High-five for a sustainable path to better hand hygiene

Ahead of World Hand Hygiene Day on 5 May, emergency physician and Chief Medical Officer of the Australian Commission on Safety and Quality in Health Care explains why healthcare practitioners need to use proper hand hygiene all the time — and use gloves at the right time — to reduce unnecessary waste.

Good hand hygiene has long been recognised as a cornerstone in preventing healthcare-associated infections and reducing the spread of pathogens. The benefit to both healthcare workers and patient outcomes is indisputable.

Handwashing was introduced to medicine and public health in the mid-19th century by Hungarian doctor Ignác Fülöp Semmelweis and the founder of modern nursing, Florence Nightingale.¹ Semmelweis is described as the ‘father of hand hygiene’ and Nightingale advocated for handwashing during the Crimean War. Nightingale is quoted as saying: “Every nurse ought to be careful to wash her hands very frequently during the day. If her face, too, so much the better.” Unfortunately, it was a long time before the hand hygiene practices that Semmelweis and Nightingale promoted were widely adopted.

The use of modern disposable gloves to reduce hand contamination and disease transmission was introduced much later. Natural rubber surgical gloves were first used in the 1890s and became routinely used from the early 1900s. It wasn’t until half a century later that the first disposable latex medical gloves arrived, revolutionising hand protection in health care and paving the way for more advanced materials like nitrile, which is now widely used in hospitals and healthcare settings.

As a practising emergency physician, I am so pleased that healthcare professionals can today achieve a high standard of infection prevention and control using evidence-based practices such as proper hand hygiene and glove use, where appropriate. The efficacy of gloves in health care has been demonstrated in clinical studies, although as the World Health Organization (WHO) advises,² gloves do not provide complete protection against hand contamination.

Saving lives — and the environment

A more recent consideration for healthcare professionals is that of sustainability in health care. While our overarching goal is always patient safety to ensure the best possible outcomes and save lives, most of us also share a commitment to saving the environment.

Plastics used in health care contribute to increasing environmental costs with one-third of waste generated coming from single-use plastics, including gloves. While the use of gloves is essential in protecting both healthcare workers and patients from infections, over-reliance on gloves without doing hand hygiene can lead to unnecessary waste. Gloves can also increase the risk of cross contamination when used incorrectly.

It is crucial for healthcare workers to understand that gloves are not a substitute for hand hygiene. In many situations, hand hygiene alone is sufficient to protect both healthcare workers and patients. The Australian Commission on Safety and Quality in Health Care (the Commission) is at the forefront of climate action in health care, driving change through the development of educational resources, strategic collaboration with key agencies and the promotion of local sustainability initiatives.

While Australia has one of the best healthcare systems in the world, it is estimated the health system is responsible, either directly or indirectly, for 5% of Australia’s greenhouse gas emissions. Infection prevention and control practices, including hand hygiene and appropriate glove use, play an important role in improving environmental sustainability in health care.

Each year on 5 May, health organisations across the world rally to promote proper hand hygiene for World Hand Hygiene Day (WHHD). The WHO theme for WHHD 2025 is: “It might be gloves. It’s always hand hygiene”.³ That is, regardless of whether gloves are worn, hand hygiene at the right times and in the right way is still one of the most important measures to protect both patients and healthcare workers.

In Australia, the Commission’s WHHD awareness campaign this year is aligned in our focus on the critical role of effective hand hygiene, and the appropriate use of gloves. Our theme is: “Gloves at the right time. Hand hygiene all the time: A sustainable path to better hand hygiene.” We have developed updated resources for health services to share with their own clinicians and health workers.⁴

Achieving sustainable health care in a changing climate

In October 2024, the Commission, the interim Australian Centre for Disease Control, Australian medical colleges and the Australian Indigenous Doctors’ Association announced an historic agreement to develop a framework for collaborative action on climate change and health.

The ‘Joint statement: working together to achieve sustainable high-quality health care in a changing climate’ represents a shared commitment to address the health impacts of climate change.⁵ This was supported by Ged Kearney, Australia’s Assistant Minister for Health and Aged Care and Assistant Minister for Indigenous Health.⁶

Some of the Commission’s initiatives to address the health impacts of climate change and support appropriate clinical care include: an Environmental Sustainability and Climate Resilience Healthcare Module, national Clinical Care Standards, the Australian Atlas of Healthcare Variation Series and a User Guide for Reviewing Clinical Variation.

In the area of infection prevention, we need to support healthcare workers to use medical equipment — including gloves — correctly and sustainably. Our new fact sheet ‘Sustainable glove use for healthcare workers’ offers a practical checklist on glove use and explains environmental sustainability and the impact of inappropriate glove use.

Encouraging hand hygiene compliance

The National Safety and Quality Health Service (NSQHS) Standards also require supporting and monitoring the safe and sustainable use of infection prevention and control resources.

In Australia, hand hygiene compliance with the WHO’s ‘5 Moments of Hand Hygiene’ is a national indicator of the safety and quality of care provided to patients in hospitals. Monitoring hand hygiene compliance is a requirement for accreditation under the NSQHS Standards.⁷ These Standards include actions that require hospitals to have a hand hygiene program (as part of their infection prevention and control program) that provides timely reports on the results of hand hygiene compliance audits — and then uses the audit results to drive quality improvement.

Appropriate hand hygiene practices contribute to high-quality sustainable health care, while reducing unnecessary glove use and the environmental impact.

Hand hygiene compliance by healthcare workers at specific times (or ‘moments’) before and after patient interactions and procedures is audited during three specific periods each year and reported against the current national benchmark of 80%. In the most recent audit period (1 July–31 October 2024) the national hand hygiene compliance rate was 86.8%. This is coordinated under the Commission’s National Hand Hygiene Initiative.

Leading the way in sustainable care

The ‘Gloves off!’ campaign at John Hunter Hospital offers a great example of how hand hygiene practices can be improved and unnecessary non-sterile glove use reduced in a healthcare setting.⁸ Prior to the 2023 campaign, hand hygiene compliance at John Hunter Hospital was 59%, with 60% of glove use deemed unnecessary and 70% of missed hand hygiene moments linked to improper glove use.

The campaign involved baseline data collection, ward-based education sessions and post-education evaluations. This initiative not only enhanced patient safety but also addressed environmental concerns, as John Hunter Hospital previously disposed of approximately 97 tonnes of gloves annually, equating to the carbon footprint of driving a fuel-efficient car around Australia 175 times.

It is heartening to hear of another recent campaign at Wyong Hospital on the New South Wales Central Coast, which discouraged the unnecessary use of disposable gloves and improved hand hygiene among clinicians.⁹ The Wyong Hospital program also focused on educating staff to identify when proper hand hygiene was sufficient protection. A year after the program was introduced, disposable glove use in the emergency department at Wyong Hospital reportedly fell by 285,000 to about 1.3 million single gloves per year, while at the same time hand hygiene compliance increased from 80 to 85%.

As healthcare workers, we can all contribute to both safer hand hygiene and sustainability efforts by assessing whether gloves are needed, choosing the right gloves, using and disposing of gloves correctly and performing hand hygiene. Let’s all consider what we can do in our healthcare services. Use the hand hygiene and appropriate glove use resources on the Commission’s World Hand Hygiene Day⁴ and ‘Sustainability and infection prevention and control’ webpages.

If you have been involved in a successful sustainability healthcare project and would like to share your story, please contact HAI@safetyandquality.gov.au.

*Conjoint Professor Carolyn Hullick FACEM is Chief Medical Officer of the Australian Commission on Safety and Quality in Health Care.

^References

^{1. Martini M, Lippi D. SARS-CoV-2 (COVID-19) and the teaching of Ignaz Semmelweis and Florence Nightingale: a lesson of public health from history, after the “Introduction of handwashing” (1847). J Prev Med Hyg. 2021;62(3):E621–E624. doi: 10.15167/2421-4248/jpmh2021.62.3.2161}

^{2. Glove use information leaflet. Leaflet. World Health Organization; 2009. Accessed 10 March, 2025. https://www.who.int/publications/m/item/glove-use-information-leaflet-(revised-august-2009)}

^{3. World Hand Hygiene Day 2025. World Health Organization. Accessed 10 March, 2025. https://www.who.int/campaigns/world-hand-hygiene-day/2025}

^{4. World Hand Hygiene Day. Australian Commission on Safety and Quality in Health Care (ACSQHC). Accessed 10 March, 2025. https://www.safetyandquality.gov.au/our-work/infection-prevention-and-control/national-hand-hygiene-initiative/world-hand-hygiene-day}

^{5. Joint statement: working together to achieve sustainable high-quality health care in a changing climate. ACSQHC. 1 October, 2024. Accessed 10 March, 2025. https://www.safetyandquality.gov.au/publications-and-resources/resource-library/joint-statement-working-together-achieve-sustainable-high-quality-health-care-changing-climate}

^{6. Improving Australia’s world-class healthcare in a changing climate. Media release. The Hon Ged Kearney MP, Department of Health and Aged Care, Commonwealth of Australia. October 1, 2024. Accessed 10 March, 2025. https://www.health.gov.au/ministers/the-hon-ged-kearney-mp/media/improving-australias-world-class-healthcare-in-a-changing-climate}

^{7. National Safety and Quality Health Service Standards (second edition). ACSQHC. Updated May 2021. Accessed 10 March, 2025. https://www.safetyandquality.gov.au/publications-and-resources/resource-library/national-safety-and-quality-health-service-standards-second-edition}

^{8. Hunter New England: gloves off! Case study. ACSQHC; 2024. Accessed 10 March, 2025. https://www.safetyandquality.gov.au/publications-and-resources/resource-library/hunter-new-england-gloves}

^{9. Forster S. NSW hospitals cut down on glove use, renew focus on hand hygiene. ABC News. 19 February, 2025. Accessed 10 March, 2025. https://www.abc.net.au/news/2025-02-19/nsw-hospitals-cut-down-on-glove-use/104771864}

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5 steps for appropriate glove use

Healthcare workers can follow these five steps to enhance hand hygiene practices while reducing unnecessary waste.

Step 1: assess the need for gloves

• Why are you wearing gloves?
• Is there a risk of blood or body fluid exposure?
• Who or what are you trying to protect?
• Would proper hand hygiene be as effective to reduce contamination?

Step 2: choose the right gloves

• Use sterile gloves when performing aseptic procedures or for contact with sterile body sites.
• Use non-sterile gloves (eg, nitrile, latex, medical vinyl) if risk of contact with infectious material (eg, blood and body fluids).
• Use non-medical gloves (eg, vinyl) for food handling.

Step 3: use the gloves correctly

• If gloves are not changed and hand hygiene is not performed between patient care activities, the risk of cross contamination and healthcare-associated infections is increased.

Step 4: remove and dispose of the gloves

• Remember that the outside of gloves is contaminated.
• Always grasp outside of glove with opposite gloved hand, peel off.
• Hold removed glove in gloved hand.
• Slide fingers of ungloved hand under remaining glove at wrist.
• Peel the second glove off over the first glove.
• Discard gloves in appropriate waste container.

Step 5: perform hand hygiene

• Gloves do not provide complete protection from contamination.
• Hand hygiene must be performed immediately before putting on and after removing gloves.

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Top image credit: iStock.com/dmphoto