Bugs on Gloves: When Barriers Become Carriers of Infection-causing Microorganisms

Gloves signify protection, often serving as a barrier to interrupt the chain of infection in health care. They can be indispensable in protecting patients from healthcare-acquired infections and safeguarding providers from occupational exposure. But when gloves are not used correctly, they become a potential danger. Improper donning and doffing, infrequent changes, and ignoring hand hygiene can turn these protective barriers into deadly vectors.

Understanding how gloves facilitate the transmission of infection is essential to protecting patients, health care providers, and health care institutions at large. Evidence from hospital settings and other health care facilities shows that while the role of gloves in infection prevention should not be undermined, their potential hazards should never be overlooked. So how do gloves pose a threat to contamination and cross-infections? It all boils down to proper use and institutional policy. Here is an overview of the risks that come with improper use of gloves.

Glove Contamination

Glove contamination occurs frequently during patient care.¹ This is particularly the case in high-contact settings such as the intensive care unit (ICU), high dependency unit (HDU), or dialysis centers. The glove contamination rates can increase progressively over the course of a single care episode, especially when health care workers wear them for long periods and use them across multiple tasks. It is quite common for ward workers to touch various surfaces with the same gloves while carrying bugs from one surface to another.

Gloves can become more contaminated than bare hands performing similar tasks. This is partly explained by reduced hand hygiene when gloves are worn, as they often give a false sense of total protection. People tend to wash or sanitize more frequently with bare hands, but with gloves, this practice is often ignored.² Coupled with prolonged usage, gloves become a potential vector of infection. Bacteria such as Acinetobacter baumannii and Pseudomonas aeruginosa have been shown to contaminate gloves, gowns, and unwashed hands of health care workers who interact with patients colonized by these organisms.³

Microperforations, which are often undetected during glove use, should not be overlooked. When present, these tiny defects provide a route for bidirectional transfer of microorganisms between the hand and the glove surface. During clinical procedures and surgeries, such perforations can significantly affect outcomes, increasing the risk of surgical site infections if precautions are not taken.

The Silent Transfer of Pathogens and Cross-contamination

Gloves can easily turn into mobile contaminants. They can rapidly facilitate the transfer of organisms from patient to patient, from patient to health care worker, and to the environment.⁴ Studies have shown a tendency to use gloves across multiple tasks. Picture a health care worker wearing a pair of latex gloves while adjusting the settings on an infusion pump, then anchoring the bed rails, and finally picking up a mobile phone to receive a call, all with the same pair of gloves.

The overuse of gloves across tasks undermines their usefulness as infection barriers. When gloves become carriers of pathogens due to improper use, health care providers, patients, and institutions bear the consequences.

Cross-contamination occurs across health care settings and often without any visible cue.¹ Only when the consequences emerge does it become apparent, and these can be catastrophic. Outbreaks of resistant organisms such as Vancomycin-resistant Enterococci (VRE), poor surgical outcomes, and even fatalities have all been linked to such lapses.

Why Improper Use of Gloves Persists

While health care workers are often blamed for glove contamination, the problem sometimes lies upstream.² Bypassing infection prevention practices can reflect institutional culture or, worse, administrative policy.

In some settings, health care workers are compelled to use resources sparingly to reduce operational costs, often at the expense of ideal infection prevention practices. Rationing forces providers to change gloves infrequently and to use them across multiple patients and tasks. Conversely, when supplies are abundant, gloves may be overused, with workers indiscriminately donning them even for tasks that do not require personal protective equipment (PPE).

Pressure to complete tasks within limited timelines and staffing shortages often causes health care workers to prioritize task completion over infection prevention. Saving a few minutes to attend to the next patient may take precedence over changing gloves. This is especially problematic in high-pressure environments such as emergency departments and critical care units.

Health care workers need training on when to wear gloves, how to use them, and how often to change them. Adequate training helps providers understand that gloves are not worn solely as PPE but also to protect patients. With regular refresher courses and point-of-care drills, gloves can truly function as tools for infection prevention across health care facilities.

Gloves are only as effective at preventing infection as the way they are used. While their value is undisputed, it is not inherent. Gloves can become contaminated and serve as vectors for latex or nitrile. The risk of contamination and misuse is influenced by both behavioral and system-level factors. However, these can be modified to achieve better outcomes.

Gloves should be viewed as passive barriers to infection, and infection prevention experts must emphasize their correct use: worn when needed, changed when required, and never considered a substitute for hand hygiene. Only then can gloves achieve their intended purpose: to interrupt, rather than enable, the transmission of infections.

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References

1. Picheansanthian W, Chotibang J. Glove utilization in the prevention of cross transmission: a systematic review. JBI Database System Rev Implement Rep. 2015;13(4):188-230. Published 2015 May 15. doi:10.11124/jbisrir-2015-1817

2. Imhof R, Chaberny IF, Schock B. Gloves use and possible barriers - an observational study with concluding questionnaire. GMS Hyg Infect Control. 2021;16:Doc08. Published 2021 Feb 22. doi:10.3205/dgkh000379

3. Morgan DJ, Liang SY, Smith CL, et al. Frequent multidrug-resistant Acinetobacter baumannii contamination of gloves, gowns, and hands of healthcare workers. Infect Control Hosp Epidemiol. 2010;31(7):716-721. doi:10.1086/653201

4. Wolfensberger A, Clack L, Kuster SP, et al. Transfer of pathogens to and from patients, healthcare providers, and medical devices during care activity-a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2018;39(9):1093-1107. doi:10.1017/ice.2018.156