers, or franchise operators, quality control and standardization can be more straightforward. Smaller complex care training providers will likely be able to meet your needs and have a small select group of trainers that deliver the training, and it is quite likely that you will get the same trainer consistently.   Trainers at small companies quite often have a vested interest in the success of the company being a shareholder or partner in the operation which drives up the desire to deliver exceptional service to their clients.

Lead time on courses is another consideration.  Small complex care training providers will likely have a lead time for course delivery that can be one to two months.  Large complex care providers have a broader network of trainers available to them and are likely to be able to deliver the desired course in a shorter timeframe if required.


Price is another important factor. Generally large complex care training companies will charge more for course delivery than small companies because larger companies have more overheads to cover.  This again needs to be considered in the context of the situation though.  For a large national healthcare provider, it may be more desirable to pay a slightly elevated training fee but not have the added complication of coordinating national training through a network of smaller companies.  Whereas a smaller healthcare provider may be more price sensitive and have less need for coordination of training provision over a wider geographic area, and a smaller complex care training team would be a better fit.

Culture and values

An often-overlooked part of the selection process is the values and culture of organizations.  When selecting an external training provider to work with it is important to make sure that the value and culture within the training providers organization align with the values and culture in your own organization and provide an environment where you can achieve a successful outcome.

Here at Actionable Intelligence our values are:

  1. Honesty – be honest and transparent with everyone, if there is a difficult conversation to be had, do this in a friendly, supportive and honest way.
  2. Communicate and communicate – 1) communicate honestly with clients or event organizers and 2) communicate effectively in the most appropriate style with delegates to ensure the best learning outcomes.
  3. Friendly, supportive and professional – We believe that everyone is doing the best they can with the tools they have so we aim to support them to the best of our ability, in a friendly, approachable manner whilst maintaining professional working relationships with everyone involved in our daily lives.
  4. To have fun and enjoy our time together!

To sum up here are a few questions to consider when selecting a training provider to work with:

  • What is the geographic distribution of the training required?
  • Is the convenience of a one stop shop for training more important to my organization than price?
  • How is the quality and standardization of training going to be maintained?
  • What about price, where does that fall on the selection criteria?
  • Are the values and culture of my organization and those of the training provider in alignment?

So, there you are, some practical thoughts on big vs small training provider, we hope they are useful…

Happy selecting!

Nurse verification of expected death: what it is, and how our training can help

The term “verification of death”, refers to the process of deciding whether a person is actually deceased. A registered nurse or doctor are able to perform this process this process.

More specifically, as set out by Hospice UK, the “recognition of death” – when relatives, nursing home staff, and others can recognise that death has occurred – is distinct from “verification of the fact of death”, which entails formally documenting the death in accordance with national guidelines. It is the time of verification that is recognised as the official time of death.

“Certification of death”, meanwhile, is specifically the process of completing the “Medical Certificate of the Cause of Death” (MCCD) by a medical practitioner, in line with The Births and Deaths Registration Act 1953. It is a key part of the legal requirements for recording a person’s death.

What is meant by “expected death”?

A death can be said to have been “expected” when it occurred as a result of an acute or gradual deterioration in the health status of the given patient. In such cases, the death will have been anticipated, expected, and predicted.

This is as opposed to a sudden or unexpected death, which is a death that was not anticipated or related to a period of illness that had already been identified as terminal.

What does our nurse verification of expected death course include?

If you are a nurse seeking accreditation for nurse verification of expected death, you have come to the right place in Actionable Intelligence.

Our training covering this process can be delivered ‘in-person’ in a classroom or remotely via Zoom; either way, it will guide you through the process of safely and effectively verifying an expected death, in accordance with Hospice UK, 2022 guidelines.

Taking on this course will enable you to learn more about the legal aspects of nurse verification of death, as well as about the actual procedure for verification of expected death. This will include the clinical observations you will need to perform.

The course will also cover the subjects of care after death, how you can support the loved ones of the deceased after death, and the documentation that is recommended in line with verification of expected death.

To learn more about this accreditation for nurse verification of expected death course, or about any of our other healthcare skills training, you are very welcome to send us an email or to give us a call today, on 0330 133 4195.

Our training can cover the key stoma competencies

How familiar are you with what a stoma is, or how you can most effectively support someone who has a stoma? Even many healthcare staff are not necessarily knowledgeable on this subject, which is why we are pleased to be able to offer stoma management training to such practitioners, easily accessible either in the classroom or online using Zoom video conferencing software.

Whichever format of training you choose, you can expect much the same high standard, including coverage of the key things you need to know if you are to responsibly support someone with a stoma.

Firstly, what is a stoma?

A stoma is an opening made through the wall of the abdomen (tummy), connected to either the digestive or urinary system, to allow the diversion of waste, either urine or faeces, out of the body. It is a surgically created opening where part of the bowel or urinary tract is brought to the skin surface to create that new opening. It will resembling a small, pinkish, circular opening. The person with a stoma usually wears a pouch on top of it, with this either being closed, or having an opening at the bottom.

Stoma surgery may be undertaken as part of the treatment for a variety of diseases and conditions, ranging from bowel cancer or bladder cancer to Crohn’s disease and cases of trauma to the abdomen. A stoma may be temporary or permanent.

With it being estimated that about one in 335 people in the UK currently have a stoma, and there not being just one type of stoma, it is important for healthcare professionals to possess a good understanding of how they can care for and support people living with a stoma. This is what our highly regarded stoma management training here at Actionable Intelligence helps make possible.

What is covered in our stoma management training?

When you take this course, whatever the delivery method, you can expect to learn about the different types of stoma surgery, including colostomy, urostomy and ileostomy, as well as the circumstances that might give rise to this operation in the first place.

Our training will also give you the opportunity to educate yourself, or your organisation’s staff, on the complications that have been linked to stoma use and care, and how you can prevent them from occurring. Also covered in the course are the principles of holistic care for someone with a stoma, and what products are out there that can support stoma management.

Last but not least, we also offer additional add-ons for this course, with simulated stoma competencies able to be provided if you choose the classroom-based training option. This is just one more example of how we dedicate ourselves to helping healthcare practitioners upgrade their knowledge and capabilities in relation to stoma management.

Would you like to learn more about this course or about any of our other training options? If so, simply complete and submit our online contact form today, or give us a call on 0330 133 4195.

Sorry, this is a trick question to start with. Both have their merits, and both have weaknesses.  It is really a question of which works for both you and the topic at hand most effectively.

Virtual training (provided by ourselves using Zoom) is when participants in different locations can communicate with each other through online video and sound. Video conferences are the virtual equivalent of a group of people sitting around a conference table. This form of training really exploded during the COVID-19 pandemic when we were unable to physically meet up.  Virtual tools, such as Zoom, allowed training to continue in the safety of our own homes.

The strengths of virtual training when compared to traditional face-to-face training:

  • Lower cost – there are no travel costs for delegates or trainers, catering expenses or room rental costs. Given the current inflationary economic environment it is fair to say that everyone is trying to reduce costs where possible, embracing virtual training where possible may be one way to achieve cost reductions.
  • Lower environmental impact – Virtual events eliminate the need for any kind of travel making them more environmentally friendly.
  • Greater attendance – it is possible to draw together people from all over the UK, and even the world, to attend events virtually. Widespread participation in this way improves the cross-pollination of knowledge between Individuals in different offices or disciplines.
  • No close contact with other people – it reduces the transmission of pathogens because people are not physically meeting, hence the 340% growth in this form of meeting during the COVID-19 pandemic
  • Highly interactive theoretical teaching platform – with the right material preparation and the right trainer, sessions delivered over virtual training platforms are interactive, inclusive and highly effective. Each platform has its own array of tools including ‘breakout rooms’ allowing delegates to divide into smaller discussion groups; whiteboards where delegates can write on the main screen to share ideas and concepts; annotation tools to highlight and write on the screen; polls to gauge an audience opinion or use as a tool to ensure knowledge and understanding during a training session; chat functionality to answer or ask a questions; and videos where pre-recorded video or live demonstrations can be played to event participants wherever they may be.

The strengths of face-to-face training when compared to virtual training:

  • Technology – Face to face training limits the technological equipment and knowledge required by the participant, the trainer takes on the burden for providing and using the technology required. In a virtual environment, participants need a good computer, mobile phone or tablet with video and audio functionality and a good Wi-Fi signal to be able to attend the session. Some participants may have a fear of technology or lack confidence in its use, which can adversely impact the learning experience.  With face-to-face training this is not a concern.
  • Practical workshops and simulated competencies – during face-to-face training practical demonstrations and the chance for attendees to get ‘hands-on’ can be easily built into the training. Simulated competencies can optionally be added onto most face-to-face training sessions offered (ask when booking if these are of interest to you and your staff).  Despite virtual training being highly interactive and inclusive if delivered correctly as discussed above, there simply isn’t the possibility to deliver practical ‘hands-on’ sessions or conduct simulated competencies.  Therefore, the outcomes desired for the participants needs to be considered before deciding on the type of training to be booked.
  • Focused training environment – face to face training is delivered in a classroom environment where distractions can be managed by the trainer. During virtual training attendees are in their home environment. When working from home in any capacity, there are always more distractions (the washing, kids, pets etc). This too could hamper the learning experience if the delegates aren’t able to focus on the course and the course alone.

Which is better?

The question of which is better between face-to-face and virtual training should really be a question of which is most suitable for the course being delivered and the outcome objectives for the audience.  With traditional face-to-face training practical sessions and simulated competencies can be included in a focused distraction free environment.  Whereas if wide participation for mainly theoretical content is the aim, then virtual training is probably the answer.

In conclusion, there are many factors to consider including the topic to be taught; the travel required; the diversity of delegates; the quality of the trainer and their ability to teach in the 2 very different environments; the availability of the technology and the participants ability to interact using the technology.

Here at Actionable Intelligence, we are comfortable delivering course content through either face-to-face or virtual training environments.  We can offer advice as to whether a particular course is more suited to face-to-face or virtual learning and how best to achieve your desired learning outcomes for the participants, but ultimately your personal preference is important to us…. The choice is yours!

To book a training event with us, simply complete and submit our online contact form today, or give us a call on 0330 133 4195.





All you need to do is switch on the news to hear about the strain the NHS is currently experiencing. There are multiple reasons for this, including our aging population, the persisting impact from Brexit and the continuing pressures from the COVID19 pandemic.

We know that ~25% of the health and social care work force are due to retire within the next 10 years and in the next ten years we will need ~27% more staff than today. That leaves a potential gap in the work force of a staggering 52%. Sadly, the pressures on our NHS are only set to increase.

How do we bridge this gap? How do we meet the needs of the most vulnerable in society – is the solution, or part of the solution, Technology?

The Care Show at the NEC in Birmingham had 90% of the exhibition stands showcasing technology to improve healthcare. I believe care homes and hospitals across the UK are starting to adopt more technology.  Technological innovations including smart home devices, AI-based tools, and patient monitoring equipment are being adopted to better serve the needs of those requiring care whilst at the same time reducing some the strain on care staff.

I had a chat with one solution that was presented to me, a care robot called “Pepper”. The robot can hold simple conversations, learn individuals interests and preferences and even perform some simple tasks. International trials found that they boost the mental health and reduce loneliness of residents and patients. After all, when did you last see a healthcare professional that wasn’t rushing from A to B and actually has time to sit and talk to someone?

The wheeled robot that I met moves independently and gesture with robotic arms and hands and are designed to be “culturally competent”, which means that after some initial programming they learn about the interests and backgrounds of care home residents. This allows them to initiate rudimentary conversations, play residents’ favourite music, teach them languages, and offer practical help including medicine reminders.

Is technology going to replace human staff in the care environment?  No, I believe human staff will always be required in the care environment, but maybe some of these amazing technological innovations can help to fill lonely periods when staff may not have time to keep residents company.


We can train healthcare staff in the essentials of managing and caring for enteral feeding tubes  

For many healthcare professionals, it is crucial to be well-informed on how they can care and maintain the safety of people with an enteral feeding tube most effectively. Enteral tube feeding is a means of supporting people who may no longer be able to consume adequate amounts of nutrition orally.  

The enteral feeding tube itself is designed to provide foods and fluids in a liquid form, and a patient may require it for any of a range of reasons. For example, the patient may be suffering from swallowing problems that heighten the risk of food or fluid going down the wrong way and ending up in the lungs rather than the stomach, or they may have a medical condition that prevents the eating or digestion of food.  

A person who requires enteral tube feeding may only need to have it in place for a limited time while undergoing treatment, or they may be living with it for a number of years. The situation will differ from one patient to the next.  

A useful course for healthcare practitioners supporting those with a feeding tube  

Healthcare practitioners will develop their theoretical and practical knowledge in the management and care of enteral feeding tubes (PEG), when they enrol on our own course on this subject. This course can be delivered in a classroom as well as remotely using Zoom video conferencing software, making it more accessible and convenient for attendees.  

This course is aimed at nurses and healthcare workers who are already competent in administering medications. It covers a broad range of important aspects of the management and care of enteral feeding tubes and associated subjects, including the anatomy and physiology of the gastrointestinal tract, and the implications and complications of gastronomy and jejunostomy tubes.  

Healthcare staff who may not have been exposed to feeding tubes previously or may not have a full appreciation of enteral feeding will learn the essentials on this course, including the different features of the tubes, and how they can best care for someone with a tube in place.  

Attendees will also learn about the site cleaning and how to use a feeding tube to administer medication or feed their patient. Also covered in this course is the all-important matter of what to do in an emergency – what are the specific considerations and actions that should be taken involving feeding tubes in an emergency situation. Would you know how and when to use and ENPLUG? 

We’ll put you in the best possible position to be more effective in your work  

This course, focusing on the management and care of enteral feeding tubes, is just one of the many programmes of study that make up our highly regarded complex care courses here at Actionable Intelligence.  

Our courses can be delivered either face-to-face or online depending on the circumstances and requirements of the attendees. Continued learning and professional development through courses such as ours play a crucial role in making healthcare safer and more effective for everyone and also count towards revalidation requirements for nurses.  

To learn more about this or any of our courses, please reach out to us today, by calling 0330 133 4195 or sending an email to  


The irony that as I sit here writing this article on stress, it is making me feel stressed is not lost on me… Stress is a word that we hear all too frequently and something we can probably all say we have experienced at some point in our lives. A question comes to mind, whether we should accept stress as part of life?

According to the Oxford English Dictionary, Stress is defined as “a state of mental or emotional strain or tension resulting from adverse or demanding circumstances”. These demanding circumstances can be resulting from work, home life or simply the pressures and expectations that we put on ourselves.

In 2019, stress was the leading cause of work absence and those working within healthcare are particularly vulnerable to stress related conditions. Stress accounted for 51% of all work-related ill health cases and 55% of all working days lost due to work-related ill health in 2019 ( We know that 2020 has presented new challenges that have never been faced before, the PPE demands, short staffing levels, unprecedented high number of deaths to name but a few and that public service industries, such as education or health and social care showed higher levels of stress compared to positions in other industries. According to the Mental health Foundation 74% of UK adults say that they have felt so stressed at some point over the last year that they felt overwhelmed or unable to cope ( The statistic that really stands out is that 32% of adults said they had experienced suicidal feelings because of stress over the last year. It is clear that a better understanding of stress is required so we can all learn to manage stressful situations and environments better before they become problematic to our overall health.

So what is Stress?

This is a very difficult question. Stress will exhibit different effects on different people in different ways. Medically speaking Stress is a feeling of emotional or physical tension. The body reacts to Stress by releasing hormones, cortisol, which make the brain more alert, causing muscles to tense, and the heart rate to increase. In the short term, these reactions are positive because they can help us handle the situation causing the stress. For example in the past the stress response would heighten our alertness and preparedness to deal with predators, in the society of today stress can help us perform exceptionally to achieve deadlines we have in our work or social lives. In these contexts it is the way the body protects us or helps us perform at heightened levels. However, if the body stays alert for extended periods of time the effect becomes damaging rather than conducive to our survival. Emotionally, long term exposure to these hormones will cause us to feel fatigued and anxious. Physically we are at risk of heart attacks, stroke, diabetes due to the continually heightened blood pressure and heart rate and even death (

As employers and managers we also need to understand that Stress can have a real damaging effect on our work force. It contributes significantly to absenteeism (as discussed above), increases staff turnover, poor time keeping and increased risk of procrastination resulting in poor performance and output, it can cause moral to deteriorate, increased employee and customer complaints due to poor service, and is highly contagious between teams (

We have to be able to recognise when we or others are Stressed so that we can control it and reduce the risk of over exposure. The more pertinent question becomes how can we recognize, manage and control the stress that we feel on a daily basis?

To address this question we need to consider stress from 3 different perspectives, and its as simple as ABC.

The A in ABC stands for AWARE, we have to be aware that we are stressed. Simply put, someone telling us we are stressed does nothing to help reduce it. An innate behaviour built into humans is to defend and deny negative feelings – we need to be able to acknowledge it in ourselves. Awareness is all about being in tune with how we are thinking, feeling, and being.

How do we recognize stress? We can check our thoughts, feelings and behaviours to give us the clues we need, it is all about knowing ourselves.

·      Thoughts can present themselves in negative words and phrases that we use such as; ‘I am useless’, ‘I don’t want to..’ (avoidance language), ‘I have to..’ (obligatory language). In addition to the loss of concentration on a given topic or our inability to prioritize tasks as your mind keeps wandering from topic to topic.

·      Feelings, at times of stress, can range from feeling down, depressed, sad, anger, scared, irritable, guilty, intolerance or simply overwhelmed with everything that is going on around us and the tasks we face. We may also be experiencing headaches (a firm favourite for my stress, particularly across the temples), stomachache, sweating, palpitations, insomnia or the inability to stay asleep, migraines, fatigue and exhaustion or a lack of energy to do your daily activities. We may feel one or a combination of these feelings and at different times and situations different combinations can present themselves.

·      Behaviour can represent our personal feeling of stress. This can include shouting at another with no justified reason, fidgeting, engaging in destructive behaviour such as biting nails or picking and scratching at our skin, drinking more, smoking more or simply putting things off that we don’t want to do. Ceccato et al, 2016, identified that Stress is significantly correlated with individuals performing higher risk behaviors which can ultimately cause harm to themselves (,actual%20behavior%20with%20real%20stakes.).

The B in ABC stands for BE WELL. To be able to have our bodies in the best possible condition to manage the effects of the stress we will undergo. it is fair to say that for most people we will never eliminate all the stress life throws our way so we must manage it. Being Well has 6 different domains to consider:

1.     Exercise. This word itself stresses me with the negatives images it generates of sweaty gyms and having to go running. So instead lets say ‘Get Moving’, whether this is going for a walk, doing some cleaning or getting outside in the sunshine to do some gardening. The government advocates we do 150 minutes (in 10 minute intervals) of movement to get our heart rate up each week ( That is just 20 minutes a day and can fit perfectly into that lunch break

2.    Diet. A healthy balanced diet with a little of what you fancy will always do you good! Don’t forget to keep hydrated too. As soon as you feel thirsty you are dehydrated.

3.    Sleep. The National Sleep Foundation Guidelines suggest that adults need between 7 and 9 hours of sleep per night. To maximize our sleep it is suggested that we have a regular routine for when we go to bed and get up, limiting the amount of blue light (electronic devices) for 1 hour before going to sleep to maximize the amount of melatonin (sleep hormone) our body creates and to keep the bedroom space dedicated to sleep (Walker, 2018, Why we sleep: the new science of sleep and dreams)

4.   Relaxation. Knowing how to relax and having techniques to help you relax can be pivotal in managing your stress levels. Two techniques that I have found to be particularly useful when I am in that stressful moment are square breathing (see Linked-In post or grounding (See Linked-In post Relaxation can also be achieved by looking at your internal language (the voice inside your head) and turning the negative thoughts to positive ones – its not what you can’t do but what you can do or what you have got to do but what you get to do. Another trick is to give the negative voice in your head the voice of a silly character (mine is Mickey Mouse), just try it and then try to take the voice seriously! Challenge the negative thoughts that you have and replace them with helpful truths. Lets be honest with ourselves, how often do we work ourselves up into a state dreading a meeting or an interview and when the moment comes the experience is actually fine sometimes event enjoyable. This certainly has happened quite often to me in the past.

5.    Perform activities that recharge you. Spend time to identify what it is that truly relaxes you. This could be a bath, a good book that allows you to step out of reality, taking a walk in nature or simply chatting with friends or family. There are lots of studies advocating the benefit of being in nature, one study found that a nature visit of 20 to 30 minutes three times a week was very effective for reducing levels of cortisol in the body (

6.    Have a strong support network. Having someone that you can turn to and talk to at moments when you feel down or anxious, someone who will not judge or criticize but listens with a genuine interest to help and support you. This may be someone at home, a stranger or a professional. There are lots of options for support from organisations such as the Good Samaritans or Mind and many employers will offer free counselling services through employee benefit packages.

The C in ABC stands for COPE with the stress we cannot avoid. Take action in the moment and identify what we can do to reduce the same stress going forward. The HSE advocate that there are 6 main areas that can cause stress if they are not managed correctly. These are:

1.     demands (including excessive work load),

2.    control (or lack of),

3.    support (or lack of),

4.   relationships including isolation,

5.    lack of meaning or purpose within our role and

6.    change.

Employers have a legal duty to protect employees from stress at work by doing a risk assessment and acting on it ( We can however take matters into our own hands to some extent and do our own risk assessment when it comes to the stress we face and see if we can gain more control and clarity of our tasks. Examples can include:

·      Changing deadlines to provide more time to perform a task and reduce demands on our time, be realistic and improve estimates for how long it will take to complete a task.

·      Rearrange our commitments to allow us to allocate dedicated time to one activity. A great book on time management is Brian Tracy’s “Eat That Frog”. If you haven’t read it and struggle with time management this is a great book.

·      Avoid distractions, turn off notifications and emails. According to a University of California Irvine study, “it takes an average of 23 minutes and 15 seconds to get back to the task [when interrupted].” (

·      Reduce your standards – do you have to give 100% or would 80% do? We will never get to perfection and sometimes striving for it all the time simply provides stress we don’t need, be realistic with your expectations of yourself and other.

Managing stress and the release of cortisol in our bodies is not easy, and it is certainly a work in progress for myself. I promise you this though, if you do nothing nothing will change, but if each day you take small actions they will add up and eventually the tide does start to turn. The actions eventually become habits and part of your everyday life. At that point you will be conquering those negative feelings without even thinking consciously about them.

“The journey of a thousand miles begins with a single step”


Personal Protective Equipment, particularly gloves, have been a hot topic of conversation over the last 12 months. We have seen headlines in the media stating that there is a national shortage of gloves, incorrect gloves being dispatched and more recently that the government has wasted £10 billion on overpriced PPE. One thing I often ask myself, is do people really understand the true reason that gloves should be worn in the battle to prevent the transmission of infection or are we wearing them out of habit and a false sense of security? If so, we are both wasting money unnecessarily and causing more environmental waste than we truly need to.

So, what is the history of glove use in healthcare?

Glove use was first introduced in the surgical field at John Hopkins Hospital, US, as far back as 1889 and resulted in a significant impact on the safety of surgery for both the patient and the healthcare professional ( During surgical procedures glove wearing by the medical staff was observed to save lives.

In 1964, the first disposable sterile latex medical gloves were manufactured by the Ansell Rubber company and quickly became a staple addition to theatre staffs PPE. However, the use of non-sterile clinical gloves in healthcare settings did not become a mainstream practice until the mid-1980s as a measure to protect healthcare workers from exposure to blood-borne viruses in blood and bodily fluids. The US Centres for Disease Control and Prevention first recommended the use of gloves in response to managing the increasing incidence of HIV and Hepatitis B cases at the time (Centers for Disease Control (CDC). Update: universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens in health-care settings. MMWR Morb Mortal Wkly Rep. 1988 Jun 24;37(24):377-82, 387-8. PMID: 2836717.)

Since then, further developments have been made to gloves. 2016 saw the removal of powered gloves due to research linking an increased risk of post-operative scars and inflammation when surgery was performed with powdered gloves. More recently a growing trend has developed to move away from the traditional rubber (latex) glove to non-latex materials, such as polyvinyl chloride and neoprene gloves, to reduce the number of latex associated allergies for both patients and healthcare professionals. Each type of glove has its own merits and drawbacks:

  • Latex gloves – have a high efficacy in protecting against bloodstream infections and properties that maintain wearer dexterity. However, the proteins found within latex can increase the risk of allergies and contact dermatitis.
  • Neoprene and nitrile gloves – have a similar efficacy to latex gloves in protecting against bloodstream infections. Nitrile gloves may also lead to sensitivity reactions.
  • Vinyl gloves – these are the kindest to our hands and research suggests produce the least skin reactions but they are not as robust against Bloodstream infections as other gloves (Loveday HP et al (2014) epic3: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection; 86: S1, S1-S70.)

So, when should we be wearing gloves?

The World Health Organization (WHO) guidelines on hand hygiene recognise the potential for gloves to be over-used and provide guidance on when gloves are indicated and when they are not required (WHO, 2009). The WHO, 2009, states that gloves should be used when:

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1.     there is a possibility that a Healthcare professional will come into contact with blood, body fluids, mucous membranes and non-intact skin;

2.    or, if there is an indication of contact precautions, such as when the patient is known or suspected to be colonised or infected with a pathogen or during emergency epidemics and outbreaks.

Gloves should not be used when there is no exposure to blood or body fluids and no reason for contact precautions. (

The glove acts as a barrier between the healthcare professional’s skin and pathogens so the healthcare professional does not become directly infected by a pathogen. However, gloves do not stop the transmission of pathogens from one place or surface to another – this is the role of hand sanitisation, see previous article ( Gloves should never be used as an alternative to hand hygiene.

Unfortunately, it appears healthcare professionals do not always following the WHO guidance. Healthcare staff have been observed wearing gloves to talk to patients and when writing notes. Two independent studies have identified that gloves are used for procedures when they are not required 42% of the time (

But does it really matter if healthcare professionals wear gloves when they do not need them? From a safety perspective one would assume not directly, although studies have shown that healthcare professionals are less likely to wash their hands after patient contact if they wear gloves (Jain, S., Clezy, K., McLaws, M. Gloves: use for safety or overuse? Am J Infect Control, 2017; 45:1407-1410). This reduction in handwashing due to wearing gloves will likely result in increased rates of infection transmission, increasing the risk of healthcare associated infections for the patient. The same research also identified that patients often feel uncomfortable with inappropriate use of gloves for personal tasks. Therefore, the overuse of gloves not only can present a potential increased risk of infection to patients but also can make the patient feel uncomfortable at the same time.

Putting the safety consideration aside, if we look at the economic and environmental impact of glove overuse, especially in the current economic climate, I would argue yes it does matter. The NHS spends over £35 million a year on more than 1.5 billion boxes of examination gloves (, if 45% of these gloves are not necessary that is a saving of £15.75 million. To date, no gloves worn in healthcare procedures are recyclable and nitrile gloves are non-biodegradable. The use of gloves where they are not indicated currently results in 675,000 gloves unnecessarily ending up in a landfill or being burned releasing avoidable hazardous materials into the environment. These are big numbers with significant impact on both the environment and our pockets – saving £15.75 million on unnecessary glove use could contribute to a good pay increase for frontline workers for instance.

So why do healthcare professionals wear gloves unnecessarily?

The answer to this question is very complex and linked to many different drivers and variables in human behaviour. However, several studies have revealed the following two main perceptions from healthcare professionals about why they choose to wear gloves.

1.     Wilson et al, 2017 found that healthcare professionals believe that gloves provide complete protection against all pathogens. The main driver for why someone will wear gloves they state is the emotional link to self-preservation (

2.    Healthcare workers also perceive the use of gloves as their professional responsibility and that patients want them to wear gloves, although as we have already discussed, this is often not the case (Jain, S., Clezy, K., McLaws, M. Gloves: use for safety or overuse? Am J Infect Control, 2017; 45:1407-1410)

The unnecessary overuse of gloves in healthcare is an issue that needs addressing not just for the economic savings or the benefit to the environment but also to improve outcomes and experience for our patients. Perceptions often held by healthcare professionals that lead to the overuse of gloves are often inaccurate and can adversely affect patient safety and comfort.

Where to start on such a mammoth task?

How do you put the genie back in a bottle? To quote Martin Luther King,

“you don’t have to see the whole staircase, just take the first step”.

The first step is to raise awareness of the important but also limited part gloves play in healthcare. When it is common knowledge amongst all healthcare professionals where glove use is appropriate and where it is not, then maybe we all can ask ourselves; do I need gloves for this task? According to research, almost half of the time, the answer will be no.

The art of hand hygiene as a concept in everyday life has not been around as long as we may think. It is only in the last century that the first public health campaigns were launched and “handwashing moved from being something doctors did to something everybody had been told to do” according to Nancy Tomes, a distinguished professor of history at Stony Brook University, New York.

In 1848, Ignaz Semmelweis, a Hungarian doctor working at Vienna General hospital, identified that by washing their hands and equipment between patients on a maternity ward the death rates reduced from 18% down to about 1%. However, his findings were met with resistance and the doctors of the day did not truly believe that they could be the source of infection and so handwashing was not universally adopted.

Florence Nightingale, following her time in military hospitals in the Crimean war, returned to the UK and revolutionised nursing with her work. Hand hygiene and sanitisation was a cornerstone of practices driven forward by Nightingale and thankfully became common practice within hospitals. However, it would be another 40 years before hand hygiene became common practice outside of the medical profession.

Over the next 40 years, driven by the work of Pasteur and Lister an understanding of germs and germ theory developed. With these developments attitudes to hygiene gradually shifted and by the 1880’s and early 1900’s the act of handwashing had transitioned from something only doctors did to something we all should do. However, I do not believe that until this Coronavirus pandemic and Boris Johnson emerged from the Cobra meeting on the 2nd March 2020 announcing that we should wash our hands to the tune of Happy Birthday that the true impact of handwashing was realised by many of today’s population in the UK.

In fact, research by Miryam Wahrman in the American Journal of Infection Control in 2009 suggested that “After urinating, 69% of women washed their hands, and only 43% of men,” she says. “After defecation, 84% of women and 78% of men washed their hands. And before eating – a critical time to wash your hands – 10% of men and 7% of women washed their hands.” ( So why was the act of handwashing so low? We can see a trend after the second world war where an increase in vaccinations and antibiotic use resulted in a decline in disease related deaths in the 20th Century, this period coincided with a decline in public health messages around hand hygiene. As a result people began to place less importance in the basics of hand hygiene. A rising trend began within some circles that germs and microbiology must be embraced to keep us healthy was observed – the table was starting to swing in the opposite direction.

It is true that we have to find a happy balance between allowing our bodies to build up natural resistance to pathogens whilst also protecting ourselves with the simple, free, basic hygiene practices such as handwashing, a task taking only 15 seconds to complete. Statistics have shown that over the winter months of 2020 and start of 2021 we have seen lower than average rates of typical communicable and respiratory diseases, such as the Influenza, Laryngitis and the Common Cold (Royal College of General Practitioners, Communicable and Respiratory disease report – week 7 of 2021).

There are several factors contributing to reduced rates of communicable disease transmission observed over the past months, the lockdowns, social distancing measures and mask wearing will have all played a significant role. The increased awareness and practice of hand hygiene will also have played its part. To what extent each factor has contributed may never truly be known as the interrelated factors are complex and difficult to unravel. The rebounding of these infections that have been suppressed as, almost, a side effect of the pandemic will be scrutinised closely by healthcare professionals as our communities return to relative normality with COVID-19 vaccine delivery continuing apace. The question that is very difficult to answer is … what impact did simple handwashing make to the control of COVID-19 infection? And, possibly more importantly, what difference can we make to both the transmission of COVID-19 and other communicable disease transmission in the future by maintaining the practice that has become so widespread? If we all got a bit tighter on our hand hygiene could we reduce the cases of all infections such as COVID-19, flu and so on forever.

One study, published in Epidemics in 2017, found significant effects from handwashing, compared with nonsignificant effects from facemask use in preventing pandemic influenza infection. It was discovered that if you washed your hands five to 10 times more than usual, “that would reduce your risk by a quarter”

For hand hygiene to be effective we must ensure that we are doing it right. Hand sanitisers have become commonplace in our busy lives making hand hygiene easier and faster, however, we have to recognise that there are limitations. Hand sanitiser (alcohol gel) is not effective on all pathogens, for instance alcohol gel is not effective against C.Diff (within the class of bacteria called Bacilli), and dirty hands are not ‘cleaned’ by putting alcohol gel on them and rubbing them together. This is where good old soap and water must play a part – so how does soap and water kill the pathogens? According to Wahrman, soap is hydrophobic as are cell membranes and the covering on virus membranes. When the cell membrane or virus covering is exposed to the soap the interaction creates a disruption in the cell structure effectively killing it. Additionally, the soap can help break the bonds between the pathogens and our skin so when we rinse our hands, we send the pathogens down the drains.

Public Health England recommends that we should be following the 13 step approach to effective handwashing and that effective handwashing should take at least 15 seconds. Check out the latest handwashing poster here:

Vaccines are now being rolled out on a phenomenal scale with over 17 million people in the UK having had their first dose of an approved COVID-19 vaccine (DHSC, 1/3/2021). The 4th COVID-19 vaccine will hopefully be approved and available in the UK in the coming months improving the diversity of vaccines available to medical professionals in the current fight against the pandemic in the UK and globally. However, I worry that with increasing vaccination we become complacent and forget about the importance of fundamental basic hand hygiene once again, as happened after the end of the second world war. It is simple, easy, free and only takes 15 seconds but, crucially, it may just save a life – it is effective handwashing.