Correct Gloving Technique – Donning, Doffing and Hygiene

Gloves ≠ hand hygiene

The most fundamental principle: gloves do not replace hand hygiene. This is a widespread misunderstanding with concrete consequences for patient safety.

Gloves reduce – but do not eliminate – microbial transmission. Hands can become contaminated via:

• Microporosity in the glove material
• Undetected and invisible defects (pinhole leaks below the AQL threshold)
• Contamination during donning/doffing

WHO recommendation: Hand hygiene is the single most important intervention for preventing infections in healthcare. Gloves are a supplement – not a replacement.

WHO's 5 moments for hand hygiene

WHO's "Five Moments for Hand Hygiene" defines when hand hygiene must be performed in a clinical context:

Gloves are donned at moments 2 and 3 – but hand hygiene is always performed before donning and after doffing.

Correct indications for glove use

Gloves are clinically indicated for:

• Expected contact with blood or other body fluids
• Contact with mucous membranes or non-intact skin
• Contact with potentially infectious material or contaminated surfaces
• Handling chemicals, cytotoxic agents or biological material

Gloves are NOT indicated for:

• Routine patient contact without risk (e.g. taking a patient's pulse on intact skin)
• Contact with intact medical equipment and clean surfaces
• Situations where the only risk is degraded hand hygiene compliance (gloves are no substitute)

Over-use of gloves is a documented problem: it creates false security, reduces compliance with hand hygiene and increases consumption unnecessarily.

Donning – correct technique step by step

Preparation

1. Hand hygiene – wash hands for 20–30 seconds OR decontaminate with alcohol-based hand rub

2. Allow hands to dry completely (wet hands give a poorer fit and increase the risk of contamination)

3. Select correct size – see size guide:

Too small = excessive mechanical stress → increased risk of rupture.

Too large = poor tactile feedback and increased risk of contamination from loose fit.

Donning

4. Remove the glove from the box by the cuff edge – avoid touching the outer surface

5. Pull the glove over the hand in one fluid movement

6. Pull the cuff up over the wrist – the cuff must cover the wrist

7. Ensure no air pockets are trapped at the fingertips (can weaken the barrier)

8. Visually inspect for visible defects

For sterile gloves:

• Use open or closed technique depending on the procedure and local guidelines
• Never touch the outer surface of sterile gloves with bare hands

Doffing – correct removal step by step

Removal is the phase where cross-contamination most commonly occurs. Correct technique is essential.

Step-by-step procedure

Step 1: With the dominant hand – grasp the outer surface of the non-dominant glove at the cuff

*(Never grasp the palm side – that is where contamination is greatest)*

Step 2: Roll the glove down over the hand, so it turns itself inside out – the outer surface (contaminated) ends up as the inner surface. Hold the folded glove in the still-gloved hand.

Step 3: Insert 1–2 fingers from the bare hand under the cuff of the remaining glove. Only touch the inner surface of the glove (clean side).

Step 4: Roll the other glove off in the same way. It now automatically encapsulates the first glove inside it.

Step 5: Dispose of as infectious waste (yellow/red waste bin according to local procedure).

Step 6: Perform hand hygiene immediately after doffing.

Common errors during doffing

Change frequency – when and why

Disposable gloves are designed for one task at a time. There are clear evidence-based limits:

Change gloves:

• Always between patients
• Always between tasks with the same patient (from contaminated to clean field)
• At visible soiling (blood, exudate, stomach contents)
• At suspicion of leakage (sudden onset of wetness sensation)
• No later than after 30–60 minutes of continuous use (sweat, moisture and friction degrade barrier integrity)

Reuse is not acceptable:

Even a glove that "looks clean" can have microporous defects, accumulated sweat-moisture and compromised material strength.

Double gloving – evidence and practice

Double gloving is well supported in specific contexts:

Surgery

Studies show that double gloves reduce the risk of perforation damage to the inner glove by 87 % compared to single gloves. The inner glove is perforated in only ~3 % of cases with double gloves vs. ~18 % with single gloves.

Recommendation:

• Standard in orthopaedics, gynaecological surgery and other high-risk procedures
• Indicated for all operations lasting more than 30–60 minutes
• The outer glove is changed at visible scratch or perforation (inner glove remains sterile)

Cytostatic treatment

Double gloving is standard or recommended for:

• Preparation and administration of cytostatics
• Handling contaminated waste and equipment
• Changing bedpans and catheters for cytostatic patients

Use specially designed chemical-resistant gloves as the inner layer during preparation.

Sizing for double gloving

• The outer glove is typically chosen one size larger than the normal size
• This provides room for the inner glove without reducing tactile feedback too much
• Too tight outer glove over inner glove → increased fatigue and error risk

Hand decontamination and gloves

Alcohol-based hand rub (70–85 % ethanol/isopropanol):

• Used before donning and after doffing
• Should not be used on gloves during use to "extend" their life – this has not been validated and can compromise the material

What alcohol does to glove material:

• Latex and nitrile: Moderately tolerant of low-concentration alcohol for short periods – but repeated exposure reduces barrier integrity
• Vinyl: More vulnerable to alcohol – should not be decontaminated

Conclusion: Gloves are not decontaminated and not reused. Hand hygiene is performed on bare hands.

Storage and shelf life

Correct storage conditions (per EN 455-4)

• Temperature: 15–25°C (avoid extreme heat)
• Humidity: 40–80 % relative humidity
• UV protection: Avoid direct sunlight (UV accelerates degradation)
• Ozone: Avoid proximity to electric motors and ozone-generating equipment

What invalidates the shelf life guarantee

• Storage in direct sunlight or hot car boot/warehouse
• Storage in damp basements (packaging absorbs moisture)
• Storage near strong chemicals (vapours can migrate in)
• Opened boxes left in a humid environment

Visual inspection

Gloves showing signs of degradation should be discarded:

• Sticky or brittle fingers
• Discolouration
• Deformation of shape

What the sales person should communicate about correct use

As a glove supplier you have not only a sales responsibility – you have a professional advisory responsibility. Customers who use gloves incorrectly will experience problems that are wrongly attributed to the product.

Key messages to communicate:

1. Size is critical – always offer a size guide and trial packs if needed

2. Changing is non-negotiable – one glove for one job, one change

3. Gloves supplement hand hygiene – they never replace it

4. Storage has consequences – show customers the correct storage requirements

5. Document allergy situations – accelerator-free for known risk groups

Clinical training:

As a supplier, offer to run short training sessions or provide educational materials on correct gloving technique. This strengthens the supplier relationship and reduces complaints.