The auditorium at the Centre International de Conferences Geneve( CICG) where many of the keynotes and plenary sessions were held at ICPIC 2025, Photo by Kelly M. Pyrek
Gloves do not replace hand hygiene, and practitioners should be aware of clinicians’ overuse or misuse of gloves.”— Dr. Eli
Perencevich analysis using generalized estimating equations was conducted to adjust for covariates, including baseline adherence.
In total, 13 hospital units participated in the trial, and 3,790 healthcare personnel were observed. Adherence to expected practice was greater in the six units with the direct-gloving intervention than in the seven usual care units( 1,297 of 1,491 [ 87 %] vs. 954 of 2,299 [ 41 %]) even when controlling for baseline hand hygiene rates, unit type, and universal gloving policies. Glove use on entry to contact precautions rooms was also higher in the direct-gloving units( 1,297 of 1,491 [ 87 %] vs. 1,530 of 2,299 [ 67 %]. The intervention had no effect on hand hygiene adherence measured at entry to non-contact precautions rooms( 951 of 1,315 [ 72 %] for usual care vs. 1,111 of 1,688 [ 66 %] for direct gloving; or at room exit( 1587 of 1,897 [ 84 %] for usual care vs. 1,525 of 1,785 [ 85 %] for direct gloving. The intervention was associated with increased total bacteria colony counts and greater detection of pathogenic bacteria on gloves in the emergency department and reduced colony counts in pediatrics, with no change in either total colony count for adult intensive care unit; for hemodialysis unit) or presence of pathogenic bacteria for adult intensive care unit; for hemodialysis unit) in the other units.
The findings from this cluster randomized clinical trial indicate that a direct-gloving strategy without prior hand hygiene should be considered by healthcare facilities.
“ As we know, the World Health Organization( WHO) 2009 regulations recommend hand hygiene before handling an invasive medical device for patient care, regardless of whether or not gloves are used, after removing sterile or non-sterile gloves, and surgical hand antisepsis should be performed before gloving, and then after, application of handrub as recommended, allowing hands to dry thoroughly before donning sterile gloves,” Perencevich explained, also pointing to the SHEA Compendium( 2022 update) that says“ Neither the CDC nor WHO consider donning non-sterile gloves to be an indication for hand hygiene but is most frequently associated with Moment 1 of the WHO Five Moments for Hand Hygiene and the CDC indication of hand hygiene prior to patient contact. Infection preventionists and hospital epidemiologists should evaluate the potential impact to patient and healthcare personnel safety associated with direct gloving to determine whether it may be considered compliant according to facility policies.”
Perencevich remarked,“ So, SHEA, IDSA and APIC are leaving it up to you at your own hospitals to determine what to do. The CDC still says if your task requires gloves, perform hand hygiene before donning gloves.”
To review, the SHEA / IDSA / APIC Practice Recommendations: Strategies to prevent HAIs Through Hand Hygiene( 2022 update) acknowledges that,“ Use of nonsterile gloves is inextricably linked to hand hygiene, not only providing benefits like reduced hand contamination during care but also introducing risks such as increased hand contamination during doffing and increased contamination of the patient care environment. Studies evaluating the transfer of environmental contaminants to gloves and bare hands have reported a reduction in hand contamination when gloves are worn. The microbial load of gloved and bare hands stabilized after four to six contacts within a patient environment; gloved hands having a microbial load 4.7 percent lower than bare hands. Hand contamination increased when gloves fit poorly( i. e., were too large), likely due to increased exposed surface area. Transfer efficiencies of A. baumannii when latex gloves were worn reduced fomite-to-fingerpad transfer by 56 percent and reduced fingerpad-to-fomite transfer by 47 percent. As anticipated, failure to wear gloves was independently associated with hand contamination following care of patients with C. difficile infection.”
Perencevich acknowledged numerous barriers to hand hygiene prior to use of nonsterile gloves that have been reported and detailed in the SHEA / IDSA / APIC Practice Recommendations, including reductions in hand hygiene prior to patient contact and failures to change gloves at appropriate moments.
He pointed to the study by Baloh, et al.( 2019) in which healthcare personnel reported that donning gloves on wet hands was unpleasant and that donning gloves without hand hygiene immediately prior saved time, particularly if anticipated contact was brief( such as when delivering a patient food tray). Physical barriers, such as lack of alcohol-based hand sanitizer( ABHS) access at points where gloves are donned, also resulted in non-adherence. According to Rock, et al., in an ICU, when hand hygiene prior to donning gloves was compared to direct gloving( i. e., no hand hygiene prior to donning nonsterile gloves), there was no significant difference in the average CFU on the surface of the gloves( 6.9 vs 8.1 CFU, respectively. It took an average of 31.5 extra seconds to perform hand
18 • www. healthcarehygienemagazine. com • nov-dec 2025