Intact, healthy skin is the best barrier protection we have against microorganisms and the threat of infectious disease. We augment that protection with gloves, but I've seen healthcare providers develop a false sense of security with regard to gloving throughout their careers. Don't take this commonplace practice for granted, since cut, scraped or otherwise compromised skin puts you and patients at risk of exposure to pathogenic organisms and harmful bacteria.

Appropriate use
Supplying the right glove, or gloves, to your staff is a function of surveying their preferences — gloves are not a second skin, but they should feel like one for the sake of practical use — and calculating their cost effectiveness to your budget. In recent years, a third factor has emerged, that of glove composition, as an increasing number of facilities have moved away from the use of latex gloves on account of their potential for allergic reactions, are in the process of doing so or at least make alternatives to them easily available.

The Centers for Disease Control and Prevention's Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, published in 2007, recommends that healthcare workers "wear gloves with fit and durability appropriate to the task." It's a short statement, but it opens the door to a lot of considerations. Besides highlighting the importance of a well-fitting glove to practical use, and a product's strength to its role as a protective barrier, it also points out that you'll want to match your glove to the job you intend to do and the environment you'll be doing it in. While a non-sterile, nitrile exam glove may serve its purpose for pre-op nurses, for example, your surgical personnel and sterile processing department are going to require a sturdier (and, in the case of OR staff, sterile) product.

Since no two gloves are created equal, spot-check them for holes or flaws before donning them. Random checks of your glove stock may also be helpful in ensuring quality control and guiding future purchases. In its 2007 Recommended Practices on Prevention of Transmissible Infections in the Perioperative Practice Setting, AORN's Recommended Practices Task Force even advises clinicians to routinely double-glove for increased protection during invasive procedures, having upgraded that advice from double-gloving for selected procedures.

In practice
When wearing gloves, keep in mind that while they may have been sterile when you donned them, they do not remain so. According to OSHA, gloves "shall be replaced as soon as practical when contaminated or as soon as feasible if they are torn, punctured, or when their ability to function as a barrier is compromised." The CDC's isolation precaution guidelines add, "Change gloves during patient care if the hands will move from a contaminated body-site (the perineal area, for example) to a clean body-site (the face, for example)."

Also, be aware of your own actions and how they impact your gloves' intended use. Have you ever spied a surgical staffer on the periphery of a procedure scratch an itchy nose? Even if it was just a split second of contact, even if the knuckle or the back of the hand was used instead of the fingertip, the gloves' sterility has been compromised for surgical purposes and should be changed. If they were contaminated, they may also have transmitted organisms to the wearer.

Just as you put on your gloves immediately before they are needed, in order to maintain sterility for the case at hand, you must remove them immediately after their use, at the point of use, to avoid spreading any contamination they may have picked up. It is impossible to know, just by looking at them, whether your hands are clean, and you could be the person who touches the door with a contaminated glove — or the one who touches it next with a bare hand. To reduce the risk of contaminating hands while removing gloves, pull the cuffs up to double over the outside of the glove and enclose the palm and fingers inside.

The hands inside
By no means do gloves replace hand hygiene; they're an adjunct to thorough hand washing and sanitizing. The use of hand scrubs or alcohol-based rubs are key to reducing bioburden on hands before donning gloves to participate in surgery or administer patient care. And hands should be fully dry, too, since damp hands may present difficulties in putting gloves on or contribute to skin irritation if soap residues remain.

It is likewise important to wash your hands immediately after removing gloves, as they may have been contaminated during the gloves' removal. You can't always see the holes that may have developed in the barrier material you're wearing, and contaminants may have wicked inside. And inside a warm, moist environment, whatever bacteria are on a gloved hand will start to grow on it.

If you're noticing contact dermatitis or other compromising conditions on the skin of your hands, wearing gloves is even more important when delivering care, since broken skin can harbor more microorganisms. Make sure you seek a professional skin assessment and choose gloves that don't exacerbate the problem — for instance, if it might be the emergence of a latex allergy. Maintain hand hygiene with lukewarm rather than hot water (which may contribute to the loss of moisture from the skin), pat your hands dry rather than rubbing them and apply a facility-approved lotion that isn't heavily perfumed and won't break down gloves.