To Don or Not to Don? The Non-Sterile Glove Question

Did you know that when misused (or used excessively and inappropriately), nonsterile (nitrile) gloves can actually hamper effective infection prevention control, pose risks to staff health, and result in unnecessary costs, waste and environmental harm?  

Well, unfortunately- this is the case. Although it is true that nonsterile gloves (NSGs) are an essential component in preventing transmission of contagions in certain cases, this medical device also can provide an “illusion of quality improvement”. If NSGs are misused, use can actually impede infection prevention and control, potentially increasing risk for contagion cross-contamination and hospital acquired infections. This is most likely to occur when NSGs are not donned and doffed with appropriate technique, not removed at critical time points, and hand hygiene does not proceed and follow use. It must be emphatically stated that NSGs are NOT a substitute for good hand hygiene. Moreover, the World Health Organization (WHO) does not consider NSG use to be a hand hygiene procedure.

We recommend using a risk-based approach for the necessary use of NSGs. The following guidelines are provided (based on the Glove Use Pyramid for Patient Care in the reference below): use NSGs when handling or in contact with the immediate environment of animals on infectious disease transmission (suspected or confirmed) or contact-based precautions (such as receiving chemotherapeutics), when handling immunocompromised patients or for staff who are immunocompromised, in the presence of nonintact skin or mucous membranes (including deep oral or perineal exams), when handling bodily fluids, tissues, excrement, or hazardous chemical materials. Furthermore, it must be highlighted that these gloves are for single use ONLY and should not be washed or sanitized and reused as this may reduce their barrier integrity. NSGs should be immediately removed after use, between patient contact, between clean and dirty procedures on the same patient, before touching surfaces (pens, charts, keyboards, door handles etc) to reduce the likelihood of cross-contamination of the environment. NSGs are likely not needed in the following common circumstances: routine examination, using a computer, phone, writing in a chart, administering subcutaneous or intramuscular injections or food preparation. Importantly, perform good hand hygiene before and after glove use, before and after patient contact or a patients’ immediate surroundings, as per the veterinary adapted WHO Five Moments of Hand Hygiene (see reference below).

The indiscriminate and overuse of NSGs to “cover all bases” can result in a huge amount of waste and unnecessary cost. NSGs are the highest volume single use medical device purchased by human healthcare annually, at a cost to US healthcare of ~ $1.5 B in 2022 alone.  The manufacture and distribution of NSGs also results in substantial GHG emissions- for US healthcare annually this is equivalent to driving a car 1.8 billion miles. Standard nitrile gloves are also very persistent in the environment when discarded. They take about 100 years or more to break down and as they do so they form micro and nano plastics, methane, carbon dioxide, and in some cases if incinerated toxic air pollutants. Biodegradable nitrile glove options are available that breakdown ~90% in 1.5 years: Natrle by Vetflex and Betterglovesby KVP. For more information see this VSA information piece on nitrile gloves.

NSG use can also result in poor hand health. Examples include: dermatitis associated with reactions to persistent accelerant chemicals embedded in nitrile gloves from their manufacture, allergies to latex-based gloves, and wearing gloves for prolonged periods can result in excessive hand wetting, maceration, and breakdown of the skin barrier, dermatitis, and increased microbial colonization.

Finally, promote good skin health and barrier protection by decreasing use of glove use when unnecessary (as per the glove use pyramid), use high-quality hand sanitizers when appropriate to replace the potentially damaging effects of frequent hand washing, ensure complete but gentle hand drying, and regular use of moisturizers.

Reference:

Westworth, DR, Battersby I, Banks, D. Nonsterile gloves: to don, or not to don, what is best practice? JAVMA, 2025. doi.org/10.2460/javma.25.04.0261