Yesterday was World Hand Hygiene Day 2025! Look out for a World Hand Hygiene Day 2025 themed Journal Club tomorrow, where we will be discussing this paper. You can register for Journal Club here.

I love the theme this year: “It might be gloves; it’s always hand hygiene.” The first time I heard the theme, I wasn’t so sure. It sounded a bit uncertain and lacking in confidence somehow. But the move I’ve thought about it, the more I like it. The issues around when we choose to wear gloves or not are uncertain. Yes, there are clear circumstances when you would definitively wear gloves, and some when you definitely would not. But there’s a lot of grey in between when you could make a pretty good case either way. This is especially true for some clinical tasks around the use of vascular access devices. What I am really looking for when I speak to front-line clinical teams is a thoughtful approach. Are they wearing gloves ‘just because’ or due to a perceived (but not tangible) risk of body fluid exposure? Or have they really worked through the task at hand, risk assessed the situation, and make an informed choice? If staff have done this, I’m pretty much always happy for them to wear gloves, whether or not I agree with their choice for this particular task. If the entire workforce thought this way, I’m convinced that our glove use would go through the floor!

And so to our paper for today. This is a consensus paper from an a group of experts in Portugal providing some guidelines for the selection and use of examination gloves in healthcare settings.

Why I chose this article:

• We have a long way to go towards best practice in the selection and use of gloves in healthcare settings – so every guidance document helps.
• The group behind this guidance are based in Portugal, so it provides some international perspective (unless you happen to be living and working in Portugal!).
• The review goes into more detail around some of the more technical aspects of glove selection and use than other guidance that I have seen.

Design and methods:

• The guidance was developed through a qualitative Delphi method to garner expert opinion from a panel of 30 experts.

Key findings:

• The guidance has an extensive section on glove production and dispensing.
• EN 455 is a key European testing standard that covers various aspects of glove testing, covering freedom from holes (AQL testing), physical properties (the level of force required to break the gloves, measured in Newtons), reactivity to the wearer (whether any ingredients or residues on the gloves are likely to cause irritation), and shelf life determination.
• The guidance recommends that gloves should have an AQL of <1.5, tensile strength of >6N, are dispensed one-by-one and from the cuff, that packaging is either recyclable or from recyclable materials, sealable and watertight, and can be disinfected.
• Ensuring that healthcare staff have adequate knowledge and skills to identify situations when gloves should (and should not) be worn is crucial. Knowledge around the unintended consequence of over-use of gloves is a critical factor.
• Training of not only healthcare staff but also patients, caregivers, and family members is an important (and less commonly discussed!) issue.
• The group consider non-sterile gloves (rather than sterile gloves) to be adequate when caring for chronic wounds (which will be controversial for some, who would argue that sterile gloves are a better choice here).
• There is a strong theme of sustainability running through the consensus document, suggesting that European manufacture for European usage is preferable, packaging and glove material to be optimised to have the least possible environmental impact, and how a higher quality glove with a lower failure rate is worth investing in!

Strengths and limitations:

• The overall document is substantial in terms of length and scope, but there is a fairly small number of the actual recommendations, which are fairly limited in scope.
• It would have been good to make some definitive recommendations on some of the more controversial aspects of glove use (e.g. when to wear gloves during some vascular access tasks, and when to choose sterile gloves over non-sterile gloves).
• In terms of waste, the recommendations mainly point towards local clinical waste approaches. I understand why this was done, because the management of clinical waste varies by country, but would have been good to open up a discussion about alternative waste steams (such as ‘offensive waste’).

Points for discussion:

• As many readers will know, I’m not the biggest fan of qualitative methods in general – but taking this approach allowed the guidance to cover some aspects of glove selection and use that an literature-based review could only ever offer: “there’s no evidence of this”!
• Are we paying enough attention to the physical characteristics of the gloves that are used in our organisation (cheapo gloves that rip easily are a false economy).
• Are there common tasks when it’s safe for us to choose not to wear gloves (some vascular access tasks, some elements of transmission-based precautions)?
• Are there areas where sterile gloves are over-used and could be replaced with (cheaper and more sustainable) non-sterile gloves (e.g. dentistry, wound care)?

What this means for IPC:

• We need to continue the conversation about gloves at every opportunity, to ensure that glove use is minimised, that when we choose to use gloves their physical properties are optimised for the task at hand, and that we consider the sustainability impact of all that we do.

Finally, hope you can join us for Journal Club tomorrow (register here).