The effectiveness of disposable gloves as a protective barrier does not only depend on the quality of the material. The way they are put on and taken off directly influences the safety of the procedure. Several technical publications show that a significant portion of occupational contamination occurs precisely during glove removal.
For this reason, ANVISA, the WHO, and the CDC recommend standardized techniques for donning and doffing, significantly reducing the risk of self-contamination.
Why is technique as important as the glove?
Even an excellent quality glove can lose its effectiveness if used improperly. Its outer surface becomes progressively contaminated during clinical care — with every contact with tissues, instruments, aerosols, or surfaces in the operative field.
If removal allows this contaminated surface to come into contact with the professional's hands or wrists, the protective barrier fails to fulfill its purpose, favoring self-contamination.
Cross-contamination: how does it happen?
In dentistry, the chain of infection can involve:
- Direct contact with blood and saliva
- Aerosols produced by rotary equipment
- Contaminated instruments
- Frequently manipulated clinical surfaces
- Professional's hands
Gloves interrupt only a part of this chain. When kept on after the procedure or removed improperly, they become a vehicle for microorganism dissemination. Therefore, Donning and Doffing techniques are an integral part of Standard Precautions.
Gloves do not replace hand hygiene
⚠️ Attention: Hand hygiene must be performed before donning and immediately after doffing gloves — no exceptions.
This recommendation exists because small perforations can go unnoticed, the material may have imperceptible micro-cracks, and accidental contamination can occur during removal. Gloves are a complementary barrier, never a substitute for hand hygiene.
What do biosafety standards say?
| Standard / Authority | Main determination |
|---|---|
| ANVISA | Gloves donned immediately before and removed immediately after the procedure; discarded after single use; do not replace hand hygiene |
| NR-32 | Free provision of appropriate PPE and periodic training on correct use |
| WHO | Glove use always associated with proper hand hygiene; avoid indiscriminate use that creates a false sense of security |
| CDC | Most failures result from inadequate donning and doffing techniques; specific protocols to minimize contact with contaminated outer surface |
Watch the video: how to don and doff gloves correctly
Donning and Doffing: understanding the concepts
Donning is the process of correctly putting on or donning PPE. In the case of gloves, the objective is to preserve their integrity and prevent the outer surface from being contaminated even before the start of the clinical procedure.
Doffing is the process of safely removing PPE. Glove removal is considered one of the most critical steps, as their outer surface may be contaminated with blood, saliva, aerosols, and biofilm. The objective is to prevent this contaminated surface from coming into contact with the professional's skin.
The internationally recommended technique is the Glove-in-Glove Technique (also called Inside-Out Removal Technique): the first glove removed remains enveloped by the second, keeping all contaminated surfaces confined inside.
Donning technique: how to put on gloves correctly
| Step | Procedure | Objective |
|---|---|---|
| 1 | Perform hand hygiene (palms, back of hands, interdigital spaces, thumbs, fingertips, nails, and wrists). Wait for complete drying. | Eliminate microorganisms before contact with the glove |
| 2 | Inspect the packaging: integrity, expiry date, appropriate size, and absence of moisture or perforation. | Avoid using a compromised product |
| 3 | Open the packaging carefully without resting the gloves on contaminated surfaces. | Reduce contact before donning |
| 4 | Hold the first glove exclusively by the inner side of the cuff. Insert fingers slowly without abrupt movements. | Preserve the integrity of the barrier |
| 5 | With the first gloved hand, manipulate only the inner region of the second glove to put it on. | Avoid skin contact with the outer surface |
| 6 | Make only the essential adjustments to the fingers, palm, and cuffs. Avoid repeated manipulations. | Reduce the risk of micro-perforations |
🧴 Hand hygiene → 📦 Inspect packaging → 📂 Open carefully → 🧤 Don 1st glove → 🧤 Don 2nd glove → ✔ Final adjustment → 🦷 Start procedure
💡 Good practice: After donning gloves, the professional should already be fully geared up. Adjustments to masks, glasses, caps, or gowns should be made before this step.
Doffing technique: how to safely remove gloves (Glove-in-Glove)
| Step | Procedure | Objective |
|---|---|---|
| 1 | Pinch the outer surface of one glove at the wrist with the other gloved hand. | Contact only between already contaminated surfaces; skin protected |
| 2 | Slowly pull towards the fingers, inverting the glove. Keep it trapped in the palm of the still-gloved hand. | Contaminated surface faces inwards |
| 3 | With the ungloved hand, insert the index and middle fingers under the inner fold of the second glove's cuff. Never touch the outer surface. | Main differentiator of the technique — eliminates skin contact with contaminated surface |
| 4 | Slowly pull off the second glove, inverting it and enclosing the first. An envelope is formed with all the contaminated surface confined inside. | Glove-in-Glove technique — safe disposal without dispersion |
| 5 | Discard immediately into the healthcare waste receptacle (according to PGRSS). Do not rest on countertops or reuse. | Compliance with RDC 222/2018 |
| 6 | Perform hand hygiene immediately after removal. | Eliminate microorganisms that may have passed the barrier |
🧤 End of procedure → ① Pinch outer surface → ② Remove by inverting → ③ Hold in gloved hand → ④ Fingers under inner surface of 2nd glove → ⑤ Remove by enclosing 1st → 🗑 Discard → 🧴 Hand hygiene
Why does the Glove-in-Glove technique work?
Inverting the glove during doffing transforms the potentially contaminated surface into an inner face, reducing the risk of direct skin contact and limiting the dispersal of microorganisms into the environment. This is the microbiological principle that justifies its adoption as an international standard.
In addition to protecting the professional, it reduces the possibility of spreading microorganisms to countertops, equipment, and other objects in the office — which is why ANVISA, WHO, and CDC place such emphasis on glove removal technique.
Frequently Asked Questions
What are Donning and Doffing?
Donning is the standardized technique for putting on PPE, such as disposable gloves. Doffing is the safe removal technique. Both are part of the Standard Precautions recommended by ANVISA, WHO, and CDC for preventing cross-contamination.
Why is glove removal considered the most critical step?
Because the outer surface of the glove accumulates microorganisms during patient care. If this surface touches the professional's skin during removal, self-contamination occurs — nullifying the protection the glove should offer.
Do I need to perform hand hygiene even when wearing gloves?
Yes. Hand hygiene must be performed before donning and immediately after doffing gloves. Small perforations and micro-cracks can go unnoticed, and contamination can occur during removal.
What is the Glove-in-Glove technique?
It is the international method of glove removal where the first glove removed remains enveloped by the second, keeping all contaminated surfaces confined inside. It reduces skin contact with the outer surface and limits the dispersal of microorganisms into the environment.
Can I reuse disposable gloves between patients?
No. Disposable gloves must be used once and discarded immediately after the procedure, as determined by ANVISA. Reuse compromises barrier integrity and increases the risk of cross-contamination.
Dental Access offers nitrile, latex, and vinyl gloves with traceability and regulatory compliance — so you can provide care with safety and excellence.
