Eliminating excess glove use would be helpful, but is skipping hand hygiene before gloving safe?”— Dr. Eli Perencevich
hygiene before donning gloves, which equates to about 20 minutes of extra time for the average ICU nurse caring for a patient in contact isolation during a 12-hour shift.
Inappropriate glove use, during tasks when there is no risk of exposure to infectious matter, or failures to change gloves at appropriate moments during care, has been associated with environmental contamination( Baloh, et al.). In an observational study, the patient-care items most frequently touched by soiled gloves included disinfectant wipes or packaging of patient-care items, patient skin, patient clothing, and durable medical equipment( Burdsall, et al.).
In a study of outpatient wound-care providers, hand contamination with a pathogen following doffing of gloves was documented in 10( 19.6 %) of 51 encounters( Bingham, et al.). Simulations of doffing using fluorescent gel indicated that the fingertips and wrists were the areas of the hands most likely to be contaminated. Hand contamination was reduced when doffing was modified to include removal of the first glove without touching the hand, followed by inserting the fingers into the dorsal side of the remaining gloved
hand to slide the glove off the hand( Alhmidi, et al.).
Wearing gloves for long periods during a work shift increases the risk of occupational irritants or allergic dermatitis. When evaluating allergic dermatitis, it is important to consider ingredients used in the manufacture of gloves, such as rubber accelerators that are used in the manufacture of nitrile gloves( Rundle, et al.).
As the SHEA / IDSA / APIC Practice Recommendations state,“ Given the risk and benefits associated with glove use, a balanced approach is needed. Healthcare personnel should be instructed in appropriate use of gloves, facility expectations related to hand hygiene prior to donning gloves, when to change gloves during care, and methods of doffing to reduce hand contamination. Ongoing observations of glove use, donning and doffing as indicated, with immediate performance of hand hygiene following doffing, should be conducted when monitoring adherence to hand hygiene. Fluorescent gel applied to gloves prior to doffing can be a useful tool to educate personnel about hand contamination during doffing.”
“ At the top of the WHO hand hygiene research priorities that came out a few years ago is the use of gloves,” Perencevich noted.“ But when you look at the data, there are many studies that say there’ s an inverse relationship. So, if you wear gloves, hand hygiene goes down, or vice versa. So, there are a lot of tradeoffs between glove use and hand hygiene.”
He continued,“ A non-U. S. study found that eliminating mandatory glove use in contact precautions was associated with increased hand hygiene compliance, 52 percent versus 85 percent. In a two-ICU U. S. study, hand hygiene compliance was four times higher when gloving. A Canadian single hospital study found glove use was associated with higher hand hygiene compliance. And finally, in a new-versus-old-hospital comparison, glove use was associated with a higher odds of hand hygiene.”
Regarding the barriers to hand hygiene before gloving, Perencevich
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nov-dec 2025 • www. healthcarehygienemagazine. com •
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