Covid 19 and gloves: When to

wear and when not to wear

Linda Nazarko
National Health Service | NHS 41.83 ·
MSc, PgDip, PgCert, BSc (Hons), RN, NIP, OBE, FRCNten for Peter Bradley 26th March 2020

The first rule of healthcare is to do no harm and some staff

working in hospitals and in shops are wearing blue nitrile
gloves. The aim is to protect themselves and people they
come into contact with but is indiscriminate use of gloves
part of the problem rather than part of the solution?
 Penyebaran virus Covid 19

• Droplets, ketika berbicara dan bernapas, lewat butir

droplets yang besar dan berat jatuh ke bawah pada jarak 50
cm;
• Yang kecil dan ringan (aerosol) terbang di udara lewat
batuk mencapai jarak 1-2 meter;
• Yang ringan (aerosol) bisa terbang dengan
menggumpal-gumpal (turbulence) mencapai jarak 8-9
meter;
Bernapas, bicara, batuk dan bersin
https://www.youtube.com/watch?v=piCWFgwysu0&feature=youtu.be
 Kesan...
• Virus dalam tubuh manusia sukar dikendalikan: tanpa
gejala, diagnosis, patofisiologi, obat, vaksin dst;
• Virus di luar tubuh lebih mudah dikendalikan, bisa dihitung
viral loadnya, antiseptik dst.
• Konsentrasi penanganan lebih banyak menyangkut
manusia, dengan segala macam kesulitannya;
• Protokol kesehatan mestinya protokol kesehatan dan
lingkungan;
• Perlu disusun program pengendalian Covid 19 dalam
lingkungan;
 Covid 19 and gloves:
When to wear and when
not to wear
 How does Covid 19 spread?

• The spread of infection within health care requires three

elements:

• A source of infecting organisms (bacteria, viruses, fungi);

• A susceptible host;

• A route of transmission of the organism from one person / site to

another.
Spread of infection (author’s own work)
 Covid 19 is a coronavirus and it is thought to be transmitted through
droplets generated by coughing and sneezing and through contact
with contaminated surfaces (DHSC et. al, 2020).

• Droplet transmission: by large droplets during coughing, sneezing,

talking and during procedures which may generate droplets such as
suctioning and bronchoscopy. The droplets are propelled only a
short distance through the air.
• Airborne transmission: caused by dispersal of smaller micro
organisms, e.g. viruses, or airborne dust particles containing the
infectious agent. These organisms can be widely dispersed by air
currents before being inhaled or deposited on the susceptible host,
or in the case of dust particles, onto horizontal surfaces and
equipment Many viruses are spread by airborne or droplet
transmission (Rosa et al, 2013)
https://www.youtube.com/watch?v=A9PMs_N33fU
How It's Made -- Rubber Gloves
Standard infection control precautions are evidence based guidance that aim to
provide staff with evidence based guidance to prevent healthcare associated
infections, figure two illustrates these categories (Loveday et al, 2014).
 Hand washing
• Hands must be washed or decontaminated before each and
every episode of direct patient contact and any activity that
could contaminate hands.
• Alcohol hand rubs should only be used on hands that are
free of dirt and organic material.
• Cuts should be covered with a waterproof dressing. Hands
and wrists should be free of jewellery.
• Staff should use hand creams regularly to protect their
hands from the drying effects of frequent washing and
decontamination.
 When you must wash your hands
• Hands must be washed or decontaminated before each and every
episode of direct patient contact and any activity that could
contaminate hands.
• The World Health Authority (2009) has produced guidance on hand
hygiene.
• This contains recommendations on when to wash your hands. Health
care workers must also decontaminate their hands before and after
all patient contact and whenever hands are visibly soiled.
• These recommendations which come from the work of Sax and
colleagues (2007) are shown in table one.
Sax and colleagues (2007)
 The problems associated with
inappropriate glove use
• The healthcare worker (HCW) who wears gloves inappropriately when
not delivering clinical care may touch a key board, answer a
telephone and touch his or her face.
• The gloves can provide the HCW with a false sense of security.
• If the HCW goes around the ward or unit wearing gloves then the
gloves can transmit the virus throughout the ward.
• Research indicates that coronaviruses such as Covid 19 can live for
extended periods on hard surfaces (Otter et. al, 2016).
• A research study found that viruses can survive on gloves for 2-4
hours (Casanova et. al, 2010).
 The problems associated with
inappropriate glove use
• It’s unthinkable for an HCW to neglect to wash hands for that length
of time however people who are completing paperwork may wear
gloves for considerable amounts of time.
• It is important that staff remove gloves with care to avoid
contaminating their hands.
• Staff should wash their hands after removing gloves.
• At present staff are using more gloves than ever before and there
have been reports of delays in obtaining supplies.
• Using gloves inappropriately can lead to a shortage of essential
equipment when it is needed to deliver care and that can cost lives.
 https://www.youtube.com/watch?v=X5xGNth5J9I
Latex gloves vs nitrile gloves | difference between latex and nitrile gloves
 The use of personal protective
equipment
• Gloves should be worn for all invasive procedures and all
activities that carry a risk of exposure to blood, body fluids,
secretions and excretions including during equipment and
environmental decontamination (DHSC, 2020).
• Gloves should be worn once only and changed between
patients.
• Staff who are allergic to latex should use alternative
products, such as nitrile gloves (Loveday et al, 2014).
• Figure 3 author’s own work) summarises guidance.
Additional guidance on glove use when caring for people
with Covid 19 infections or suspected infections.
 Handwashing Liquid soap products

• Washing hands with a liquid soap or detergent will remove

dirt, organic material and transient micro-organisms.
• This method of hand decontamination is all that is required
for most routine health care related procedures.
• Bar soap should not be used in clinical areas as it can
harbour some micro-organisms.
Alcohol Hand Rub/Gel (with or without
antibacterial additives)

• Alcohol hand gel can be used to remove microorganisms

from clean hands. .
• Alcohol hand gel can also be used between tasks and
between patients and is useful where adequate facilities are
not available Alcohol is inactivated in the presence of
organic matter and therefore is not used on soiled, grubby
hands.
 https://www.youtube.com/watch?v=Bx1lidaX1qk
Why gloves won’t do much to protect you from COVID-19
 Antiseptic Detergents (e.g.
Chlorhexidine)
• An antiseptic detergent may be preferred when caring for a patient
known to be colonised or infected with an antibiotic resistant
organism, e.g. MRSA, and prior to performing an aseptic procedure
or minor surgery.
• Aqueous, antiseptic hand washing agents are used to remove
organic contamination and reduce levels of resident flora, and with
repeated use, maintain low bacterial counts on the skin, e.g. under
sterile gloves.
• Antiseptic products must not be used routinely for hand washing.
• Prolonged, repeated use of antiseptic products can damage skin and
lead to an increased number of bacteria on the skin
 The My 5 Moments for Hand Hygiene approach
defines the key moments when health-care workers
should perform hand hygiene.
• This evidence-based, field-tested, user-centred approach is designed
to be easy to learn, logical and applicable in a wide range of settings.
• This approach recommends health-care workers to clean their hands

1. before touching a patient,

2. before clean/aseptic procedures,
3. after body fluid exposure/risk,
4. after touching a patient, and
5. after touching patient surroundings.
 The My 5 Moments for Hand Hygiene approach
defines the key moments when health-care workers
should perform hand hygiene.
 How to wash your hands
• Some areas of the hands are more frequently missed than
the others during hand decontamination.
• It is important to pay attention to all areas of the hands,
whilst washing, but paying particular attention to the finger
tips and nail area.
• These are the areas most in contact with the patient and
can be heavily contaminated with micro-organisms.
• Figure four, below show areas of the hands most frequently
missed.
More frequently missed

• All areas of the hands

• The finger tips and nail area

• The areas most in contact

with the patient
Some areas of the hands are more
frequently missed than the others
during hand decontamination.

It is important to pay attention to all

areas of the hands, whilst washing,
but paying particular attention to the
finger tips and nail area.

These are the areas most in contact

with the patient and can be heavily
contaminated with micro-organisms.

Figure four, below show areas of the

hands most frequently missed.
Wet hands under running water, then apply the recommended amount
of hand cleanser, rub hands together vigorously to make a lather using
following technique (see page ):

• Palm to palm (including wrists);

• Right palm over left dorsum & left palm over right dorsum;
• Palm to palm with fingers interlaced;
• Backs of fingers to opposing palms with fingers interlaced;
• Rotational rubbing of thumbs with thumbs clasped in
opposite palms;
• Rotational rubbing of finger tips in palms; REPEAT EACH
STEP 5 TIMES.
 Turn off taps using elbows

• Rinse the hands thoroughly under running water;

• Turn off taps using elbows or clean paper towels to prevent
recontamination, and dry hands thoroughly with clean paper towels.
• If in patient’s home, dry hands first and turn taps off using paper
towels or towel.
• Dispose of paper towel into a foot operated pedal bin. Do not lift up
the lid of the bin with hands as this will re-contaminate them. If
necessary, use hand towels to lift lid.
• If in patient’s home, dispose of towels into domestic waste.
 Conclusion
The appropriate use of personal protective equipment including gloves.

• Caring for patients with Covid 19 is a new experience for

healthcare workers and our knowledge of how the virus
affects people is still developing.
• There is a sound body of evidence that guides practice
when dealing with infectious diseases and that includes the
appropriate use of personal protective equipment including
gloves.
 Reducing the viral burden

• Infection control is a team effort and whilst wards where

people who have Covid 19 infections will have additional
cleaning measures in place staff may be required to wipe
down surfaces in frequently touched areas more
frequently.
 Glove Use Information
Leaflet
Outline of the evidence and considerations on medical glove
use to prevent germ transmission
 Medical gloves are defined as disposable gloves
used during medical procedures; they include:

• Examination gloves (non sterile or sterile)

• Surgical gloves that have specific characteristics of

thickness, elasticity and strength and are sterile

• Chemotherapy gloves – these gloves are not addressed

within this document
 Medical gloves are recommended to
be worn for two main reasons:

• To reduce the risk of contamination of health-care workers

hands with blood and other body fluids.

• To reduce the risk of germ dissemination to the

environment and of transmission from the health-care
worker to the patient and vice versa, as well as from one
patient to another.
1. Sterile
gloves
indicated;
2. Examination
gloves in
clinical
situation;
3. Gloves not
indicated;
Donning gloves
Donning gloves
Remove gloves
 Kesimpulan

• Dalam kaitan dengan Covid 19 seberapa besar peranan

sarung tangan dapat mengurangi penularan;
• Ternyata ada banyak pendapat kapan pakai dan kapan tidak
perlu pakai sarung tangan;
• Kajian mendalam perlu dilakukan dalam penggunaan
sarung tangan ini.