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Are Gloves Effective Protective Barriers in Clinical Practice?

The Occupational Safety and Health Administration has mandated that health care workers wear gloves to reduce the transmission of microorganisms to and from their hands and to reduce the risk of occupationally acquired blood-borne viral diseases. Previous studies have shown that gloving before contact with mucous membranes or non-intact skin reduces cross-infection. However, gloves are not a completely impermeable barrier and they may leak not only during use but before (vinyl gloves leak more often than latex gloves). This study assessed the effectiveness of nonsterile examination gloves as microbial barriers in routine hospital procedures.

The investigators evaluated 137 procedures during which a health care worker's gloved hand contacted a patient's mucous membrane. The procedures included oral and endotracheal tube care, digital rectal sphincter stimulation for spinal-cord-injured patients, and dental procedures. Cultures were obtained from each health care worker's hands before and after the glove contact and from exterior glove surfaces after contact and tested for gram-negative rods or enterococci. Eighty-six of 135 cultures of external glove surfaces were positive, and worker's hand cultures were positive in 11 of these 86 cases (13%) more often with vinyl (10 of 42) than latex (1 of 44) gloves. Despite leaks in 26 of 61 vinyl gloves and 6 of 70 latex gloves, gloves with leaks prevented hand contamination in 77% of the procedures during which they were used.

Comment: All gloves, but especially vinyl gloves, have a tendency to leak. Leaking gloves put the wearer at risk for hand contamination, but most health care workers are unaware of leaks. Surprisingly, many of the cases of hand contamination in this study occurred with gloves that did not leak. It is crucial for health care workers to be aware that gloves reduce hand contamination but are not absolute barriers. The authors appropriately recommend that health care workers wash their hands after using gloves for procedures where there is contact with mucous membranes or non-intact skin.

— JS Dover

Published in Journal Watch Dermatology September 1, 1993

Citation(s):

Olsen RJ et al. Examination gloves as barriers to hand contamination in clinical practice. JAMA 1993 270 350-353.

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Copyright © 1993. Massachusetts Medical Society. All rights reserved.