Gloves are a fundamental component of infection control, serving as a protective barrier for both the healthcare provider and the patient. This barrier is categorized into non-sterile (clean) gloves and sterile gloves, each designed for a specific level of pathogen elimination. Clean gloves are disposable and primarily used to prevent the transfer of microorganisms during routine contact. Sterile gloves, however, are individually packaged and treated to be completely free of all microorganisms, including bacteria, viruses, and spores. The decision to use one type over the other depends entirely on the risk of introducing pathogens into a part of the patient’s body that is normally microbe-free.
Defining the Need: Surgical Versus Medical Asepsis
The distinction between glove types is rooted in medical and surgical asepsis, the two main approaches to infection prevention in healthcare. Medical asepsis, often called clean technique, focuses on reducing the number of microorganisms and preventing their spread. This is achieved through practices like hand hygiene and surface disinfection. The goal is to keep pathogen numbers low enough to prevent infection, which is sufficient for non-invasive procedures.
Surgical asepsis, or sterile technique, is a rigorous approach aiming to create an environment completely devoid of all microorganisms. This method involves strict protocols, including the use of specialized sterile equipment, gowns, and gloves. The purpose is to eliminate the risk of introducing pathogens during procedures that bypass the body’s natural defenses. Therefore, sterile gloves are used to maintain this germ-free environment during an invasive procedure.
Critical Procedures Requiring Sterile Gloves
Sterile gloves are mandatory for high-risk clinical scenarios where the patient’s internal tissues or body cavities are accessed. These procedures carry the highest potential for Healthcare-Associated Infections (HAIs) and demand the protection of sterile technique. Any procedure that involves penetrating the skin barrier or entering a typically sterile part of the body requires sterile technique.
The insertion of central venous catheters (CVCs) and peripherally inserted central catheters (PICCs) requires sterile gloves. This prevents the introduction of pathogens directly into the bloodstream, making absolute sterility during insertion non-negotiable. Similarly, sterile gloves are required for the insertion of indwelling urinary catheters, such as Foley catheters, to protect the normally sterile urinary tract.
Sterile gloves are also necessary for procedures involving deep, complex wounds or burns to prevent contamination of compromised tissue. This includes sterile dressing changes for extensive surgical wounds or wounds where underlying structures, like bone or tendon, are exposed. Furthermore, sterile gloves are used when setting up a sterile field for involved bedside procedures, such as preparing for a chest tube insertion.
Common Tasks Where Clean Gloves Are Sufficient
In contrast to invasive procedures, many routine nursing tasks only require clean, non-sterile gloves, as the risk of contamination to a sterile body site is minimal. These gloves primarily function as personal protective equipment (PPE) for the nurse, preventing contact with bodily fluids and contaminated surfaces. They are designed to maintain a clean environment, not a sterile one.
Routine physical examinations, taking vital signs, and administering oral medications generally do not require gloves, relying instead on good hand hygiene. However, clean gloves are used when there is an anticipated risk of touching blood, body fluids, mucous membranes, or non-intact skin.
Clean gloves are appropriate for tasks such as handling soiled linens, emptying urinary catheter collection bags, or managing emesis to protect the healthcare worker from exposure to potential contaminants. They are also appropriate for administering injections, such as intramuscular or subcutaneous shots, and for routine peripheral intravenous (IV) insertion or discontinuation. Simple, non-surgical dressing changes for minor abrasions or superficial wounds can also typically be performed using clean technique.
Recognizing and Responding to Contamination
When a nurse is performing a sterile procedure, the concept of a sterile field is paramount, and any breach in sterility must be immediately addressed to protect the patient. Contamination occurs if a sterile glove touches any non-sterile surface, such as the nurse’s clothing, the patient’s skin outside the prepped area, or a non-sterile piece of equipment. Even a sterile field that is out of the direct line of sight is considered contaminated.
If a sterile glove is compromised, the nurse must immediately stop the procedure and change the gloves. The immediate action involves removing the contaminated gloves, performing hand hygiene, and donning a new sterile pair to re-establish the barrier. This response is a non-negotiable part of surgical conscience, as using a contaminated glove, even briefly, defeats the purpose of the sterile technique and significantly increases the risk of a Healthcare-Associated Infection.