Should we disinfect disposable medical gloves?

The disinfection of disposable medical gloves is a topic that is being hotly debated and researched. We looked over recent studies to provide an overview of the debate.

Wearing disposable medical gloves is an integral part of everyday hospital life for nursing staff and physicians. This is a practice designed to increase occupational safety and infection prevention.

The Commission for Hospital Hygiene and Infection Prevention at the Robert Koch Institute (KRINKO) dictates that healthcare disposable gloves must be worn [1]:

• To protect medical staff in the event of possible contamination with blood, secretions and excretions, including pathogens.
• To prevent the release of pathogens from the hand into aseptic areas of patients, which include wounds and mucous membranes.
• In the case of pathogens that are insensitive to alcohol-based hand sanitizers, for example, Clostridium difficile.

The KRINKO continues that after the activity, the medical disposable gloves must be removed and hands must always be disinfected. The final disinfection is important, since undetected perforations on the glove can lead to contamination of the hands. The removal and disposal of the used disposable gloves also introduces the risk of contimination.

Proper hand hygiene before putting on the gloves should also be practiced. It is important to note that to prevent skin damage and an increased risk of perforation, the hands must be completely dry. In other words, the hand disinfectant must be completely absorbed.

Disposable gloves: policy vs. reality

As the name suggests and as generally recommended by the KRINKO, disposable gloves should also be worn only once. That is, for a specific activity on the patient. This is also the recommendation of the  World Health Organization (WHO).

Scientific studies show, these gloves are often disposable only in name. A survey of more than 200 anesthesiologists found that only about 14% “always” change disposable medical gloves between patients. [2] Conversely, this means that a large majority do not change them between multiple treatments. The consequence of multiple use of disposable gloves is shown by a British study. The authors identified misuse of gloves in 42% of all cases in six wards of a hospital, resulting in a risk of cross-contamination in a total of 60 observed patient treatments. [3]

Disinfection of disposable gloves: Is it possible?

The prolonged wearing of gloves over several patient treatments is common—despite the obvious risk of infection. This reality keeps bringing up discussions of disinfection of disposable gloves in professional circles. The KRINKO also takes a stand here and communicates a clear recommendation to healthcare facilities. According to the commission, “gloved hands should only be disinfected in special cases, for example, in situations where frequent glove changes are necessary but difficult to implement based on experience […].”

However, important requirements for disinfection apply:

• The glove must be chemical resistant according to the EU standard (EN 374).
• The glove is not recognizably contaminated with blood, secretions, or excrement and has no visible perforations
• The glove should only be used during treatment on one and the same patient.
• In exceptional cases, however, gloved hands may be disinfected between patient treatments if the workflow cannot otherwise be guaranteed

In its position paper “Disinfectability of medical examination gloves”, Aktion Saubere Hände (ASH) presents two concrete practical examples [4]:

• In routine activities on the same patient, where an alternation of unclean and clean activities is required.
• For successive blood draws on different patients.

According to the ASH publication, disposable medical gloves should be worn for no more than 30 minutes or five hand disinfections.

The KRINKO requires glove changes in intensive care units after just 15 minutes and after washing any patient. Key to allowing extended use of gloves is providing clear indications for when gloves need to be disinfected in the hygiene plan by the hospital’s hygiene specialist. Communicating clear standards is important.

How disposable gloves are really being used                     

The need for proper disposable medical gloves practices must be communicated and trained has been highlighted by recent studies. A study from the University Hospital of Leipzig shows emphatically that hand hygiene compliance before and after glove wearing must be improved—the authors led by hospital hygienist Dr. Iris Chaberny refer to this as “peri-glove compliance”. This is because, overall, hospital staff in the study disinfected their hands before using the disposable gloves in only 18.6% of cases, which increases the potential risk of nosocomial infections. After disposal, the figure was still 65%. [5]

Overall, the wearing of disposable medical gloves appears to negatively affect hand hygiene compliance in hospitals, increasing the importance of targeted training in glove use. French researchers examined this relationship in a study of eleven healthcare facilities. [6]

Finally, results from the University Medical Center Göttingen are promising. The research team, led by Prof. Simone Scheithauer, found that the effectiveness of hand disinfection of gloved hands was at least equivalent to that of bare hands. Some differences appeared when using different product combinations (glove material vs. chosen hand disinfectant). [7] These findings should help hygiene professionals when it comes to selecting the most effective hygiene products to be used in the hospital.

Sources:

[1] Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Insitut “Händehygiene in Einrichtungen des Gesundheitswesens.” Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz 9 (2016): 1189.

[2] El Mikatti, N., P. Dillon, and T. E. J. Healy. “Hygienic practices of consultant anaesthetists: a survey in the North‐West region of the UK.” Anaesthesia 54.1 (1999): 13-18.

[3] Loveday, H. P., et al. “Clinical glove use: healthcare workers’ actions and perceptions.” Journal of Hospital Infection 86.2 (2014): 110-116.

[4] Aktion Saubere Hände, Positionspapier „Desinfizierbarkeit von medizinischen Untersuchungshandschuhen“, 06.07.20215

[5] Imhof, R., Chaberny, I. F., & Schock, B. (2021). Gloves use and possible barriers–an observational study with concluding questionnaire. GMS Hygiene and Infection Control, 16.

[6] Eveillard, Matthieu, Marie-Laure Joly-Guillou, and Patrick Brunel. “Correlation between glove use practices and compliance with hand hygiene in a multicenter study with elderly patients.” American journal of infection control 40.4 (2012): 387-388.

[7] Scheithauer, S., et al. “Disinfection of gloves: feasible, but pay attention to the disinfectant/glove combination.” Journal of Hospital Infection 94.3 (2016): 268-272.

Further literature recommendation: Kampf G et al. Desinfektion behandschuhter Hände. Krankenhaushygiene 2018; 13: 27–40