Infection prevention
When to use gloves While gloves are used frequently in health and care settings, the recommended use cases for gloves by healthcare providers are relatively narrow. The National Infection Prevention and Control Manual (NICPM) in England outlines these use cases for gloves under Standard Infection Control Precautions (SICPs), which are used for all patients all the time2
, to include:
l Non-sterile gloves to be worn when exposure to blood and/or other body fluids, non-intact skin or mucous membranes is anticipated or likely.
l Sterile gloves to be worn when sterility is required in an operating theatre.
l Sterile gloves to be worn for some aseptic techniques, e.g. insertion of central venous catheters, insertion of peripherally inserted central catheters, insertion of pulmonary artery catheters and spinal, epidural and caudal procedures.
l When undertaking EPP.
The NICPM also outlines Transmission-Based Precautions (TBPs), to be used for patients with infection risks.2
In addition to the use cases
for gloves under SICPs, under TBPs, gloves are required: l When caring for patients who are on droplet or airborne precautions.
l For patients on contact precautions with specific organisms following risk assessment, including scabies, multi- drug resistant organisms or those with increased potential for hand and environmental contamination such as spore forming organisms e.g. Clostridioides difficile.
l When caring for patients with a High Consequence Infectious Disease (HCID), for which there are separate PPE recommendations.
The NICPM also provides some “DOs and DON’Ts” for glove use, including: l No double gloving during routine care (although this may be required for some EPP and HCID).
l No gloves for near patient administrative tasks, e.g. when using the telephone, using a computer or tablet, writing in the patient chart; giving oral medications; distributing or
AQL* 1.5
0.65 Table 1 40
www.clinicalservicesjournal.com I November 2024
Defect rate 1 in 65
1 in 150 (-57% vs 1.5) collecting patient dietary trays.
l Gloves should be changed immediately after each patient and/or after completing a procedure/task even on the same patient, and hand hygiene performed.
l Changed if a perforation or puncture is suspected.
l Appropriate for use, fit for purpose and well- fitting.
l Never decontaminated with ABHR or soap between use.
l Low risk of causing sensitisation to the wearer. l Appropriate for the tasks being undertaken, taking into account the substances being handled, type and duration of contact, size and comfort of the gloves, and the task and requirement for glove robustness and sensitivity.
l Pulled on taking care to minimise contamination of the outer surface by holding gloves at the wrist opening only.
These guidelines in the English NICPM are in line with recommendations from WHO.
Which gloves to use? The NICPM sets certain key parameters that influence the choice of gloves, including: l Clinical scenario (e.g. sterile or non-sterile gloves).
l Glove quality (to ensure they are appropriate for use, fit for purpose, appropriate for the task undertaken in terms of comfort, robustness, and sensitivity).
l Glove fit (to ensure they are well-fitting). Typical example
Standard non-sterile examination glove Sterile surgical glove
* AQL (Acceptance Quality Limit) is defined, in accordance with ISO 2859-1 and EN455, as the “quality level that is the worst tolerable”.
Several technical considerations are important factors that influence glove choice in order to meet the requirements set out in the aforementioned parameters.
AQL Gloves do not all offer the same level of protection. A crucial factor that is the Acceptable Quality Level (AQL) of the gloves. The AQL determines the number of defects allowed in a sample of gloves, which directly influences their effectiveness in protecting staff and patients. AQL is a measure of how many defective gloves, from randomly selected samples off a batch, are accepted. The lower the AQL, the lower the rate of defect, meaning that gloves with a lower AQL are both safer and more sustainable. The AQL of disposable gloves in healthcare typically ranges from 0.65 (for a typical sterile surgical glove) to 1.5 (for a typical disposable non-sterile nitrile glove). Despite the importance of low AQL, not all gloves available on the market reach the same quality standard. Professionals are often faced with a variety of options, some of which may compromise safety due to a higher AQL. Therefore, it is important that glove manufacturers, suppliers, and end users understand the importance of AQL to ensure safety in the workplace. Typical defect rates are illustrated in Table 1.
Tensile strength The tensile strength of gloves plays a crucial role in protecting healthcare professionals and patients. During medical procedures, gloves can be subjected to considerable forces such as stretching, twisting, and pressure. Gloves with lower tensile strength are more likely to break during use, which can expose healthcare professionals to pathogens present in patients’ body fluids. Gloves with higher tensile
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