Microorganisms, pathogens and infectious agents, such as bacteria, viruses, fungi, protozoa and prions, live in, on and all around us (Delves et al, 2017). Although these do not always present a threat, in some individuals, who may be susceptible or more likely to be exposed to larger numbers of organisms (patients and healthcare workers), they may enter the body and cause infection and disease (Ward, 2016). For this reason, within healthcare institutions, great care is taken in order to reduce the spread of these microorganisms. One way that this can be achieved is by limiting the means of transmission, the most common being touch (direct or indirect). Hands are therefore a primary source of the spread of infection and as such, hand hygiene is an essential preventive measure to reduce the risk of the transmission of healthcare-associated infections (National Institute for Health and Care Excellence, 2017). However, although handwashing is effective, there are some instances when an additional layer of protection is required in order to safeguard the wearer and patient.
Medical gloves are just one product within the range of personal protective equipment (PPE), that are widely used and play a primary role in the protection of patients and health professionals. These must be worn when making contact with blood and bodily fluids, when handling sharps and contaminated devices, when carrying out invasive procedures, and when making contact with sterile sites (Loveday et al, 2014).
Which gloves and application technique to use
Before selecting which gloves are required, it is important to consider what the task or skill being undertaken entails, and whom the gloves are protecting. Non-sterile gloves should be worn when carrying out non-invasive routine interventions, such as assisting with personal hygiene and when handling bed linen (Ratcliffe and Smith, 2014). When carrying out a clinical procedure, an aseptic non-touch technique (ANTT) risk assessment is additionally required in order to ascertain whether the procedure requires a standard or surgical ANTT approach. This involves assessing the difficulty of protecting the key parts and sites associated with the skill, while also considering the number and sizes of the key parts, environment, invasiveness and user competency (Association for Safe Aseptic Practice (ASAP), 2015). For standard ANTT procedures, non-sterile gloves can be worn as the key parts and key sites are limited, such as in cannulation and venepuncture. However, for surgical ANTT procedures such as urinary catheterisation, sterile gloves must be worn, due to the level of invasiveness (ASAP, 2015).
It is important to select the correct size glove for the wearer's hands. If the gloves are too large, they could easily become dislodged, and the additional material at the end of the fingers could hinder manual dexterity. If too small, they could restrict blood flow to the fingers.
The correct procedure
As health professionals, it is important to work within guidelines and policies, and use evidence-based practice (Nursing and Midwifery Council, 2018). Therefore, nurses must ensure that they are aware of the different application methods that are available and how these relate to the different types of gloves that can be used. Additionally, being able to correctly apply and remove gloves has been found to reduce the risk of contamination of health professionals' hands and consequently reduces the potential transmission of healthcare-associated infections (World Health Organization (WHO), 2009).
Hand health and hygiene
Before donning any gloves, make an assessment of hand health. If required, gather an appropriate dressing to cover areas of open skin, as these need to be adequately covered in order to prevent infectious agents from entering the body.
In order to remove transient microorganisms and reduce the number of resident microorganisms, undertake hand hygiene/cleaning using the correct procedure. Dry hands using the correct technique and apply the dressing. Drying hands is just as important as washing as microorganisms thrive in a warm, moist environment.
Non-sterile gloves
The procedure for applying non-sterile gloves is shown in Figure 1. Once both gloves are donned, it is important to inspect for any signs of damage before commencing the task or procedure. If during application the gloves become damaged, these must be removed and replaced because gloves that are not intact will not act as an effective barrier against infectious agents (WHO, 2009).
Sterile gloves
The ‘open method’ for applying sterile gloves is shown in Figure 2.
A second technique, the closed method, can be used when a sterile surgical gown is also being worn as part of the surgical ANTT:
Removing gloves
Figure 3 shows the correct procedure for removing gloves after use.
Conclusion
This article has explored how medical gloves can be used to protect both the wearer and patients from the transmission of infectious agents. However, although PPE is beneficial for the prevention and control of infection, the wearing of gloves should not remove the need to undertake strict hand-hygiene practices. Therefore, the wearer should use appropriate handwashing techniques before donning and on removal of medical gloves.