Hand hygiene.pdf

quality gloves, reuse, shortage of appropriate glove size, and imprecision of tests for perforations
prior to reprocessing, if necessary 642 .
Although no recommendation exists concerning the washing and reuse of gloves nor the
washing or decontamination of gloved hands followed by reuse on another patient, these are
common practices in many health-care settings in developing countries where glove supply
is limited 642 . In one study, washing gloved hands between patient treatments using 4% chlorhexidine
and 7.5% povidone-iodine liquid soaps for 30 seconds eradicated all organisms
inoculated from both glove surfaces 643 . Another study describes a significant reduction of
bacterial count on perforated gloves to permit their reuse for non-sterile procedures after
cleansing of the gloved hand using an alcohol-based preparation with chlorhexidine 644 .
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 645 .
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 645 .
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 646 .
Cleansing gloved hands to allow for prolonged use on the same patient can result in considerable
savings of disposable examination gloves in resource-poor settings. This practice
depends on the type of gloves and the agent used. Some evidence exists that cleansing
latex-gloved hands using an alcohol-based handrub solution is effective in removing microorganisms,
and shows increasing contamination rates of hands only after 9–10 cycles of
cleansing (M. Rotter, personal communication). However, cleansing plastic-gloved hands
with an alcohol-based formulation leads to early dissolving of the plastic material.
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. Interestingly,
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 647 . 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 opinion of international experts consulted by WHO is that glove reprocessing must
be strongly discouraged and should be 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 addressed.
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 due to unnecessary use and by providing a secure
stock of good quality single-use surgical and examination gloves, together with a budget for
regular restocking. 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 avoid inappropriate use
of gloves (see Figure I.20.1).