Outline of the evidence and considerations on medical glove use to prevent germ transmission
Definitions Medical gloves are defined as disposable gloves used during medical procedures; they include:
1. Examination gloves (non sterile or sterile)
2. Surgical gloves that have specific characteristics of thickness, elasticity and strength and are sterile
3. Chemotherapy gloves – these gloves are not addressed within this document
Rationale for using medical gloves: Medical gloves are recommended to be worn for two main reasons:
1. To reduce the risk of contamination of health-care workers hands with blood and other body fluids.
2. To reduce the risk of germ dissemination to the environment and of transmission from the health-care worker to the patient and vice versa, as well as from one patient to another.
Gloves should therefore be used during all patient-care activities that may involve exposure to blood and all other body fluid (including contact with mucous membrane and non-intact skin), during contact precautions and outbreak situations. The efficacy of gloves in preventing contamination of health-care workers’ hands and helping to reduce transmission of pathogens in health care has been confirmed in several clinical studies. Nevertheless, health-care workers should be informed that gloves do not provide complete protection against hand contamination. Pathogens may gain access to the caregivers’ hands via small defects in gloves or by contamination of the hands during glove removal. Hand hygiene by rubbing or washing remains the basic to guarantee hand decontamination after glove removal.
The impact of wearing gloves on adherence to hand hygiene policies has not been definitively established, since published studies have yielded contradictory results. However, the recommendation to wear gloves during an entire episode of care for a patient who requires contact precautions, without considering indications for their removal, such as an indication for hand hygiene, could actually lead to the transmission of germs.
Key learning point: prolonged use of gloves for contact precautions in the absence of considering the need to perform hand hygiene can result in the transmission of germs.
Glove use and the need for hand hygiene:
• When an indication for hand hygiene precedes a contact that also requires glove usage, hand rubbing or hand washing should be performed before donning gloves.
• When an indication for hand hygiene follows a contact that has required gloves, hand rubbing or hand washing should occur after removing gloves.
• When an indication for hand hygiene applies while the health-care worker is wearing gloves, then gloves should be removed to perform handrubbing or handwashing.
Inappropriate glove use:
• The use of gloves when not indicated represents a waste of resources and does not contribute to a reduction of cross-transmission.
• It may also result in missed opportunities for hand hygiene.
• The use of contaminated gloves caused by inappropriate storage, inappropriate moments and techniques for donning and removing, may also result in germ transmission.