Happy Hand Hygiene Day! Rethinking Glove Use for Safer, Cleaner, and More Ethical Health Care

Clean Hospitals Corner With Alexandra Peters, PhD

Normally, I use this column to talk about issues specifically related only to environmental hygiene. But in honor of the World Health Organization (WHO) May 5 World Hand Hygiene Day,¹ I would like to focus on the misuse and overuse of gloves in health care. Any of us who have worked in health care have all seen someone touch numerous things in a room with gloves on and then insert a catheter into a patient without doing hand hygiene. Or not do hand hygiene before donning gloves or performing a dirty procedure, and continue to touch clean body sites or health care supplies without removing them.

Gloves are essential to modern medicine because they create an additional protective barrier between health care workers (HCWs), patients, and their environment. It’s important to remember that environmental services (EVS) workers are also HCWs! Gloves can protect HCWs from bodily fluids and patients from any open skin on the HCWs’ hands. They are, of course, also useful when handling any toxic or corrosive substances, be that in the context of medications that the HCW might be in contact with, or cleaning/disinfecting agents the EVS workers might be in contact with.

For patient care staff, there are very clear guidelines, and all staff should be intimately familiar with the WHO’s My 5 Moments for Hand Hygiene² to understand their role within the chain of transmission. However, we also need to broaden our focus and our thinking about glove use for health care environmental hygiene (HEH). Although EVS workers don’t have much direct patient contact, they are constantly in contact with the patient environment and play an essential role in infection prevention. Although some proposals have been published, no solid, evidence-based equivalents of “My 5 Moments” for environmental hygiene exist.

Although hand hygiene is usually associated with direct patient care, it is also important to remember its role in HEH. Unless we look at hand hygiene and HEH holistically, we will never be able to control the transmission of infections in the patient zone effectively.

Unfortunately, gloves are often misused. The WHO dictates that gloves must be changed, and hand hygiene must be performed at every indication for hand hygiene when giving care. Because HCWs feel safe when wearing gloves, and because gloves are cumbersome to change during a sequence of care, hand hygiene moments are often missed, leading to decreased adherence and putting patients at risk. There is a great deal of misinformation around gloves, namely that they are an infallible barrier against infectious material (they are not) or that they should be worn for most sequences of care (they should not).

In HEH, gloving and hand hygiene are far less studied than in patient care. But generally, there must be no transmission between the EVS worker and the health care environment, the environment and the cleaning cart, a particular patient room/ zone and another, and between a patient zone and the larger hospital environment. In regular patient rooms (not highly infectious ones), that are only being cleaned with detergent or microfiber and water, this means that gloves must be changed, and hand hygiene must be performed after touching waste products, any dirty areas of the room (toilet, etc), before touching the cleaning cart once gloves are soiled, and between each patient room.

If the EVS workers’ gloves constantly touch disinfectant products, such as when cleaning with cloths preimpregnated with disinfectant, hand hygiene can be performed less frequently, as there is a much lower infection risk. In this case, EVS workers should perform hand hygiene and change gloves if they have been in contact with body fluid or are visibly soiled, as well as at the beginning of their shift.

If gloves are left on for a prolonged period, like in this scenario, it is important that they are chemical-resistant gloves (not single-use disposable ones) and that the cuff is folded upward when worn to catch any potential drips of disinfectant from the cleaning cloths (although if the cloths are correctly impregnated, this should not happen).

The overuse and misuse of gloves are not only a danger to patients and staff but also cause much harm to the environment. Hundreds of billions of gloves are used and discarded globally, and they are often contaminated with toxic chemicals such as phthalates or bisphenol A.^3,4 Their environmental impact is enormous, and they usually end up in landfills, disintegrating into microplastics that stay in the environment. Furthermore, they are mostly produced in factories in China and Malaysia, where labor abuses are common.⁵

In short, use gloves if they are indicated, but please only use them when necessary. Try to buy gloves made locally by companies with transparent production methods.

Some of my colleagues and I have written a far more detailed editorial on this subject, in case you would like further information on the details of the misuse of gloves, as well as their harm to workers and the environment:

Check back for this link. It will go live on May 6, 2025.

This animation was developed to highlight the issues with glove misuse and overuse. It resulted from a collaboration of Brighton and Sussex Medical School Centre for Equitable Health Research, Whitman & Parrish, Green Healthcare Hub, Clean Hospitals, University of Geneva Institute of Global Health, University of West London, NHS Sussex, and Newcastle University.

Happy World Hand Hygiene Day, everyone!

References:

1. World Hand Hygiene Day 2025. World Health Organization. Published 2025. Accessed May 5, 2025. https://www.who.int/campaigns/world-hand-hygiene-day/2025
2. World Health Organization. WHO Your 5 Moments for Hand Hygiene (Poster). 2009.
3. UK Department of Health & Social Care. Experimental statistics – personal protective equipment distributed for use by health and social care services in England: quarterly update to 31 March 2023. Published 2023. Accessed May 5, 2025. https://www.gov.uk/government/statistics/ppe-distribution-england-quarterly-update-to-31-march-2023/experimental-statistics-personal-protective-equipment-distributed-for-use-by-health-and-social-care-services-in-england-quarterly-update-to-31-marc
4. Michaels BS, Lin X, Patel S, et al. Potential for glove risk amplification via direct physical, chemical, and microbiological contamination. J Food Prot. 2024;87:100283. doi:10.1016/j.jfp.2023.100283
5. Bhutta M, Bostock B, Brown J. Forced labour in the Malaysian medical gloves supply chain before and during the COVID-19 pandemic: evidence, scale and solutions. Modern Slavery and Human Rights Policy and Evidence Centre. Published 2021. Accessed May 5, 2025. https://www.bsms.ac.uk/_pdf/about/forced-labour-in-the-malaysian-medical-gloves-supply-chain-full-report-july-2nd-2.pdf