Surge capacity refers to the ability to manage a sudden, unexpected increase in patient volume that would otherwise severely challenge or exceed the present capacity of a facility. While there are no widely accepted measurements or triggers to distinguish surge capacity from daily patient care capacity, surge capacity is a useful framework from which to approach a decreased supply of gloves during the COVID-19 response. Three general strata have been used to describe surge capacity and can be used to prioritize measures to conserve glove supplies along the continuum of care.
- Conventional capacity: measures consist of providing patient care without any change in contemporary daily practices. This set of measures, consisting of engineering and administrative controls and personal protective equipment (PPE) should already be implemented in general infection prevention and control plans in healthcare settings.
- Contingency capacity: measures may change daily standard practices but may not have any significant impact on the care delivered to the patient or the safety of healthcare personnel (HCP). These practices may be used temporarily during periods of expected glove shortages.
- Crisis capacity: strategies that are not commensurate with standard U.S. standards of care. These measures, or a combination of these measures, may need to be considered during periods of glove shortages.
The following contingency and crisis strategies are based upon these assumptions:
- Facilities understand their current glove inventory and supply chain.
- Facilities understand their glove utilization rate.
- Facilities are in communication with local healthcare coalitions, federal, state, and local public health partners (e.g., public health emergency preparedness and response staff) regarding identification of additional supplies.
- Facilities have already implemented other engineering and administrative control measures including:
- Reducing the number of patients going to the hospital or outpatient settings
- Excluding HCP not directly involved in patient care
- Reducing face-to-face HCP encounters with patients
- Excluding visitors to patients with confirmed or suspected COVID-19
- Cohorting patients and HCP
- Maximizing use of telemedicine
- Facilities have provided HCP with required education and training, including having them demonstrate competency with donningexternal icon and doffing, for any PPE ensemble that is used to perform job responsibilities, such as provision of patient care
Continue providing patient care without any change in daily contemporary practices
Note: CDC does not recommend double gloves when providing care to suspected or confirmed COVID-19 patients.
- Continue use of approved disposable medical gloves in accordance with standard and transmission-based precautions in healthcare settings and when indicated for other exposures such as handling cleaning chemicals.
- Reinforce indications and recommended practices for non-sterile disposable glove use.
- Prioritize sterile gloves for surgical and other sterile procedures.
- Medical gloves for handling chemotherapy agents (chemotherapy gloves) should be prioritized for HCP handling chemotherapy and other hazardous drugs.
- Remind HCP about indications for when gloves are needed, as well as common care situations when gloves may not be needed.
Use of gloves past their manufacturer-designated shelf life for training activities
Non-sterile disposable gloves cleared by the Food and Drug Administration (FDA) are not required to have expiration date labelingexternal icon; however, some manufacturers choose to designate a shelf life.
Facilities may consider using gloves past their manufacturer-designated shelf life (if a shelf life is designated) for situations where HCP are not exposed to pathogens, such as during training activities.
Use of gloves conforming to other U.S. and international standards
Healthcare facilities may consider using disposable medical gloves that are similar to FDA-cleared surgical and examination gloves but are approved under other U.S. or international standards. Examples are shown in the table below.
|Country||Performance Standard||May Be Used in Lieu of|
|U.S.||NFPA 1999-2018 (single use emergency medical gloves)||Examination glovesa|
|ANSI/ADA 76-2005||Examination glovesa|
|Europe||EN 455 (EN 455-1:2000;
EN 455-2:2015; EN 455-3:2015; EN 455-4:2009)b
|EN 455 (EN 455-1:2000;
EN 455-2:2015; EN 455-3:2015; EN 455-4:2009)d
|EN ISO 374-5:2016e||Examination glovesa|
|China||GB 10213:2016||Examination glovesa|
|Australia||AS/NZS 4011.1:2014 (latex)
AS/NZS 4011.2: 2014 (vinyl)
|Japan||JIS T9107:2018||Surgeon’s gloves
|JIS T9115:2018||Examination glovesa|
|Malaysia||MS 1155:2003||Examination glovesa|
|International||ISO 10282:2014||Surgeon’s gloves
|ISO 11193-1:2008 (latex)||Examination gloves
|ISO 11193-2:2006 (vinyl)||Examination gloves
a Recognized standards for patient examination gloves include ASTM D3578-19 (latex rubber), ASTM D5250-19 (polyvinyl chloride), ASTM D6319 (nitrile rubber), and ASTM D6977 (chloroprene rubber).
b Surgeon’s (surgical) gloves must be provided sterile and powderless; products meeting requirements for surgical gloves should have the mark “CE EN455.”
c Surgeon’s (surgical gloves) must be provided sterile and powderless.
d Examination gloves must be provided powderless; products meeting requirements for surgical gloves should have mark of “CE EN455.”
e Gloves must have “CE mark” with certificate to indicate compliance with EN ISO 374-5 and have Level 2 or higher per EN ISO 374-2:2014.
Use of gloves past their manufacturer-designated shelf life for healthcare delivery
Non-sterile disposable gloves cleared by the FDA are not required to have expiration date labelingexternal icon; however, some manufacturers choose to designate a shelf life. Facilities may consider using gloves past their manufacturer-designated shelf life for healthcare delivery. Sterile gloves past their manufacturer-designated shelf life should not be used for surgical or other sterile procedures.
Prioritize the use of non-sterile disposable gloves
Non-sterile disposable gloves should be prioritized for use during activities when gloves are recommended to protect the hands from contact with potentially hazardous substances, including blood and body fluids (e.g., wound care, aerosol generating procedures).
Facilities may consider suspending use of gloves when entering the room of patients with endemic multidrug resistant organisms (e.g., MRSA, VRE, ESBL-producing organisms). However, HCP should wear gloves when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, nonintact skin, or potentially contaminated intact skin could occur. When HCP are exposed to such MDROs, employers must ensure that hand hygiene protocols are stringently followed. These organisms can be carried on the skin and under the fingernails, leading to transmission to other patients or colonization of HCP.
Consider non-healthcare glove alternatives
In instances of severely limited or no available disposable medical gloves, non-healthcare disposable gloves (e.g., food service or industrial chemical resistance gloves) may be considered for situations where HCP are not exposed to pathogens. These gloves are available in many different materials, including polyvinyl chloride, nitrile, and latex. Sizing and limitations to dexterity should be considered. Additional information regarding glove alternatives can be found in the FDA guidance for medical glove conservation strategiesexternal icon. The recommended extended use guidance (below) does not apply to non-healthcare glove alternatives.
Extended use of disposable medical gloves
Note: The following extended use guidance applies only to disposable medical gloves and does not apply to non-healthcare glove alternatives.
Extended use of disposable medical gloves by HCP refers to the practice of wearing gloves without changing them between patients or tasks. Disposable medical glove extended wear is most easily implemented when patients are cohorted, such as when caring for a group of patients with the same confirmed infectious disease diagnosis (e.g., patients with confirmed COVID-19) in a shared or adjacent location.
During glove supply crisis gloves can remain on but must be sanitized between patients within the cohort to prevent cross transmission of any other pathogens from patient to patient.
Gloved hands must be cleaned following cleaning procedures described in detail below at intervals where gloves would normally be changed (e.g., when moving from a ‘dirty’ to ‘clean’ task, between patients) or hand hygiene normally performed.
Disposable medical gloves should always be discarded after:
- Visible soiling or contamination with blood, respiratory or nasal secretions, or other body fluids occurs
- Any signs of damage (e.g., holes, rips, tearing) or degradation are observed
- Maximum of four hours of continuous use
- Doffing. Previously removed gloves should not be re-donned as the risk of tearing and contamination increases. Therefore, disposable glove “re-use” should not be performed.
After removing gloves for any reason, hand hygiene should be performed with alcohol-based hand sanitizer or soap and water.
Methods for performing hand hygiene of gloved hands for extended use of disposable medical gloves
CDC does not recommend disinfection of disposable medical gloves as standard practice. This practice is inconsistent with general disposable glove usage, but, in times of extreme disposable medical glove shortages, this option may need to be considered.
Alcohol-based hand sanitizer (ABHS)
ABHS is the preferred method for performing hand hygiene of gloved hands in healthcare settings when the gloves are not visibly soiled. Research has shown multiple disposable latex and nitrile glove brands maintained their integrity when treated with ABHS.[1-2] Disposable medical gloves can be disinfected for up to six (6) applications of ABHS or until the gloves become otherwise contaminated or ineffective (for one or more of the reasons stated in extended use guidance above). Follow hand hygiene guidance for proper application of ABHS.
Soap and water
If ABHS is not available, soap and water can be used to clean donned disposable medical gloves between tasks or patients. HCP planning to wash gloves with soap and water should wear long-cuffed surgical gloves; as washing may be impractical for short cuffed gloves where water may become trapped inside the worn gloves. Disposable medical gloves can be cleaned with soap and water up to 10 times or until the gloves become otherwise contaminated or ineffective (for one or more of the reasons stated in extended use guidance above). Follow hand hygiene guidance for proper soap and water hand hygiene procedures.
Diluted bleach solution as a disinfectant
Limited data1 show that when nitrile gloves were tested in accordance with ASTM F739-12: “Standard Test Method for Permeation of Liquids and Gases Through Protective Clothing Materials Under Conditions of Continuous Contact” using a 10-13% bleach solution, no permeation was observed. Therefore, disinfection of disposable gloves using diluted bleach may be considered as outlined below.
- Check gloves for signs of damage (e.g., holes, rips, tearing) or degradation (e.g., brittle, stiff, discoloration, tackiness). If damage or degradation is observed, discard the gloves and do not disinfect.
- While gloves are donned, dip gloved hands into a dilute bleach solution for five (5) seconds to ensure complete coverage. Solution should not touch the skin.
- Allow the dilute bleach solution to remain on the donned gloves for one minute (starting after removing gloved hands from the solution) to ensure adequate decontamination. Leave hands in a downward position to reduce the risk of the bleach solution dripping onto arms.
- Rinse dilute bleach solution off gloved hands using water.
- Wipe gloves dry with a clean, absorbent material.
- Check gloves again for signs of damage (e.g., holes, rips, tearing) or degradation (e.g., brittle, stiff, discoloration, tackiness). If damage or degradation is observed, discontinue use and discard the gloves.
Instructions for making an appropriate dilute bleach solution can be found on the CDC website.
Although a diluted bleach solution has been shown to be effective for disinfecting disposable medical gloves, the odor and potential for respiratory irritation, potential for inadvertent spills, and potential staining of clothing are reasons this should be the last option for disinfection. If disinfection using the diluted bleach method is conducted, it should be done in a well-ventilated area. Diluted bleach solution must be mixed fresh at least daily, and any time the solution becomes soiled with organic material, which can reduce the effectiveness of the bleach. Available permeation data1 suggests that disposable medical gloves may continue to provide protection when disinfected with diluted bleach solution up to 10 times or until the gloves become otherwise contaminated or ineffective (for one or more of the reasons stated in extended use guidance above).[2-3]