Yes, it’s another COVID-19-related editorial. At this point, I’m sure we’re all running into pandemic fatigue. From seeing occasional high-risk patients (because we should in order to rule out sight-threatening eye pathology) to worrying about the asymptomatic spreaders, the ordeal has been draining. I encourage all of you to not yet drop your guard. Help certainly seems to be nearby, as more of us get vaccinated. As a front-line provider and part of a heavy exposure group, I hope that we take full advantage of the offer to getting the vaccine early. 

A seemingly mundane but important topic of intense discussion is the decision to use gloves in your practice. For those of us who see contact lens patients, or even occasionally place a lens on an eye, such as a bandage lens, it’s quite difficult to handle a lens with gloves on. 

The use of gloves, as well as the frequency of removal and disinfection, has been a recent topic in our office and in online chat groups. We have 32 providers in our group and each of us is managing glove use a little differently. Some glove up throughout the day and replace their set after seeing each patient; others are handwashing between each patient and room. 

What are you doing as a health care provider for hand hygiene? Are you wearing gloves throughout the day (changing between every patient and room)? Are you wearing the same pair of gloves during multiple patient encounters using gel sanitizer between patients? Are you washing your hands between patients and rooms? 

Note that hand sanitizers over gloves may actually miss portions of the glove, and, after repeated application, the effectiveness may also be lost. Although the use of gloves can reduce skin irritation, it is not more effective than handwashing with soap for 20 seconds for routine patients and provides little additional protection for the user.¹ 

Keep Sanitation at Hand

The Centers for Disease Control & Prevention (CDC) provides a helpful COVID-19 hand hygiene guidance document for health care providers (www.cdc.gov/coronavirus/2019-ncov/hcp/hand-hygiene.html). 

The CDC continues to highlight the importance of hand hygiene in response to COVID-19. They recommend the use of alcohol-based hand rub gels and handwashing as effective measures in preventing the spread of infections and pathogens in health care settings. Handwashing mechanically removes pathogens, and alcohol-based gels (60% to 95%) can inactivate SARS-CoV-2.^1,2 

Supplies necessary for adherence to hand hygiene should be readily accessible in all areas of the office.³ There is some evidence that suggests an alcohol-based hand rub is preferred over simply washing hands since there may be better compliance with the hand rub—and it may be even less irritating over time.³

Some providers will continue to use gloves. But, remember to change and remove them carefully between rooms and patients. You still need to also wash your hands carefully before you put on a new pair of gloves for added protection to ensure the gloves are not doing more harm than good. Review the proper way to don and doff gloves (twitter.com/accpchest/status/1242876172402393088).² Using gel or any form of sanitization or disinfection on a used pair of gloves poses problems, so I’d strongly advise against this practice. 

My Personal Verdict

For me, I’ll make the shift from gloves back to handwashing. However, I will also make sure to use hand moisturizers at the end of the morning and the end of the day to protect my hands from frequent handwashing. You can certainly use gloves when you need to protect your hands and especially if you are seeing a confirmed case of COVID-19 or if you have any open sores or lesions on your hands. 

You may also want to assure your patients in some fashion before or during the exam that by not wearing gloves you really are not losing out on any measurable benefit if your hands are washed properly. Patients do have this false impression that gloves are universally better than handwashing or alcohol-based hand rub. That doesn’t seem to be the case.

Here’s wishing all of you a better 2021 and hoping you continue to stay safe!

1. CDC. Hand hygiene recommendations: guidance for healthcare providers about hand hygiene and COVID-19. www.cdc.gov/coronavirus/2019-ncov/hcp/hand-hygiene.html. May 17, 2020. Accessed January 4, 2021.  2. CDC. Sequence for putting on personal protective equipment. (PPE). www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf. Accessed January 4, 2021. 3. CDC. Hand hygiene in healthcare settings: show me the science. www.cdc.gov/handhygiene/science/index.html. Accessed January 4, 2021.