Is Handwashing Before Gloves Necessary? Examining the Evidence

Non-sterile gloves are widely used in healthcare settings to provide dual protection: they shield patients from potential pathogens on healthcare workers’ hands while also protecting providers from exposure to bodily fluids. Yet there’s often confusion about whether hand hygiene is required before glove use, and if so, what the proper sequence should be when applying and removing gloves.

Currently, the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommend performing hand hygiene first, allowing hands to dry completely, and then donning gloves. These guidelines are also endorsed by most national and international infection control organizations.

However, while SwipeSense and healthcare facilities continue to follow these established recommendations, a growing body of evidence over the last decade has begun to question whether hand hygiene before donning non-sterile gloves provides meaningful additional protection compared to direct gloving.

The Challenges of Handwashing Before Gloves

The recommendation to perform hand hygiene before donning gloves has a logical foundation. Healthcare workers’ hands often carry bacteria, and reaching into a glove box with contaminated hands could transfer pathogens to the gloves themselves. Additionally, with hundreds of gloves per box, contamination from one healthcare worker might affect gloves subsequently used by others.

However, this practice comes with practical challenges, particularly related to workflow efficiency:

• Time Constraints
  Hand hygiene before donning gloves requires healthcare personnel to wait for their hands to dry completely before putting on gloves. Studies indicate this process adds approximately 30-45 seconds per instance, which accumulates significantly across multiple patient interactions throughout a shift.
• Urgent Care Situations
  This delay becomes particularly problematic in urgent situations where immediate care is required. Healthcare workers must choose between waiting for their hands to dry properly or responding quickly to patient needs.

Perhaps due to these practical challenges, research shows that compliance with hand hygiene before gloves is often suboptimal. A recent multi-center clinical trial found that healthcare workers following a direct-gloving strategy (donning gloves without prior hand hygiene) demonstrated significantly higher overall compliance rates compared to those following traditional hand hygiene before gloves (87% vs. 41% adherence).

The Evidence on Bacterial Contamination

While it’s not surprising that compliance increases when protocols are simplified, what is remarkable is the research findings regarding bacterial contamination. Multiple studies have examined whether hand hygiene before donning gloves actually reduces bacterial presence—with intriguing results.

A controlled study published in the American Journal of Infection Control collected baseline finger and palm prints from healthcare workers’ hands, then randomized participants to either directly don non-sterile gloves or perform hand hygiene before donning gloves. The conclusion was clear: There was no significant difference in bacterial contamination between direct gloving and hand hygiene before gloving.

Similarly, another study compared bacterial loads on healthcare workers’ hands after proper hand hygiene versus new non-sterile gloves taken directly from glove boxes. In the end, researchers found essentially identical amounts of bacteria on freshly cleaned hands as on fresh non-sterile gloves taken directly from boxes. The median bacterial colony count was 1 for both groups, indicating very low contamination levels in both scenarios.

From a microbiological standpoint, these studies provide compelling evidence that hand hygiene before donning non-sterile gloves may not reduce bacterial contamination. When we combine this finding with the dramatic decrease in compliance when hand hygiene is required before gloves, the current protocol may actually be counterproductive to infection prevention goals.

Balancing Current Guidelines with Evolving Evidence

Despite these compelling findings, it’s important to note that the CDC and other regulatory bodies currently maintain their recommendation for hand hygiene before donning gloves. Healthcare facilities should continue following these established guidelines while the scientific community works toward consensus on this issue.

As research continues to develop and potentially reshape our understanding of best practices, this example illustrates why healthcare technology should be designed with adaptability in mind—because healthcare changes fast. 

SwipeSense’s hand hygiene monitoring system, for example, is built with flexibility as a core principle, allowing healthcare facilities to maintain compliance with current protocols while being prepared for potential future updates. Our platform requires no hardware changes or replacements to accommodate protocol updates—simply a software configuration change that can be implemented remotely.

By staying informed about emerging research and maintaining adaptable systems, we ensure our partners are well-positioned to implement whatever evidence-based protocols emerge from this ongoing scientific investigation. Above all, our top concern remains the safety of both patients and healthcare workers.