Use of gloves for personal protection and prevention of disease transmission has become a mainstay component of infection control for dentistry. Both the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA) have issued specific recommendations concerning the use of gloves to both prevent disease transmission and protect against exposure to harsh chemicals, such as surface disinfectants. This article will review the procedures concerning the proper use of gloves, the types of gloves available, and basic hand hygiene.
In dentistry, any procedure involving exposure directly or indirectly to saliva or blood requires use of personal protective equipment (PPE), including gloves. In nonsurgical clinical procedures, nonsterile examination gloves are acceptable. Sterile gloves are required for surgical procedures, which are invasive procedures that involve cutting of soft tissue or bone, or those involving exposure of normally sterile tissues. All clinical and most laboratory procedures in dentistry require some form of glove protection. While glove utilization is important for disease prevention, optimizing the effectiveness of glove use begins with basic hand hygiene.
It is important to understand that gloving does not replace the need for proper handwashing and that this simple procedure is the first and most important step in disease prevention.
Unless involved in a surgical procedure, employ the following handwashing protocol, which comes from the Organization for Safety and Asepsis Procedures (OSAP) in its CDC Guidelines Workbook, From Policy to Practice: OSAP’s Guide to the Guidelines. Routine handwashing is required prior to donning and after removing gloves, before leaving the operatory or lab, when hands are visibly soiled, and after contact with inanimate objects that may be contaminated.
Before and after treating each patient:
- First, wet hands with water
- Apply plain or antimicrobial soap to hands and rub hands together to create a lather
- Rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers
- Rinse hands with water - avoid using hot water; repeated exposure to hot water may increase the risk of dermatitis
- Dry hands thoroughly with a disposable towel and avoid using multiple-use towels of the hanging or roll type
- If the faucet is manual, use the towel to turn off the faucet (you do not want to contaminate your clean hands)
Surgical procedures require the following protocol:
- First, remove rings, watches, and bracelets
- Use a nail cleaner under running water to remove debris from under fingernails
- Scrub hands and forearms for the length of time recommended by the manufacturer (usually two to six minutes) with antimicrobial soap with proven persistent activity
- Dry thoroughly before donning sterile surgical gloves
Alcohol-based hand rubs have become a viable alternative within hand asepsis protocols, especially when handwashing facilities are not readily available. Hand rubs are as effective as washing with antimicrobial soap. Studies indicate that compliance is greater when hand rubs are used. Also, common adverse effects associated with handwashing, such as drying and irritation, are minimal. However, if hands are obviously soiled, do not use alcohol hand rubs. Rather, use soap and water or an antimicrobial soap.
Alcohol-based hand rubs require proper technique. Steps include:
- Read and follow the manufacturer’s recommendations, especially as to the proper amount of product to use
- Apply hand rub to the palm of one hand and then rub hands together, assuring coverage of all hand surfaces
- Continue rubbing until hand surfaces are dry (at least 15 seconds)
Use and selection of gloves
As stipulated, all procedures involving blood or saliva require glove utilization. Nonsterile examination medical-grade gloves are appropriate for all procedures aside from those classified as surgical. In those cases, sterile/surgical grade gloves are required. Gloves should fit well, not compromising movement of the fingers. Tight gloves impinge hand musculature, potentially contributing to musculoskeletal disorders (MSD). Conversely, loose gloves may cause clinicians to apply excessive pressure that may also contribute to MSD.
To evaluate proper fit of gloves, clinicians should stand up straight with their arms to the side at rest. Note the position of the thumbs and fingers. Clinicians then don a glove and evaluate thumb and finger positions while at rest; they should be identical to the at-rest position observed without gloves. Avoid the use of loose-fitting gloves because they may gap, tear, or puncture, resulting in exposure. Ideally, gloves are hand-specific (right and left) in specific sizes. Hand-specific gloves usually offer more sizing options than ambidextrous gloves. Finally, clinicians should evaluate the cuff extension and may wish to choose a glove with a cuff that extends over the bottom of a long-sleeved protective gown. This will prevent snagging of items on the edge of the sleeve and will help keep the sleeve cuff debris-free.
Gloves should not be rinsed or washed and must be replaced immediately if torn, punctured, or damaged in any way. Additionally, replacement of gloves between patients is mandatory. Gloves are single-use, disposable items. Replace gloves contaminated with blood/body fluids during a procedure. Clinicians should be aware that gloves become less effective the longer they are used. For that reason, change gloves on a regular basis during lengthy procedures.
Removing contaminated gloves, decontamination procedures, and latex sensitivity
At the completion of a clinical procedure, the first PPE item removed is gloves. Using a gloved hand, grab the other glove at the outside cuff and pull downward, turning the glove inside-out. Then use the ungloved hand to grab the inside of the remaining glove and pull downward. Once removed, gloves should be properly disposed of and hands then thoroughly washed.
Patient examination and sterile gloves are for direct patient care procedures and not considered appropriate for indirect contact or decontamination/cleaning of instruments and environmental surfaces. Instead, use puncture- and chemical-resistant heavy-duty utility gloves. These gloves protect against sharps injury during instrument decontamination/cleaning. They also prevent exposure to the chemicals used during operatory cleaning/disinfection procedures. Interestingly, the materials that make up most utility gloving used in dentistry - neoprene and nitrile - are also options that exist in examination gloves for those with latex sensitivity or allergies.
Those clinicians with latex sensitivity or allergy should avoid latex gloves and instead opt for nonlatex gloves. Latex-free options are made of synthetic materials such as nitrile, neoprene, or vinyl and are widely available. Some products may also offer additional protection against chemical contaminants. Powder-free gloves with low protein content are also available. Regardless of whether or not a practice employs a clinician with latex sensitivity or a latex allergy, latex-free options must be available for those patients who fall into these categories.
Maximizing safety through hand hygiene
While gloves are an integral part of proper PPE use and infection control, complete hand hygiene includes handwashing and asepsis protocols. Routine handwashing combined with gloving will provide both clinicians and patients optimal preventive protection from disease transmission. Hand hygiene is the single most effective means against disease transmission and must be carefully considered, integrated, and implemented for optimal safety and health.
An excellent resource available to the profession covering this and the other CDC recommendations is the Organization for Safety and Asepsis Procedures (OSAP) From Policy to Practice: Guide to the Guidelines, a workbook designed to assist practices with integration and implementation of all the CDC guidelines. Contact OSAP at www.osap.org for this resource and membership information. Offices that are members of OSAP are on the cutting edge of infection control technology, regulation updates, and optimal infection control practices. You can also reach OSAP at (800) 298-OSAP.
Kristy Menage Bernie is director and co-founder of Educational Designs, a dental hygiene consulting service that designs and implements education-based marketing strategies. She is an active member of both OSAP and ADHA and welcomes comments and inquiries at (925) 735-3238 or at [email protected].
Ideal glove characteristics and considerations
- Well fitting, not too tight or loose (comfortable fit)
- Low pin-hole rates
- Credible manufacturer
- Appropriate material for the task
- Good tactile sensitivity without instrument slippage
Considerations for glove use
- Do not wash or reuse for any purpose
- Replace immediately if torn, heavily contaminated, or worn for an extended period of time
- Ensure latex-free options for latex sensitivity or allergic clinicians and/or patients
- Gloves with flavoring agents may provide greater patient acceptance
Special considerations for hand hygiene and glove use from the 2003 CDC Infection Control Guidelines for Dentistry
- Use hand lotions to prevent skin dryness
- Consider compatibility of antiseptic products and the effect of petroleum or other oil emollients on the integrity of gloves during product selection and glove use
- Keep fingernails short with smooth, filed edges to allow thorough cleaning and prevent glove tears
- Avoid the use of artificial fingernails
- Do not wear artificial fingernails or extenders when having direct contact with patients at high risk (e.g., those in intensive care units or operating rooms)
- Do not wear hand or nail jewelry if it makes donning gloves more difficult or compromises the fit and integrity of the glove