Ask any healthcare provider about the most important rules about gloving in a medical setting, and you’ll hear that disposable gloves should never be reused. After all, the very fact that they are disposable means that they are intended for a single use, and those who intend to use gloves multiple times should buy reusable versions instead.
Suddenly, the demand for disposable gloves has skyrocketed. While the market is attempting to keep up, and officials are begging the public to save masks and gloves for healthcare providers who will need them for the battles ahead, these same providers are left wondering whether there is any way to stretch their current supply.
After all, in an ideal world, disposable gloves should be changed after becoming soiled, between patients, and even between certain procedures when done on the same patient. But providers are wondering whether they can squeeze more life out of these gloves by applying strong hand sanitizers or even by autoclaving them. Will doing so actually eliminate any microorganisms? Will it damage the gloves’ protective properties? What does the research say?
A Brand New Concern?
Surprisingly, this question is not new – at least in some parts of the globe. In many developing countries, medical necessities have always been in short supply. A disposable glove shortage often means that healthcare providers need to look for ways to cut corners, which includes finding ways to reuse their gloves as safely as possible.
Unfortunately, this has led to an underground business in which people illegally recover medical gloves from dumping sites and use questionable methods to “reprocess” them and resell them as recycled gloves.
The upside of this ugly truth? Researchers have done some – not much, but some – investigations into the concept of disposable glove reuse.
Glove Reuse: The Main Concerns
All researchers agree on one indisputable fact: ideally, disposable gloves should not be reused in any form. Any methods used to clean disposable gloves, from washing to decontamination or reprocessing, can compromise the health of both healthcare worker and patient.
When it comes to assessing the efficacy of disposable glove reuse, researchers focus on two main concerns:
- How effective different cleaning methods are in removing harmful microorganisms from the glove.
- Whether the cleaning process damages the protective properties of the glove.
Concern #1: Decontamination Effectiveness
There is research that suggests that some cleaning methods may effectively eliminate disease-causing microorganisms – but that others are completely ineffective.
For example, turning gloves inside out is probably the worst “method” of disposable glove reuse. This method transfers any germs on the hands onto the outer surface of the gloves, as well as any germs on the outside of the gloves onto the hands, defeating both purposes of gloving.
Cleaning the gloves with certain types of disinfectants have been studied as well. In one Turkish study, researchers found that liquid soaps containing 4% chlorhexidine and 7.5% povidone-iodine effectively eliminated all harmful microorganisms. Another study, conducted by Johns Hopkins Hospital, found that disposable gloves could be most effectively disinfected using an alcoholic-based chlorhexidine. In fact, some research suggests that disposable gloves can be disinfected up to 9-10 times using these types of solutions.
Concern #2: Effect on Protective Properties
At the same time, gloves can be damaged significantly during the disinfecting process, potentially compromising the protective nature of the glove. The alcohol in many of the disinfecting solutions that have been tested can cause the plastic in many disposable gloves to dissolve. In addition, other techniques such as autoclaving have an even higher failure rate, leading sections of the glove to stick together, and then to tear slightly upon separation. For example, gloves that were autoclaved in Sri Lanka due to financial concerns were discovered to have a perforation rate of 194/654, or 29.6%. Another study found 41% of autoclaved gloves at the Kenyatta National Hospital in Kenya to be substandard. Note that these studies were performed on latex or nitrile gloves, but other types of gloves may be affected differently.
The Bottom Line
Again, in an ideal situation, disposable gloves should never be reprocessed, recycled, or reused in any way. But in a less than ideal situation, when the supply of gloves runs low and a careful evaluation has concluded that glove reprocessing cannot be avoided, what guidelines should be followed?
- Avoid wasting gloves as much as possible through unnecessary use, by educating healthcare workers in the appropriate use of gloves during specific applications.
- Develop clear guidelines that discuss any clinical situations that may arise, including when disposable gloves should be reprocessed, when they should definitely be disposed of (e.g., when they are visibly soiled with blood or feces), and when they should be discarded after reprocessing (e.g., if perforations have been detected).
- Ensure that the donning and doffing of gloves is done properly, to avoid contamination of the inner surface from the outer contaminated surface.
- Create a system in which it is apparent how many times a set of gloves have been reprocessed, and decide on a number of processes that a glove can go through before it should be discarded.
- Make sure that all gloves are inspected for defects due to reprocessing. This includes:
- Inspecting gloves for visible cuts, holes, or openings
- Inspecting gloves for visible discoloration
- Inspecting gloves for visible cracking, as well as changes in shape or texture
- Lightly inflating gloves and then spraying them with a mild and dilute dish soap solution to check for air leakage
- Gloves should be washed with soap and water and then sanitized while on the hand.
- Consider double gloving when using reprocessed gloves, if possible.
Disposable medical gloves are intended to be for single use, and can risk transmission and infection if used incorrectly. They are difficult to reprocess adequately without compromising their effectiveness. At a time like this, however, it is important to consider how, under extreme circumstances, disposable glove reprocessing can be done in a way that is most likely to be effective.
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