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Healthcare-associated infections affect millions of patients annually. This guide integrates the WHO Five Moments for Hand Hygiene with evidence-based glove use protocols to reduce cross-transmission and improve patient safety. Healthcare-associated infections (HAIs) remain one of the most significant threats to patient safety worldwide. The World Health Organization (WHO) estimates that hundreds of millions of patients are affected by HAIs each year, leading to increased mortality, prolonged hospital stays, and higher healthcare costs. Hand hygiene is the single most effective measure to prevent HAIs, yet compliance remains suboptimal in many settings. Gloves serve as a critical adjunct to hand hygiene, but improper use can paradoxically increase infection risk. This article integrates the WHO Five Moments for Hand Hygiene with evidence-based glove protocols to provide a practical framework for healthcare workers. 1. The WHO Five Moments for Hand Hygiene The WHO Five Moments define when hand hygiene must be performed during patient care: Moment Description Glove relevance 1. Before touching a patient Clean hands before patient contact to protect the patient from germs carried on your hands Don gloves if contact with blood, body fluids, mucous membranes, or non-intact skin is anticipated 2. Before clean/aseptic procedure Clean hands immediately before any aseptic task to protect the patient from harmful germs Sterile gloves required for invasive aseptic procedures 3. After body fluid exposure risk Clean hands immediately after exposure risk to protect yourself and the healthcare environment Remove gloves and perform hand hygiene immediately 4. After touching a patient Clean hands after touching the patient or their immediate surroundings to protect yourself and the environment Remove gloves and perform hand hygiene; do not wear the same gloves between patients 5. After touching patient surroundings Clean hands after touching any object or furniture in the patient's immediate surroundings Gloves should already be removed; perform hand hygiene 2. When to Use Gloves vs Hand Hygiene Alone Gloves are not a substitute for hand hygiene. The decision to wear gloves depends on the anticipated exposure: Clinical situation Hand hygiene Gloves required? Glove type Routine patient examination (intact skin) Yes (Moments 1, 4) No - Contact with blood or body fluids Yes (Moments 2, 3) Yes Examination gloves (nitrile or latex) Invasive aseptic procedure Yes (Moment 2) Yes Sterile surgical gloves Contact with contaminated surfaces Yes (Moment 5) Yes, if heavy contamination expected Examination gloves Handling sterile equipment Yes (Moment 2) Yes Sterile gloves 3. Common Errors in Glove-Hand Hygiene Sequence Errors in the sequence of glove use and hand hygiene can negate the protective benefits of both: Error Why it is harmful Correct action Wearing gloves without hand hygiene before donning Contaminants on hands are trapped against skin, promoting microbial growth Perform hand hygiene before donning gloves Wearing the same gloves between patients Cross-transmission of pathogens between patients Remove gloves and perform hand hygiene between every patient contact Reusing single-use gloves Compromised barrier integrity; AQL testing assumes single use Dispose of gloves after each use Skipping hand hygiene after glove removal Glove juice and micro-tears allow hand contamination Always perform hand hygiene immediately after glove removal Using gloves as a substitute for hand hygiene Gloves have micro-perforations; hands become contaminated during use Hand hygiene is always required, regardless of glove use 4. Glove Selection by Clinical Task Task Recommended glove Key specification General patient examination Nitrile examination glove, 3.5-4.5 mil AQL 1.5, powder-free Surgical procedures Sterile surgical glove, latex or synthetic SAL 10^-6, AQL 0.65-1.5, anatomical fit Chemotherapy handling Chemotherapy-rated nitrile, 7-9 mil ASTM D6978 compliant, tested against specific drugs High-risk infection isolation Nitrile examination glove, extended cuff AQL 1.5, EN 374 or ASTM D6978 if chemical exposure Food service / non-medical Vinyl or nitrile, 3-4 mil Food contact compliance (FDA 21 CFR 177 or EU 1935/2004) 5. Best Practices for Integration To maximize HAI prevention, healthcare facilities should integrate glove protocols into hand hygiene training: Combined training: Teach hand hygiene and glove use as complementary, not alternative, practices Visual cues: Post WHO Five Moments posters at point-of-care with glove decision aids Audit compliance: Monitor both hand hygiene compliance and appropriate glove use Product placement: Position glove dispensers and alcohol rubs together to reinforce sequential use Staff feedback: Provide real-time feedback on glove-hand hygiene sequence errors during clinical audits Data sources: WHO Guidelines on Hand Hygiene in Health Care (2009, updated 2021); CDC Guideline for Isolation Precautions (2007); EN 455 series; ASTM D6319; EN ISO 21420:2020. Information current as of September 2026. FAQ Q: What are the WHO Five Moments for Hand Hygiene? A: The WHO Five Moments are: (1) before touching a patient, (2) before clean/aseptic procedures, (3) after body fluid exposure risk, (4) after touching a patient, and (5) after touching patient surroundings. They define the critical times when hand hygiene must be performed to prevent healthcare-associated infections. Q: Should I perform hand hygiene before putting on gloves? A: Yes. Hand hygiene must be performed before donning gloves. If hands are contaminated when gloves are donned, the warm, moist environment inside the glove promotes microbial growth, a phenomenon known as "glove juice." Q: Can gloves replace hand hygiene? A: No. Gloves are not a substitute for hand hygiene. Gloves have micro-perforations (even at AQL 1.5, some pinholes exist), and hands become contaminated during glove use through these micro-perforations and during removal. Hand hygiene is required before donning and after removing gloves. Q: What is the correct sequence for glove removal and hand hygiene? A: The correct sequence is: (1) perform hand hygiene, (2) don gloves, (3) perform clinical task, (4) remove gloves using a no-touch technique, (5) perform hand hygiene immediately. Never wear the same pair of gloves between patients. Q: How do gloves contribute to HAI prevention when used correctly? A: Gloves provide a physical barrier against bloodborne pathogens and body fluids when contact is anticipated. When combined with proper hand hygiene, they reduce cross-transmission between patients, protect healthcare workers, and prevent environmental contamination. Correct use includes appropriate selection, single-patient use, and hand hygiene before donning and after removal.