Direct Gloving vs Hand Hygiene Before Donning Gloves: A Hospital Infection Control Study


Read about a cluster randomized clinical trial that found that direct gloving without prior hand hygiene significantly improved infection prevention practice adherence among health care personnel.

Close-up hand male under automatic alcohol gel dispenser for hand hygiene.  (Adobe Stock 364444583 by bigy9950)

Close-up hand male under automatic alcohol gel dispenser for hand hygiene.

(Adobe Stock 364444583 by bigy9950)

Adherence to strict protocols in infection control is paramount to safeguard the health of patients and health care personnel (HCP). One such protocol involves hand hygiene before donning nonsterile gloves. However, a recent cluster randomized clinical trial recently published in JAMA Network Open suggests that an alternative strategy—direct gloving without prior hand hygiene—may significantly impact adherence to infection prevention practices among HCPs.

The study, led by Kerri A. Thom, MD, and a team of investigators from multiple academic centers, aimed to evaluate the effectiveness of a direct-gloving policy in a hospital setting. This mixed-method, multicenter trial included 3790 health care personnel across 13 hospital units and was conducted from January 1, 2016, to November 30, 2017. The primary outcome measured was adherence to the expected practice at room entry and exit.

“A rigorous approach to evidenced-based guidelines is needed to increase acceptance and adherence while improving efficiency and decreasing unnecessary demands on HCPs’ time,” according to the study’s authors. “We found poor adherence with the expectation of hand hygiene before nonsterile glove use in the baseline period of this study at 35% overall, ranging from a low of 8% in EDs to a high of 63% in hemodialysis units, rates that are similar to prior reports.”

According to the study’s results, the hospital units assigned to direct gloving, where hand hygiene before donning gloves was not required, exhibited a 46% increase in adherence to infection prevention practices compared to units following the usual care protocol (87% vs. 41% adherence).

This increase in adherence was observed even after controlling for factors such as baseline hand hygiene rates, unit type, and universal gloving policies. The use of gloves upon entering contact precautions rooms was also higher in units implementing the direct-gloving strategy (87% vs. 67%).


However, the study also identified some potential drawbacks of the direct-gloving approach. Specifically, it was associated with increased total bacteria colony counts and greater detection of pathogenic bacteria on gloves in the emergency department. In contrast, pediatric units saw a reduction in colony counts. The study found no significant changes in other units' total colony counts or the presence of pathogenic bacteria.

Adherence to expected practices was higher in the 6 units using direct-gloving (87%) compared to the 7 units following usual care (41%), even after accounting for baseline hand hygiene rates, unit type, and universal gloving policies (risk ratio [RR], 1.76; 95% CI, 1.58-1.97). Additionally, glove usage upon entering contact precautions rooms was also greater in the direct-gloving units (87% vs. 67%; P = .008).


Thom KA, Rock C, Robinson GL, Reisinger HS, Baloh J, Li S, Diekema DJ, Herwaldt LA, Johnson JK, Harris AD, Perencevich EN. Direct Gloving vs Hand Hygiene Before Donning Gloves in Adherence to Hospital Infection Control Practices: A Cluster Randomized Clinical Trial. JAMA Netw Open. 2023 Oct 2;6(10):e2336758. doi: 10.1001/jamanetworkopen.2023.36758. PMID: 37883088; PMCID: PMC10603500.

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