23.1.1. Reasons for glove use

Prior to the emergence of HIV and the acquired immunodeficiency syndrome (AIDS) epidemic, gloves were essentially worn primarily by HCWs either caring for patients colonized or infected with certain pathogens or exposed to patients with a high risk of hepatitis B. Since 1987, a dramatic increase in glove use has occurred in an effort to prevent the transmission of HIV and other bloodborne pathogens from patients to HCWs.905 The National Institute for Occupational Safety and Health Administration in the USA (NIOSHA) mandates that gloves be worn during all patient-care activities involving exposure to blood or body fluids that may be contaminated with blood,906 including contact with mucous membranes and non-intact skin. In addition, gloves should be worn during outbreak situations, as recommended by specific requirements for Personal Protective Equipment (PPE).58,423,906 The broad scope of these recommendations for glove use potentially leads to inevitable, undesirable consequences, such as the misuse and the overuse of gloves; therefore, there is a need to define glove use indications with greater precision.

Medical glove use by HCWs is recommended for two main reasons: 1) to reduce the risk of contaminating HCWs’ hands with blood and other body fluids; 2) to reduce the risk of germ dissemination to the environment and of transmission from the HCWs to the patient and vice versa, as well as from one patient to another.701,884,907,908

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Single-use (also called disposable) examination gloves, either non-sterile or sterile, are usually made of natural rubber latex or synthetic non-latex materials such as vinyl, nitrile and neoprene (polymers and copolymers of chloroprene). Because of the increasing prevalence of latex sensitivity among HCWs and patients, the FDA has approved a variety of powdered and powder-free latex gloves with reduced protein contents, as well as synthetic gloves that can be made available by health-care institutions for use by latex-sensitive HCWs and for patients with latex hypersensitivity.909 Several new technologies are emerging (e.g. impregnated glove materials that release chlorine dioxide when activated by light or moisture to produce a disinfecting micro-atmosphere),910 but none of them has so far led to changes in glove use recommendations.49 The correct and consistent use of existing technologies with documented effectiveness is encouraged before new technologies are introduced. The main feature of examination gloves to bear in mind is that they are meant to be single-use and to be discarded.907,911,912 In most cases, they are non-sterile.

Sterile surgical gloves are required for surgical interventions. Some non-surgical care procedures, such as central vascular catheter insertion, also require surgical glove use. In addition to their sterile properties, these gloves have characteristics of thickness, elasticity and strength that are different from other medical gloves (either sterile or non-sterile).

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Medical gloves are designed to serve for care purposes only and are not appropriate for housekeeping activities in health-care facilities. Other specific types of gloves are intended for these types of non-care activities.

In published studies, the barrier integrity of gloves has varied considerably based on the type and quality of glove material, intensity of use, length of time used, manufacturer, whether gloves were tested before or after use, and the method used to detect glove leaks.913-920 In some published studies, vinyl gloves more frequently had defects than did latex gloves, the difference being greatest after use.913,914,917,921 Intact vinyl gloves, however, provide protection comparable to that provided by latex gloves.913 Limited studies suggest that nitrile gloves have leakage rates close to those of latex gloves.922-925 Although recent studies suggest that improvements have been made in the quality of gloves,919 the laboratory and clinical studies cited above provide strong evidence that hands should still be decontaminated or washed after glove removal.73,123,139,204,520,914

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