WHO Guidelines on Hand Hygiene in Health Care - Safe Care ...

PART I. REVIEW OF SCIENTIFIC DATA RELATED TO HAND HYGIENE
assessment and some criteria for opting for reprocessing gloves
in order to minimize the risks and to optimize the results. Before
planning or continuing the reprocessing of used gloves, every
health-care facility should first undertake an assessment of
factors leading to the shortage of single-use gloves, such as
budget constraints or interrupted supply chains. Efforts should
focus on reducing the need for gloves by avoiding wastage
caused by unnecessary use and by providing a secure stock
of good quality single-use surgical and examination gloves,
together with a budget for regular restocking. Opting for glove
reprocessing without having made these assessments would
amount to contributing to the maintenance of inappropriate
glove use. Health administrators are encouraged to purchase
good quality disposable gloves and replenish stocks in time.
In addition, clinic managers and supervisors should check
that gloves are not wasted, and HCWs should be educated to
appropriate use of gloves (see Figure I.23.1).
In institutions with limited resources, some authors suggest that
if the necessity for the reprocessing of single-use gloves persists
after a thorough evaluation, the reprocessing of previously
decontaminated and thoroughly cleaned surgical gloves using
sterilization (autoclaving) or high-level disinfection (steaming) can
produce an acceptable product; when combined with double
gloving, this may constitute a temporary tolerable practice. 952,953
However, the practice could be retained only if basic criteria,
such as glove quality, are satisfied and the selected processes
and technologies for reprocessing are reliable and under
control. A universal problem is the introduction of equipment,
technology, and method with no evaluation of associated needs.
In this case, their reliability and safety are not guaranteed. 929
If reprocessing does take place, the institution should develop
clear policies to define clinical situations where gloves are
needed, when the use of reprocessed gloves can be tolerated,
and when gloves should be discarded and not reprocessed
(e.g. when holes are detected). Only surgical latex gloves may
be reused either as surgical gloves using double gloving or as
gloves for examination purposes. Some authors recommend
that latex rubber surgical gloves should be discarded after
three reprocessing cycles because gloves tear more easily
with additional reprocessing. 954,955 Examination gloves should
never be reprocessed because of their particular composition
properties, thinness, and inelasticity.
Systematic research is urgently needed to evaluate
reprocessing methods and to develop and validate a process
that leads to a product of acceptable quality. Furthermore,
well-conducted cost–benefit studies are required to evaluate
the potential benefits of reprocessing gloves and the general
need for investing in preventive measures. Through an analysis
of the financing structures of health-care delivery systems in
developing countries, incentives for investment in the prevention
of HCAIs from the individual, institutional, and societal
perspectives can be identified.
The practice of autoclaving used plastic gloves in case of
shortage and of autoclaving new plastic gloves meant for
examination for use as surgical gloves has been described. 956
The reprocessing at 125 °C leads to gloves sticking together,
and separation causes tears and holes. The authors found 41%
of recycled gloves with impaired integrity. 956 Another potential
hazard is often witnessed in developing countries: many
reprocessing units use powder inside reprocessed latex gloves
to prevent material sticking together and to facilitate reuse. The
consequences of use of powdered latex gloves in terms of the
development of latex allergies and impaired working conditions
leading to sickness in HCWs are well documented. 957
In general, one of the major risks of reprocessing gloves is that
they could show a higher rate of non-apparent holes and tears
after the reprocessing cycle than new ones. A study by Tokars
et al. showed that surgeons wearing a single layer of new
surgical gloves had blood contact in 14% of the procedures,
and blood contact was 72% lower among surgeons who double
gloved. 958 Therefore, double gloving in countries with a high
prevalence of HBV, HCV and HIV for long surgical procedures
(>30 minutes), for procedures with contact with large amounts
of blood or body fluids, for some high-risk orthopaedic
procedures, or when using reprocessed gloves is considered an
appropriate practice.
The illegal recovery and recycling of discarded gloves from
hospital waste dumping sites, often using dubious and
uncontrolled reprocessing methods, can constitute an additional
health hazard and is of growing concern in countries with limited
resources. Hospitals are therefore encouraged to destroy each
glove before discarding.
In brief, the opinion of international experts consulted by <strong>WHO</strong>
is that glove reprocessing must be strongly discouraged and
avoided, mainly because at present no standardized, validated,
and affordable procedure for safe glove reprocessing exists.
Every possible effort should be made to prevent glove reuse
in health-care settings, and financial constraints in developing
countries leading to such practices should be assessed and
tackled. Institutions and health-care settings should firmly avoid
the reuse of gloves. In circumstances where the reprocessing
of gloves has been carefully evaluated but cannot be avoided,
a clear policy should be in place to limit reprocessing and reuse
of gloves until a budget is allocated to ensure a secure supply of
single-use gloves. Policies for exceptional reprocessing should
ensure a process that follows strict procedures for collection,
selection and reprocessing, including instructions for quality/
integrity control and discarding of unusable gloves.
23.1.7 Conclusions
Medical glove use is an evidence-based measure to protect
patients, HCWs, and the environment. The recommendations
for glove use must be implemented regardless of the type
of setting and the resources available. Nevertheless, glove
misuse is observed regularly worldwide, irrespective of the
underlying reasons. Even in institutions where gloves are widely
available, HCWs often fail to remove gloves between patients
or between contact with various sites on a single patient,
thus facilitating the spread of microorganisms. 154,744,952,959,960
Knowledge dissemination and practical training on the
appropriate use of gloves are the foremost interventions leading
not only to best practices, but also to resource saving. Deficient
glove procurement in terms of quantity and quality causes
inappropriate and unsafe practices such as glove misuse
and overuse and may lead to uncontrolled reprocessing. 929,947
No evidence-based recommendations for glove reuse or
reprocessing exist other than those described above. Medical
gloves are meant to be disposable and for single use. They are
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