Gloves

Task-specific gloves (Table 2) should be worn by all OHCP to prevent contamination of the hands when (1) anticipating direct contact with blood, mucous membranes, nonintact skin, and OPIM; (2) having direct contact with patients who are colonized or infected with pathogens transmitted by the contact route, or (3) handling visibly or potentially contaminated patient care items and environmental surfaces.^1-5

Gloves have been reported to reduce the volume of blood on the external surfaces of sharps by 46.86% (residual blood in the lumen of a hollow-bore needle is not affected).³ The extent to which gloves will protect OHCP from transmission of bloodborne pathogens (e.g., HIV, HBV, and HCV) following a needlestick or other sharps injury that penetrates the glove barrier has not been determined.³

Patient examination gloves, classified as Class I medical devices, should be worn during dental preventive, restorative, and other non-surgical dental procedures.17 Sterile surgeon’s gloves are intended for use during surgical procedures to protect the provider and the wound from contamination. Surgeon’s gloves, subject to design control requirements, are classified as Class I medical devices. Surgeon’s gloves must also be sterile when offered for sale to end-users.¹⁷

Patient examination gloves and surgeon’s gloves are made primarily of latex, nitrile, or vinyl.¹⁷ While there is little difference in the barrier properties of unused intact gloves; vinyl gloves have higher failure rates than latex or nitrile gloves.³ For this reason latex or nitrile gloves are preferable for procedures that involve extensive patient contact. To reduce the risk of latex-related allergies, powdered gloves were banned by the FDA in December of 2006¹⁸ and low-allergen latex gloves or nitrile gloves should be used.

Patient examination gloves and surgeon’s gloves are single-use patient-care items. They may not be washed for subsequent reuse because microorganisms cannot be removed reliably and continued glove integrity cannot be guaranteed. Washing gloves can lead to wicking (penetration of liquids through undetectable holes in the gloves) and subsequent hand contamination. Glove reuse has been associated with transmission of MRSA and gram-negative bacilli.³

When gloves are torn or punctured, they must be changed as soon as possible. To prevent transmission of infectious pathogens, it is also necessary to change gloves when during the course of treatment radiographs, dental charts, computer keyboards, or other equipment are touched. When donning and removing gloves, strict adherence to hand hygiene guidelines is imperative.¹⁴ Double-gloving is acceptable for extensive surgical procedures.

Gloves that fit snugly around the wrist are preferred for use because they will cover the gown cuff and provide a more reliable continuous barrier for the arms, wrists, and hands. When gloves are worn in combination with other PPE, they are to be put on last (Figure 1). Following glove removal, hand hygiene further ensures that the hands will not transmit pathogens that might have penetrated the gloves through small tears or contaminated the hands during glove removal.

Figure 1. Sequence for putting on PPE.¹⁹

Figure 1. Sequence for putting on PPE.¹⁹

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The FDA does not regulate cleaning (utility or general purpose) gloves used for routine janitorial functions in healthcare facilities and it is illegal for manufacturers to label or suggest that such gloves are suitable for medical use.¹⁷ Gloves used for cleaning patients, or cleaning or handling surfaces or items contaminated with patient waste or fluids and patient-care devices contaminated with blood or OPIM should meet requirements for patient examination gloves.¹⁷