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Accepted Manuscript

Disinfection of gloved hands for multiple activities with indicated glove use on the
same patient

Günter Kampf, Sebastian Lemmen

PII: S0195-6701(17)30343-2
DOI: 10.1016/j.jhin.2017.06.021
Reference: YJHIN 5144

To appear in: Journal of Hospital Infection

Received Date: 30 January 2017

Accepted Date: 16 June 2017

Please cite this article as: Kampf G, Lemmen S, Disinfection of gloved hands for multiple activities
with indicated glove use on the same patient, Journal of Hospital Infection (2017), doi: 10.1016/
j.jhin.2017.06.021.

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ACCEPTED MANUSCRIPT
Disinfection of gloved hands for multiple activities with indicated glove use on the same patient

Günter Kampf1,2*, Sebastian Lemmen3

1Knieler
und Team GmbH, Infection Control Science, Kattrepelsbrücke 1, 20095 Hamburg,
Germany;

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2Ernst-Moritz-Arndt University, Institute for Hygiene and Environmental Medicine, Walter-
Rathenau-Straße 49 A, 17475 Greifswald, Germany; email: guenter.kampf@uni-greifswald.de
3University Hospital Aachen, Department of Infection Control and Infectious Diseases,

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Pauwelsstr. 30, 52074 Aachen, Germany

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Summary
Most hand hygiene guidelines recommend that gloves should be changed during patient care
when an indication for hand disinfection occurs. Observational studies indicate that the majority
of healthcare workers (HCWs) do not disinfect their hands at all during continued glove wear.
The aim of this narrative review is to assess the potential benefits and risks for disinfecting
gloved hands during patient care for multiple activities with indicated glove use on the same
patient. Continued glove wear for multiple activities on the same patient often results in
performing procedures, including aseptic procedures with contaminated gloves, especially in a
setting where there are many indications in a short time, e.g. anaesthetics or accident and

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emergency departments. Of further note is that hand hygiene compliance is often lower when
gloves are worn. To date, three independent studies have shown that decontamination is at least
as effective on gloved hands as on bare hands and that puncture rates are usually not higher

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after up to 10 disinfections. One study on a neonatal intensive care unit showed that promotion
of disinfecting gloved hands during care on the same patient resulted in a significant reduction
in the incidence of late-onset infections and of necrotizing enterocolitis. We conclude that

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disinfection of gloved hands by HCWs can substantially reduce the risk of transmission when
gloves are indicated for the entire episode of patient care and when performed during multiple
activities on the same patient.

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Introduction
Disinfection of gloved hands was first proposed in 1899 by Kocher who advocated the wearing
of sterile gloves for every operation, whether hands were washed beforehand or not. He
proposed that during long operations the gloved hands should be immersed from time to time in
a strong antiseptic solution in cases “when the surgeon wants to work particularly carefully” [1].
Today, the topic is no longer relevant for procedures such as surgery where sterile gloves are
worn. However, for medical examination gloves, disinfection of gloved hands might contribute to
patient safety more than most healthcare workers (HCWs) would anticipate.

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It is generally recommended that gloves should be used for activities that could involve
exposure to blood or other body fluids; where patients are isolated with contact precautions;
and in outbreak settings. [2-6]. Gloves should then be removed when they are damaged or non-

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integrity is suspected [2, 3]; after contact with blood or other body fluids, non-intact skin or
mucous membranes [2, 3, 5]; on leaving an isolation room, and as soon as an episode of patient
contact or treatment has ended [2-5]. Individual guidelines also recommend removal of gloves

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where there is an indication for hand hygiene [2, 3] or after use for washing a patient [3].
Inappropriate glove use refers to the wearing of gloves where there is no indication, and also to
the continued wearing of gloves that should have been removed [7]. For example, in

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rehabilitation units an indication for glove use was found in 17.1% of all contacts, but gloves
were worn for 41.4% of all contacts [8]. In another study 213 anaesthetists were asked whether
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they routinely change gloves between patients. The total response rate was 68.1% with only
14.5% “always” changing gloves between patients and 40% doing so “frequently” [9]. Although
levels of inappropriate glove use differ from country to country, the practice appears to be
common worldwide. For example, data from Malaysia show a high proportion of inappropriate
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glove use of 74.3% [10], whereas in the UK a rate of 57.5% was reported, resulting in a risk of
cross-transmission in 36.8% of patient care episodes [7]. The main risks of inappropriate glove
use are missing opportunities for hand hygiene and that gloves may be a vector for microbial
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transmission [2]. Indeed in long-term care facilities, unnecessary glove use was observed to have
a clear negative effect on hand hygiene compliance [11]. Substituting glove use for hand hygiene
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can place both HCWs and patients at risk of colonization or infection with pathogenic
microorganisms [12].
Despite the emphasis on removal of gloves after single use and avoidance of inappropriate glove
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use [7], there are many clinical situations when HCWs (perhaps appropriately) routinely wear
gloves during multiple activities on the same patient. For example, anaesthetists and their
assistants may wear the same gloves during an entire surgical procedure [13-15], despite
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limited hands-on patient time. The routine use of gloves is recommended in this setting [16, 17].
However, whilst wearing gloves that may be contaminated with a patient’s microorganisms
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anaesthetists will repeatedly touch anaesthetic equipment and computer keyboards [18]. In
accident and emergency departments and in ambulances staff continue to wear the same gloves
when attending patients, despite the likelihood of their gloves becoming contaminated with
patients’ microorganisms and having contact with the environment [19, 20]. Recently a survey
among 417 paramedics in Australia revealed that all of them wear disposable gloves for every
clinical case. The majority (57.8%) of them only changed gloves at the end of a case. The physical
difficulty of changing gloves in some of the operational environments was a major barrier for
hand hygiene compliance [21]. Another example is the insertion of central venous catheters
(CVC). Kocent et al observed 20 CVC insertions and reported that immediately before CVC
insertion the gloved fingertips of the operator was contaminated with microorganisms in 55% of
cases; contamination was assumed to originate from touching the previously disinfected skin.
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However, use of alcoholic chlorhexidine successfully decontaminated gloved hands. The authors
therefore proposed that gloved hands should be disinfected immediately before CVC insertion
[22], especially if a no-touch technique was not performed. In the recent ebola virus disease
(EVD) epidemic in West Africa decontamination of gloved hands became standard practice,
following transmission of the disease to a nurse in Spain [23] and to two nurses in the USA [24].
A new key component of the WHO guidelines was the disinfection of gloved hands during patient
care and during doffing of the personal protective equipment (PPE). Depending on the number
of elements of PPE, the current guidelines recommend up to eight disinfections of gloved hands
during doffing of PPE [25].

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The EVD guidance has reopened the debate about the pros and cons of disinfection of gloved
hands. In this narrative review we explore the routine wearing of gloves during multiple
activities on the same patient. We will assess (1) the risk of glove contamination and cross-

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transmission for subsequent activities; (2) the compliance with hand hygiene during continued
glove use; (3) the efficacy of hand disinfection on gloved hands; (4) glove integrity after using
hand rubs on gloved hands; and (5) the impact of disinfecting gloved hands on nosocomial

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infections.
Method

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A systematic literature search was conducted via the National Library of Medicine (PubMed) on
10th January 2017 and via the Cochrane Library on 14th January 2017 using the following terms:
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medical glove (19 hits), examination glove (29 hits), compliance, adherence, glove use (371 hits)
with compliance (74 hits) or adherence (41 hits), universal gloving (12 hits), gloving practice
(89 hits), gloved hand (78 hits), contaminated glove (126 hits), disinfection of gloves (0 hits),
disinfection of gloved hands (0 hits), glove integrity (19 hits) and glove puncture (44 hits). In
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addition, studies deemed suitable for this review were also included. Data were extracted from
the publications by one author and reviewed by the other author. Studies were selected when
they provided original data on glove use (medical or examination gloves) and hand hygiene
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compliance for multiple and/or single patients as well as for multiple and single patient care
activities (15 studies), when they contained original data on glove integrity after washing or
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disinfecting gloved hands (9 studies), when they contained original data on the efficacy of hand
hand disinfection on gloved hands (6 studies), and when they contained original data on the
nosocomial infections when gloved hands are allowed or even promoted to be disinfected during
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patient care (1 study). Guidelines from the UK (epic3 and NICE), Germany (AWMF and RKI) and
the WHO were also reviewed.
Results
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Risk of glove contamination and cross-transmission for subsequent activities


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The recommendations on glove use when HCWs perform multiple activities in a single patient
are clearly defined by the WHO, who state that “when wearing gloves, change or remove gloves
during patient care if moving from a contaminated body site to either another body site
(including non-intact skin, mucous membrane or medical device) within the same patient or the
environment” [5]. In the NICE guideline, it says “gloves must be changed between different care
or treatment activities for the same patient” [4]. Furthermore, the epic3 guideline recommends
that “gloves must be removed as soon as an episode is completed” and “changed between caring
for different patients” [6].
We found three studies that addressed glove contamination. An observational study in a
Swedish Department of Anaesthetics showed that patient care procedures with used gloves

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(described as contaminated) occurred in 65.7% of 242 observed activities. Gloves are not always
doffed even when afterwards an aseptic procedure is performed on the same patient [26]. In two
convalescence and rehabilitation hospitals in Hong Kong, it was described that in 75% of cases
gloves were not changed after a “dirty activity” when multiple activities were performed on the
same patient [27]. On ICUs in the USA, only 72% of HCWs removed gloves after suctioning,
whereas the remaining HCWs may have performed other clinical activities on the same patient,
or even on other patients, with the same gloved hands [28].
One approach that has been proposed to deal with this problem in anaesthetics is double
gloving, where the outer pair of gloves is removed after completion of the induction before

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touching the anaesthesia cart or keyboard, thereby resulting in an immediate reduction of the
workspace and stopcock contamination [29].

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Compliance with hand hygiene during continued glove use
When HCWs perform multiple activities on the same patient, different indications for a hand
hygiene procedure might occur. What should be done in these situations? WHO [2, 5], RKI [30]

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and AWMF [3] all recommend that gloves should be taken off when there is an indication to
perform hand hygiene.
Moreover, a number of studies have looked at hand hygiene compliance rates in the context of

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wearing gloves. On a medical ICU, contact precautions were implemented for a total of 3 months
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(study period 1). During the next 3 months, HCWs were instructed to wear gloves before every
patient contact without contact precautions (“universal gloving”; study period 2). In study
period 1, HCWs wore gloves in 31.7% of all patient care activities. In study period 2, the rate
rose dramatically to 87.0%. The compliance rates with hand hygiene before and after patient
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contact were significantly reduced for study period 2 at the same time from 18.7% to 11.4% and
57.7% to 52.5%, respectively. Of further interest is that in period 2, the incidence density of
nosocomial bloodstream infections increased significantly from 6.2 to 14.1 cases per 1000
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patient days, the incidence density of urinary tract infection increased from 4.4 to 7.4 cases per
1000 patient days, and the incidence density of ventilator-associated pneumonia increased from
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0 to 2.3 cases per 1000 patient days [31].


In addition, Girou et al found that the continued use of gloves without removal after patient
contact resulted in 64.4% of all contacts being performed without adequate hand hygiene.
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Especially for patient contacts requiring strict aseptic precautions, 82.3% were performed with
gloves that have not been removed after previous care. Poor compliance with glove changing
during patient care was identified as an independent factor for hand hygiene non-compliance
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[32].
Another example of the effect of wearing gloves on hand hygiene compliance is the analysis of
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compliance data from HCWs caring for patients in contact precautions. Cusini et al observed that
HCWs donned gloves before entering the room of an isolated patient and tended to remove them
only after leaving the room without changing them and without performing adequate hand
hygiene when indicated. To change this negative behaviour, they stopped mandatory glove use
and implemented contact precautions. Hand hygiene compliance increased significantly from
51.9% to 85.4% [33].
Data from Malaysia indicated that HCWs often regarded wearing gloves as a substitute for hand
hygiene (70.3%) [10]. Finally, a similar finding was reported from the UK, i.e. that hand hygiene
compliance is significantly lower when gloves are worn [34].
Decontamination of gloved hands
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For HCWs wearing gloves to comply with international recommendations during multiple
activities on the same patient they would frequently have to doff gloves, perform hand
disinfection, and don a new pair of gloves, which is probably unrealistic [8]. Thus,
decontamination of gloved hands may be an attractive alternative. In 1992, Best and Kennedy
proposed that decontamination of gloved hands may be carried out under limited circumstances
[35]. Indeed this approach is already endorsed by some national guidelines. In 2016, the
Commission for Hospital Hygiene and Infection Prevention at the Robert Koch Institute, Berlin,
Germany stated that when the workflow can only be assured without a glove change, gloves may
be used for multiple activities on the same patient with a disinfection of gloved hands [30]. The

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Association of the Scientific Medical Societies (AWMF) in Germany adds that as an exception,
gloved hands may be disinfected instead of changing gloves when the work flow can only be
assured this way [3], for example when undertaking consecutive venepunctures on different

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patients, or moving from a clean to a dirty task on the same patient [3].
Efficacy of hand disinfection on gloved hands

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As early as 1933, the outer surface of surgical gloves was described as easier to disinfect than
bare hands [36].
Bactericidal efficacy

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To date, three studies have addressed the bactericidal efficacy of alcohol-based hand rubs on
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gloved and artificially contaminated hands similar to the EN 1500 study protocol (Table I). these
studies confirm that the mean efficacy of hand rubs is at least as good on gloved hands as on
bare hands for the various combinations of medical gloves and types of hand rubs . Even hands
wearing perforated gloves can be effectively disinfected on their outer surface with alcohol-
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based solutions as shown on gloves contaminated with E. coli or P. aeruginosa [37].


Virucidal efficacy
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Using poliovirus type 1, it was shown that the virucidal efficacy was similar on gloved and bare
hands. Interestingly, the application of 5 ml of 80% ethanol on gloved hands for 30 s reduced the
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viral load by 0.42 log10-steps, whereas the effect of 5 ml of 70% ethanol for the same conditions
was 1.26 log10-steps [38]. The authors went on to conclude that viral load from non-enveloped
viruses is easier to be reduced on gloved hands [38].
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Sporicidal efficacy
When gloved hands are contaminated with spores of C. difficile, it is also possible using.
chlorinated lime or a “sporicidal alcohol” to achieve a 1.7 to 3.3 log10 reduction in contamination,
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depending on the type of hand rub and application method (rubbing in or wiping away) [39].
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In summary, it can be concluded with reasonable certainty that decontamination of gloved


hands is at least as effective as treating bare hands
Glove material integrity after repeated application of hand rubs
A prerequisite for the disinfection of gloved hands is the evidence of compatibility of the glove
with the hand disinfectant [3].
Leakage rate
Three studies have investigated whether treatment of gloved hands with alcohol-based hand
rubs results in higher perforation rates using EN 455-1. In one study, 20 gloves from 5 different
types of gloves were treated 10 times with an unknown volume of 60% iso-propanol for 60 s
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[40]. In another, 48 to 50 gloves from 2 different types of powder-free latex gloves were treated
10 times with hand rubs or water [41]. A third study looked at perforation rates after treating 3
different types of gloves 5 times with 5 different types of hand rubs [42]. The results are
summarized in Table II.
Leakage rates of different types of gloves treated 10 times on hands with different types of hand
rubs or water were in a similar range as usually found for untreated gloves [42-44] although
specific glove-handrub combinations may show leakage rates up to 15% after 5 treatments [42].
Overall, clinically relevant damage to the gloves was not detected. Clinically relevant damage is

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therefore probably more due to mechanical stress leading to perforations in gloves. Physical
activity can indeed result in higher perforation rates as shown with nitrile gloves although the
difference to unused gloves is still small (2.1% versus 1.5% perforation rate) [45].

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Effect on tensile strength and ultimate elongation
A new study revealed changes of tensile strength and ultimate elongation of 5 latex examination

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gloves (mean thickness: 0.176 mm) and 8 nitrile examination gloves (mean thickness: 0.093
mm). Up to six hand disinfections were performed every 2 minutes with 2.5 ml per application
on gloved hands with commercially available products based on 70% ethanol or 63% iso-
propanol. The tensile strength of latex gloves was reduced on average by 4.3% and 18.1% after

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using the ethanol- and iso-propanol-based products, respectively. Notably, the tensile strength
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of nitrile gloves was reduced by 26% and 35.3% after using the ethanol- and the iso-propanol-
based products, respectively. Ultimate elongation did not change much in latex gloves
irrespective of the type of hand rub. In stark contrast, in some types of nitrile gloves, the
ultimate elongation increased by 30.5%, whereas in other types of nitrile gloves, it was reduced
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by 17.3%. Overall, latex gloves treated with the ethanol-based product showed the smallest
changes, whereas nitrile gloves treated with the iso-propanol-based product showed the largest
changes – although all combinations were still within the normative acceptability limits [46].
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Finally, the WHO guideline statement that cleansing plastic-gloved hands with an alcohol-based
formulation leads to early dissolving of the plastic material was not generally confirmed by Gao
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et al. [46].
Permeability
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One option to demonstrate compatibility of the glove with the hand disinfectant is to prevent
permeation according to EN 374 [3]. First, alcohol itself may permeate through the glove. When
gloves composed of different types of material were exposed to an ethanol-based hand rub, it
was possible for the ethanol to permeate through the glove material after 10 min with any type
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of glove. Of note is that for some types of glove, ethanol permeated in only 2 min [47]. This
finding does, however, not constitute a risk for the glove user in clinical practice because hand
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disinfection usually lasts approximately 30 s, and entails ethanol having direct contact with the
skin. Importantly, it is currently not clear whether repeated exposure (e.g. 3 times for 30 s
within 6 min) increases general permeability for other substances that (1) may be harmful to the
skin and (2) may have contaminated the outer site of the glove during patient care.
In another study, three types of latex gloves, two types of nitrile gloves and one type of neoprene
gloves were exposed to 70% iso-propanol for 15 min (equivalent to 30 hand disinfections for 30
s each). After this exposure, the permeability of 17 cytotoxic drugs was measured. Only in latex
gloves, did the permeability increase a little; however, this small increase was still under the
threshold considered to be safe. All other types of gloves showed effectively no change in
permeability [48].

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Impact of targeted disinfection of gloved hands on nosocomial infections in critical care
patients
In one study, the effect of two different hand hygiene procedures was evaluated over 6 years on
very low birth weight infants with a maximum weight of 1500 g on a neonatal intensive care
unit. During the first 3 years, hands were routinely washed with an antiseptic soap based on 4%
chlorhexidine and the use of gloves was not mandatory. During the second 3 years, HCWs had to
perform hand hygiene as described in Table III.
The number of patients were similar in both study periods (161 in period 1 versus 176 in period

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2), as was mean birth weight (1115 g versus 1163 g), mean days of ventilation (9 versus 8) and
the mean number of hospital days (80 versus 76). The modified hand hygiene regime in period 2
resulted in a significant decrease in the rate of late-onset infections (4.8 per 1000 patient days in

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period 2 compared to 13.5 in period 1). There was a particularly dramatic reduction in the rate
of necrotizing enterocolitis, to 0.8 per 1000 patient days in period 2 compared to 3.0 in period 1
[49].

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Discussion
There are some situations when HCWs should routinely wear gloves during patient care, and the
number of these situations is likely to increase as multidrug-resistant Gram-negative bacteria

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become more prevalent. Most studies have shown that HCWs who wear gloves do not perform
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adequate hand hygiene (doffing gloves, hand disinfection, donning new pair of gloves) when an
indication occurs. Disinfection of gloved hands requires less time and requires fewer resources
than changing gloves. However, against that, there is also a psychological component in that
wearing gloves seems to replace hand hygiene. Although HCWs are trained to perform hand
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disinfection whenever 1 of the 5 moments occurs, doffing gloves, followed by hand disinfection,
and then donning a new pair of gloves is complex and time-consuming. The reality is that
healthcare workers do not decontaminate their hands frequently in such settings. Disinfection of
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gloved hands is simpler, and allows HCWs to intuitively follow the 5 moments concept during
clinical care.
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Medical examination gloves are recommended by manufacturers for single use and belong to
class I medical devices [50]. In fact, a definition is provided in the medical devices directive and
states that class I medical devices are “a device intended to be used once only for a single
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patient” (Directive 2007/47/EC). The WHO may advise against glove washing, decontamination
or reprocessing [5] but reprocessing and reuse is common in some healthcare settings,
especially in developing countries where glove supply may be limited. Manufacturers are not
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responsible for glove integrity when the single use principle is not respected [5].
Disinfection of gloves which are still on the hands of the same HCW during the care of the same
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patient is different to reprocessing, and we believe that currently no guideline specifically


outlaws this practice. The practice is even gaining currency in developed countries; a proposal to
allow disinfection of gloved hands was recently published by the “Aktion Saubere Hände” in
Germany [51]. Indeed, disinfection of gloved hands for multiple activities on the same patient
has become accepted procedure in some hospitals, including at the University Hospital Aachen.
We propose that the Directive 2007/47/EC does not preclude decontamination of gloves on the
hands of the same HCW between activities on the same patient. We also consider that it is very
unlikely that disinfection of gloved hands during indicated glove use would result in an overall
prolongation of glove wearing compared to changing gloves when an indication for hand
hygiene occurs. Thus, we would not expect this practice to be associated with an increased risk

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of contact dermatitis.
To date, many studies on the efficacy of alcohol-based hand rubs have been performed according
to EN 1500. The norm is usually applied to determine the efficacy of hand rubs on bare hands
and to verify whether a product fulfils the European efficacy requirements. In two of the three
studies, the fingertips were sampled in broth containing neutralizing agents as recommended to
obtain valid data [40, 42]. However, in one study, this detail was not described [41], and thus,
the efficacy of the hand rubs may have been overestimated. A hand rub that passes the efficacy
requirements of EN 1500 may be recorded in a positive list for disinfectants (e.g. by the VAH) or
approved as a biocidal product for hygienic hand disinfection. Of note is that quite a number of

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hand rubs have been described not to fulfil the EN 1500 efficacy requirements [52, 53]. Hand
rubs that are already effective on bare hands and also have a sufficient efficacy on gloved hands
should therefore be effective enough for the application on gloved hands.

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In our review we found no evidence to indicate that disinfection of gloved hands is not safe, from
the point of view of either efficacy of hand disinfection or the integrity of gloves being affected

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by decontamination procedures. Despite the current lack of conclusive studies for some aspects
(e.g. effect on compliance in hand hygiene, acceptance by healthcare workers, and effect on
nosocomial infections), we still strongly recommend that targeted disinfection of gloved hands
can be used in selected clinical settings.

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We recommend that implementation of such an approach should be preceded by a trial period to
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refine, and ensure acceptance of the new practice. If HCWs notice that the glove material does
not tolerate the used hand rub (e.g. stickiness, perforations, etc.), it would be appropriate to
review the selected type of glove and hand rub. Overall, nitrile gloves seem to show a better
material compatibility compared to latex gloves and ethanol-based hand rubs seem to stress the
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glove material less than propanol-based ones. Nevertheless, it would be useful if glove
manufacturers provided compatibility data for different hand rubs. Training of HCWs would also
be vital, including: (1) indications for routine wearing and removal of gloves; (2) highlighting
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that gloves are only for the treatment of one single patient; (3) highlighting that 3 of the 5
moments for hand hygiene are now performed on gloved hands, namely “before aseptic tasks”
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(moment 2), “after body fluid exposure risk” (moment 3) and “after contact with patient
surroundings” (moment 5); (4) the importance of changing gloves that are visibly soiled or
perforated; (5) the need to remove gloves, and clean hands immediately after all patients
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activities are finished; (6) limiting the number of disinfections of gloved hands to a maximum of
10 times before the gloves need to be changed; and (7) use of gloves without powder (powdered
gloves are likely to become sticky). For implementation, we also recommend that HCW must use
the best fitting glove size, because creases in overlarge gloves will prevent effective
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decontamination.
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Our review has highlighted a lack of good quality evidence. In particular, we recommend further
research is required to examine hand hygiene compliance rates with and without disinfection of
gloved hands being permitted. Studies of user acceptability are also an important hgap in the
existing literature.
Conclusions
When gloves are used for an appropriate purpose, and multiple activities are carried out on the
same patient, compliance with hand disinfection is very low. In this setting, we suggest that
there is sufficient evidence that up to ten disinfections of gloved hands for the moments 2, 3 and
5 is safe and effective.

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Conflict of interest
None.
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Table I: Mean log10-reduction by treating artificially contaminated gloved and bare hands with
various types of hand rubs; experiments based on EN 1500.

Type of glove Active ingredient(s) in Mean log10-reduction after Reference


hand rub and type of application application application
application 1 5 10

Peha-soft Sterillium, 3 ml for 30 s 7.0 4.8 4.3 [41]


Puderfrei Sterillium Virugard, 3 ml 4.0 4.9 4.9 [41]
for 30 s

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Amphisept E, 3 ml for 30 3.3 3.9 3.6 [41]
s
Satin Plus Sterillium, 3 ml for 30 s 4.5 4.2 3.8 [41]

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Sterillium Virugard, 3 ml 4.5 3.7 3.2 [41]
for 30 s
Amphisept E, 3 ml for 30 4.6 4.9 3.8 [41]

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s
Biogel iso-propanol (60%) for 6.4 - 6.4 [40]
Diagnostic 60 s*
Safeskin iso-propanol (60%) for 6.1 - 5.9 [40]

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Satin Plus 60 s*
Safeskin LPE iso-propanol (60%) for 5.1 - 3.8 [40]
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60 s*
Baxter Non- iso-propanol (60%) for 6.6 - 5.2 [40]
Sterile 60 s*
Best Nitrile iso-propanol (60%) for 5.2 - 4.1 [40]
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60 s*
No glove iso-propanol (60%) for 4.1 - - [40]
(bare hand) 60 s*
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Vasco Braun Sterillium** 5.65 - [42]


Sensiva** 5.55 - [42]
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Descoderm** 5.67 - [42]


Desderman pure** 5.27 - [42]
Promanum pure** 5.48 - [42]
Nitrile Blue Sterillium** 5.81 - [42]
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Eco-Plus Sensiva** 6.06 - [42]


Descoderm** 5.38 - [42]
Desderman pure** 5.61 - [42]
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Promanum pure** 5.71 - [42]


Latex Med Sterillium** 5.41 - [42]
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Comfort Sensiva** 5.61 - [42]


Descoderm** 5.57 - [42]
Desderman pure** 5.48 - [42]
Promanum pure** 5.40 - [42]
*volume not specified; ** volume and application time not specified

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Table II: Leakage rate of different types of gloves after different types of treatment on gloved
hands.

Type of glove Treatment of gloved hand with Gloves with leak Reference
(n)
Safeskin Satin plus 10 x iso-propanol (60%)* for 60 s 0 out of 20 [40]
Biogel Diagnostic 10 x iso-propanol (60%)* for 60 s 0 out of 20 [40]
Baxter Non-Sterile 10 x iso-propanol (60%)* for 60 s 0 out of 20 [40]
Safeskin LPE 10 x iso-propanol (60%)* for 60 s 0 out of 20 [40]
Best Nitrile 10 x iso-propanol (60%)* for 60 s 3 out of 20 [40]

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Peha-soft 10 x 3 ml water for 30 s each 1 out of 49 [41]
10 x 3 ml Amphisept E for 30 s each 0 out of 50 [41]
10 x 3 ml Sterillium for 30 s each 0 out of 50 [41]

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10 x 3 ml Sterillium Virugard for 30 s 1 out of 50 [41]
each
Satin Plus 10 x 3 ml water for 30 s each 2 out of 48 [41]

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10 x 3 ml Amphisept E for 30 s each 0 out of 50 [41]
10 x 3 ml Sterillium for 30 s each 2 out of 50 [41]
10 x 3 ml Sterillium Virugard for 30 s 0 out of 50 [41]
each

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Vasco Braun 5 x Sterillium** 0 out of 20 [42]
5 x Sensiva** 0 out of 20 [42]
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5 x Descoderm** 0 out of 20 [42]
5 x Desderman pure** 0 out of 20 [42]
5 x Promanum pure** 0 out of 20 [42]
Nitril Blue Eco- 5 x Sterillium** 1 out of 20 [42]
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Plus 5 x Sensiva** 1 out of 20 [42]


5 x Descoderm** 0 out of 20 [42]
5 x Desderman pure** 0 out of 20 [42]
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5 x Promanum pure** 0 out of 20 [42]


Latex Med Comfort 5 x Sterillium** 3 out of 20 [42]
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5 x Sensiva** 1 out of 20 [42]


5 x Descoderm** 1 out of 20 [42]
5 x Desderman pure** 2 out of 20 [42]
5 x Promanum pure** 0 out of 20 [42]
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*volume not specified; ** volume and application time not specified


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Table III: Hand hygiene regimes in a neonatology intensive care unit as described by Ng et al
[49]

When What

Before each patient contact in the incubator Hand disinfection, followed by donning gloves,
followed by disinfection of gloved hands

More patient care activities at the same No visible contamination of hands:


patient disinfection of gloved hands, e.g. after

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touching utensils such as the monitor,
thermometer, pencils or patient charts.
Visible contamination of hands: glove change.

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After finishing all activities at the same patient Doffing gloves followed by hand disinfection

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