COMMENTARY

Does Glove Disinfection Work?

Rami Sommerstein, MD

Disclosures

January 24, 2017

Editorial Collaboration

Medscape &

The Gloves Are Off?

In the past, there were reports that hand-hygiene compliance improved after mandatory glove use was eliminated from contact precautions. This improvement might stem from a false sense of safety induced by gloving, or the erroneous belief that glove use obviates hand hygiene.

A recent hand-sampling study by Bingham and colleagues[1] evaluated 17 healthcare workers in outpatient wound care clinics at 46 discrete moments during patient care encounters. The investigators focused on World Health Organization (WHO) hand-hygiene moments 2 (before performing a clean or aseptic procedure) and 3 (after gloves are removed following body fluid exposure). (See SAVE LIVES: Clean Your Hands.)

At least one healthcare associated pathogen (such as methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus) was detected in 28% of the sampling conducted on healthcare workers' hands. Hands were equally contaminated (17%) before a clean procedure and after a dirty procedure (ie, wound care). Hand contamination was more common when gloves were worn (20%) compared with ungloved hands during care (15%). Of note, contamination in the five observations before performing an aseptic procedure (moment 2) for gloved hands reached a contamination rate of 40%.

Viewpoint

This report provides a strong case for attention to hand hygiene and infection prevention practices in outpatient wound settings. The results emphasize the need for attention to glove donning and doffing practices, because glove use did not prevent contamination of the hands.

As a possible solution, hand contamination in these critical moments could be reduced by regular disinfection of the gloved hand. However, reprocessing of gloves is currently against manufacturers' recommendations.

Despite this valid limitation, Scheithauer and colleagues[2] conducted an interesting study on the question of disinfection efficacy of gloves using standardized, artificial contamination with Escherichia coli. Their data included recovery rates after contamination, reduction efficacy, fingertip immersion culture, and checking for tightness on different combinations of gloves and disinfectants.

The first surprising finding was that disinfection efficacy was higher for gloved than ungloved hands. Also, for most combinations, disinfection efficacy was always > 5.0 log10. Relevant differences were associated with specific disinfection/glove combinations. For example, when Sterillium® (the main component of which is propanol) was used in combination with latex-containing gloves, disinfection efficacy was below expectations, probably owing to material incompatibilities and leaks in the glove material. Nitrile gloves performed better with Sterillium.

These important results prove that disinfection of gloves may be acceptable as a strategy to improve hand hygiene, but also show that glove material can compromise efficacy. Furthermore, medicolegal questions have to be answered before glove disinfection is included as a novel "WHO moment" of hand hygiene.

Abstract

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