Removal of nosocomial pathogens from the contaminated glove. Implications for glove reuse and handwashing

Study Objective: To evaluate the effectiveness of three different types of handcleansing agents in decontaminating gloved hands that were inoculated with a series of four nosocomial pathogens. Design: A controlled, experimental trial. Setting: Tertiary care referral center. Patients or Other Participants: Five healthy volunteers participated in all portions of the study. Interventions: A standard concentration of one of four representative mosocomial pathogens was placed on the gloved hand, spread, and allowed to dry. One of three different handcleansing agents - a nonmedicated soap, a 60% isopropyl alcohol preparation, or 4% chlorhexidine gluconate - was used to cleanse the gloves, which were cultured using a broth-bag technique. The gloves were then removed and the hands were cultured in a similar manner. Measurements and Main Results: The handwashing agents reduced the median log₁₀ counts of organisms to 2.1 to 3.9 after an inoculation of 10⁷ colony forming units. The proportion of positive glove cultures for Staphylococcus aureus, 8% to 100%; Serratia marcescens, 16% to 100%; and Candida albicans, 4% to 60% varied greatly after use of the different handcleansers (P < 0.001), and varied considerably for Pseudomonas aeruginosa, 20% to 48% (P = 0.085). After the gloves were removed, the differences among the observed proportions of hands contaminated with the test organisms varied from 5% to 50%, depending on the handcleansing agent used (P < 0.001). Conclusions: In the era of universal precautions these data suggest that it may not be prudent to wash and reuse gloves between patients. Further, handwashing is strongly encouraged after removal of gloves.