I recently attended a webinar hosted by the Medical Society Consortium on Climate & Health focused on reducing harmful plastics in healthcare. I wish I could share a recording, but thus far, I haven’t come across one on the Consortium’s website, and though I searched my email inbox, I don’t think a recording was sent out yet to attendees. As part of Plastic Free July, I wanted to share a little bit about what I learned. 

I’ll need to write a separate post about the eye-opening information I gleaned from Julie Jacobson Vann’s presentation on di(2-ethylhexyl) phthalate, aka DEHP, and its presence in a wide variety of medical devices. If you’ve been in the hospital for virtually any reason in the U.S., as a patient or a staff member, you’ve likely been exposed to DEHP. This substance is a plasticizer that negatively impacts human health, and is actively avoided in medical devices in countries like Norway. Some U.S. states have passed, or are working on, legislation to ban the use of DEHP and similar substances in medical devices. But that’s a separate story, coming soon to another post. I mention it here simply because it’s one of the interesting plastic-related takeaways I got from the excellent Consortium webinar.

What I want to focus on in today’s post is the notion that single-use plastic gloves are being vastly overused in medical settings, as explained by Yvonne Huckleberry, PharmD, BCPS, FCCM, of Banner University Medical Center in Tucson, AZ, during the recent webinar. She described Banner’s “Gloves Off” campaign to encourage health care workers to rethink their use of disposable gloves, avoiding them when good hand hygiene through the use of hand washing or hand sanitizing gel would be appropriate. Again, since I don’t have access to a recording or the slides from the webinar, I can’t share exact statistics related to their efforts, but this campaign has reportedly helped that institution reduce waste, cut costs, and improve sanitation. 

I’ve worked in laboratory settings in the past, so I have personal experience using these types of disposable plastic gloves. And because of my work with the zero waste team at the Illinois Sustainable Technology Center (ISTC), I’m also aware of programs to recycle them, including Kimberly-Clark’s brand specific RightCycle program and TerraCycle’s collection boxes and pallets geared toward any brand of disposable gloves. Further, from ISTC experience, I know that these types of disposable gloves represent a significant form of plastic waste generation not only in laboratory and health care settings, but also in food service and facilities/janitorial services. 

My colleagues and I have suggested recycling programs to clients in all of these settings, and while I tend to always focus more on waste reduction/prevention and reuse as better strategies than recycling waste after it has been generated, for some reason, I’ve never thought much about avoiding the use of these disposable gloves as a strategy. I suppose that having used them myself in both lab settings and during waste audits (involving the hand sorting of messy garbage and recycling), I’m predisposed to think that if someone is wearing these items, there’s a perfectly good reason to do so. However, I learned during this webinar that there is a tendency in the medical profession to wear them even when there’s no risk of exposure to bodily fluids or pathogens or need to provide sanitation beyond that which could be conferred by good hand hygiene. Ironically, studies have shown that wearing gloves in non-essential circumstances, or continuing to wear them improperly during patient-related activities, can lead to cross-contamination of surfaces and the spreading of germs, presumably because gloves give people a false sense of security or protection in some instances, causing folks to pay less attention than they should to the state of their gloves and their own behaviors while wearing them. For examples of scholarly articles discussing misuse of disposable gloves in clinical settings, see Lindberg et al, 2020 at https://doi.org/10.1016/j.infpip.2020.100091 and Paul et al, 2021 at  https://doi.org/10.1016/j.ajic.2021.04.002m. 

In Chapter 23 of the text, Hand Hygiene, A Handbook for Medical Professionals, Chraïti et al. state: “Gloves are an effective barrier to protect HCWs from microbial transmission when their hands are exposed to body fluids, and to prevent microbial spread within the care environment and to the patient. However, gloves do not ensure total protection, regardless of their characteristics (either surgical gloves or examination gloves, sterile or nonsterile), and the material they are made of (latex, vinyl, nitrile, and neoprene mostly). Microorganisms can pass through gloves; the microbial load depends on the quality of gloves, the mechanical stress applied to the material, the presence of undetected tears and holes, the duration of glove wearing, and the concentration of microbial exposure. HCW hands may become contaminated despite glove use as a result of poorly fitting gloves, contamination of hands during glove removal, or by touching contaminated gowns or clothing after glove removal. As reported in several studies, gloves can get contaminated as easily as bare hands when touching patients, their environment, or both. Thus, when misused, gloves may change from being protective to becoming a means of germ transmission. Thus, gloves should be considered as an adjunct to hand hygiene rather than a substitute. Wearing gloves does not modify indications for hand hygiene and does not replace it.” [Chraïti, M.-N., Allegranzi, B. and Larson, E. (2017). Glove Use and Hand Hygiene. In Hand Hygiene (eds D. Pittet, J.M. Boyce and B. Allegranzi). https://doi.org/10.1002/9781118846810.ch23; note that “HCW” refers to healthcare workers] 

I also found a 2009 World Health Organization (WHO) document devoted to hand hygiene. Part 1, section 23 of that document includes information on glove policies, glove efficacy, glove use and hand hygiene, and guidance on the appropriate and safe use of gloves, with helpful illustrations. Table I.23.1 provides “Indications for gloving and for glove removal,” and Figure I.23.1 is a helpful illustration listing examples of clinical situations requiring and NOT requiring glove use. I would share it here, but don’t want to violate copyright. Essentially, gloves (sterile or non-sterile, depending on circumstances) should be used in situations requiring sterility (e.g. surgery, birth, invasive procedures, vasucular access, etc., or direct or indirect patient exposure involving blood, bodily fluids, secretions or excretions, or items visibly soiled by bodily fluids. Beyond that, gloves shouldn’t be used except for contact precautions. So, for example, if you’re taking the blood pressure of a person, providing oral medications, providing or collection food trays, or replacing bed linens, among other things, there’s no reason to wear gloves. Instead, you should exercise proper hand hygiene. (See WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care. Geneva: World Health Organization; 2009. 23, Practical issues and potential barriers to optimal hand hygiene practices. Available from: https://www.ncbi.nlm.nih.gov/books/NBK144047/.) As I recall, Banner University Medical Center had created some posters along these sorts of lines to encourage workers to more carefully consider disposable glove use.

During the webinar, I learned that good hand hygiene is typically part of training for nurses (and presumably doctors and other medical professionals), but in practice, people are sometimes instructed to use gloves by mentors/managers, or they see the use of gloves modeled by others, and so they adopt overuse of gloves despite their training.

While (unsuccessfully) trying to find online information on Banner University Medical Center’s “Gloves Off” campaign, I came across evidence of similar campaigns elsewhere, mostly in the UK, illustrating that this is not a unique program. The following journal articles and other resources relate to those UK efforts and illustrate waste reduction and cost savings from these campaigns:

So if you work in a health care setting and you’re interested in reducing plastic waste generation, consider championing a “gloves off” campaign at your workplace. Not only will you reduce plastic waste if the campaign is successful, but you’ll also reduce costs AND prevent contamination and the spread of germs. 

If you’re a health care professional and your organization has implemented this type of campaign, especially if you’re in the USA (beyond Banner University Medical Center), I’d love to hear more about it!