48.

PUTTING ON STERILE GLOVES AND REMOVING SOILED GLOVES

DEFINITION

• When applying and wearing sterile gloves, keep hands above waist level and away from
nonsterile surfaces. Replace gloves if they develop an opening or tear, the integrity of the
material becomes compromised, or the gloves come in contact with any unsterile surface or
unsterile item. Refer to Fundamentals Review 4-2 for additional guidelines related to working
with sterile gloves. It is a good idea to bring an extra pair of gloves with you when gathering
supplies, according to facility policy. That way, if the first pair is contaminated in some way and
needs to be replaced, you will not have to leave the procedure to get a new pair.

EQUIPMENT

• Sterile gloves of the appropriate size

• PPE, as indicated

ASSESSMENT

 Assess the situation to determine the necessity for sterile gloves. In addition, check the
patient’s chart for information about a possible latex allergy. Also, question the patient about
any history of allergy, including latex allergy or sensitivity and signs and symptoms that have
occurred. If the patient has a latex allergy, anticipate the need for latex-free gloves.

NURSING DIAGNOSIS

Determine the related factors for the nursing diagnoses based on the patient’s current status. An
appropriate nursing diagnosis is Risk for Infection. Other nursing diagnoses that may be
appropriate include:

• Ineffective Protection • Risk for Latex Allergy Response

OUTCOME IDENTIFICATION AND PLANNING

The expected outcome to achieve when putting on and removing sterile gloves is that the gloves
are applied and removed without contamination. Other outcomes that may be appropriate
include the following: the patient remains free of exposure to infectious microorganisms, and the
patient does not exhibit signs and symptoms of a latex allergy response.

IMPLEMENTATION
ACTION RATIONALE

Perform hand hygiene and put on PPE, if Hand hygiene and PPE prevent the spread
indicated. of microorganisms. PPE is required based
on transmission precautions.
Identify the patient. Explain the procedure to
the patient.
Check that the sterile glove package is dry
and unopened. Also note expiration date,
making sure that the date is still valid.
Place sterile glove package on clean, dry
surface at or above your waist.
Open the outside wrapper by carefully
peeling the top layer back (Figure 1).
Remove inner package, handling only the
outside of it.
Place the inner package on the work surface
with the side labeled ‘cuff end’ closest to the
body.
Carefully open the inner package. Fold open
the top flap, then the bottom and sides
(Figure 2). Take care not to touch the inner
surface of the package or the gloves.
FIGURE 1. Pulling top layer of outside
wrapper back.
With the thumb and forefinger of the
nondominant hand, grasp the folded cuff of
the glove for the dominant hand, touching
only the exposed inside of the glove (Figure
3).
Keeping the hands above the waistline, lift
and hold the glove up and off the inner
Patient identification validates the correct
patient and correct procedure. Discussion
and explanation help allay anxiety and
prepare the patient for what to expect.
Moisture contaminates a sterile package.
Expiration date indicates the period that the
package remains sterile.
Moisture could contaminate the sterile
gloves. Any sterile object held below the
waist is considered contaminated.
This maintains sterility of gloves in inner
packet.
Allows for ease of glove application.
The inner surface of the package is
considered sterile. The outer 1-inch border
of the inner package is considered
contaminated. The sterile gloves are
exposed with the cuff end closest to the
nurse.
FIGURE 2. Folding back side flaps.
Unsterile hand touches only inside of glove.
Outside remains sterile.
package with fingers down (Figure 4). Be
careful it does not touch any unsterile
object.
FIGURE 3. Grasping cuff of glove for
dominant hand.
Carefully insert dominant hand palm up into
glove (Figure 5) and pull glove on. Leave
the cuff folded until the opposite hand is
gloved.
Hold the thumb of the gloved hand outward.
Place the fingers of the gloved hand inside
the cuff of the remaining glove (Figure 6).
Lift it from the wrapper, taking care not to
touch anything with the gloves or hands.
Carefully insert nondominant hand into
glove. Pull the glove on, taking care that the
skin does not touch any of the outer
surfaces of the gloves.
FIGURE 5. Inserting dominant hand into
glove.
Glove is contaminated if it touches any
unsterile objects.
FIGURE 4. Lifting glove from package.
Attempting to turn upward with unsterile
hand may result in contamination of sterile
glove.
Thumb is less likely to become
contaminated if held outward. Sterile surface
touching sterile surface prevents
contamination.
Sterile surface touching sterile surface
prevents contamination.
FIGURE 6. Sliding fingers under cuff of
glove for nondominant hand.
Slide the fingers of one hand under the cuff
of the other and fully extend the cuff down Sterile surface touching sterile surface
the arm, touching only the sterile outside of prevents contamination.
the glove (Figure 7). Repeat for the
remaining hand.

Adjust gloves on both hands if necessary, Sterile surface touching sterile surface
touching only sterile areas with other sterile prevents contamination.
areas (Figure 8).

FIGURE 7. Sliding fingers of one hand FIGURE 8. Adjusting gloves as necessary.

under cuff of other hand and extending cuff
down the arm.

Continue with procedure as indicated.

Removing Soiled Gloves

Use dominant hand to grasp the opposite

glove near cuff end on the outside exposed
area. Remove it by pulling it off, inverting it
as it is pulled, keeping the contaminated Contaminated area does not come in
area on the inside (Figure 9). Hold the contact with hands or wrists.
removed glove in the remaining gloved
hand.

Slide fingers of ungloved hand between the

remaining glove and the wrist (Figure 10).
Take care to avoid touching the outside
surface of the glove. Remove it by pulling it
off, inverting it as it is pulled, keeping the Contaminated area does not come in
contaminated area on the inside, and contact with hands or wrists.
securing the first glove inside the second
(Figure 11).
FIGURE 9. Inverting glove as it is removed. FIGURE 10. Sliding fingers of ungloved
hand inside remaining glove.

FIGURE 11. Inverting glove as it is removed, securing first glove inside it.

Discard gloves in appropriate container. Proper disposal and removal of PPE

Remove additional PPE, if used. Perform reduces the risk for infection transmission
hand hygiene. and contamination of other items. Hand
hygiene prevents the spread of
microorganisms.

EVALUATION

The expected outcome is met when gloves are applied and removed without contamination.
Other expected outcomes are met when the patient remains free of exposure to potential
infection-causing microorganisms, and does not exhibit signs and symptoms of a latex-allergy
response.

DOCUMENTATION

It is not usually necessary to document the addition of sterile items to a sterile field. However,
document the use of sterile technique for any procedure performed using sterile technique.

UNEXPECTED SITUATIONS AND ASSOCIATED INTERVENTIONS

• Contamination occurs during application of the sterile gloves: Discard gloves and open new
package of sterile gloves.
• A hole or tear is noticed in one of the gloves: Discard gloves and open a new package of
sterile gloves.
• A hole or tear is noticed in one of the gloves during the procedure: Stop procedure. Remove
damaged gloves. Wash hands or perform hand hygiene (depending on whether soiled or not)
and put on new sterile gloves.
• The patient touches the nurse’s hands or the sterile field: If the patient touches your hands
and nothing else, you may remove the contaminated gloves and put on new, sterile gloves. It
is always a good idea to bring two pairs of sterile gloves into the room, depending on facility
policy. If the patient touches the sterile field, discard the supplies and prepare a new sterile
field. If the patient is confused, have someone assist you by holding the patient’s hands or
reinforcing what is happening.
• Patient has a latex allergy: Obtain latex-free sterile gloves.