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Peer-reviewedCC BY-NC-NDAntimicrobial resistance and infection control

Hand hygiene versus continued glove use in simulated nursing care: a crossover study on microbial kinetics and unintended transmission.

  • G Walder1,2
  • R Pörnbacher1
  • L Knabl3
  • P Suntinger1
  • S Obererlacher1
  • K Edrisi Maryan1
  • B Faustini1
  • C Bundschuh4,5,6
6 affiliations
  1. 1Dr. Gernot Walder-GmbH, Außervillgraten, East Tyrol, Austria.
  2. 2Institute for Primary Care Medicine, Johannes Kepler University (JKU), Linz, Austria.
  3. 3Y2L2Science GmbH, Zams, Austria.
  4. 4Dr. Gernot Walder-GmbH, Außervillgraten, East Tyrol, Austria. [email protected].
  5. 5Institute for Primary Care Medicine, Johannes Kepler University (JKU), Linz, Austria. [email protected].
  6. 6Laboratory Dr. Bundschuh, Oberstiftung 59, 4190, Bad Leonfelden, Austria. [email protected].
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Abstract

Background

Healthcare workers' (HCWs) hands are primary vectors for pathogen transmission. While non-sterile examination gloves (NSG) are intended to protect against contamination, they are often perceived as a substitute for hand disinfection (HD). This crossover simulation study in student nurses compared the microbial kinetics of once-disinfected bare hands versus continued NSG use and explored unintended Staphylococcus aureus transmission between participants.Methods

Using a crossover design, twenty-five student nurses performed standardised nursing tasks on manikins under both conditions in randomised order: (i) NSG worn continuously for 45 min without change; (ii) HD with an alcohol-based hand rub immediately before tasks (no gloves). Hand-impression cultures were taken at 0, 5, 15, 25, 35 and 45 min, plate-reading after 24 and 48 h. Counts > 100 CFU were capped at 100. Behaviour was video monitored. Group differences were analysed using the Wilcoxon signed-rank test with Bonferroni correction; S. aureus detection (≥ 1 positive timepoint per arm) was compared by McNemar's exact test.Results

In the HD arm, mean CFU increased from 1.7 ± 3.3 (baseline) to 31.8 ± 30.4 at 5 min and then plateauing around 40-45 CFU for 15-45 min. In the NSG arm, CFU progressively accumulated, reaching 76.7 ± 29.1, 77.1 ± 27.7 and 81.0 ± 27.7 at 25, 35 and 45 min, respectively. From 25 min onwards, NSG counts were significantly higher than HD counts (p = 0.0007, 0.0012 and 0.0003; Bonferroni-corrected α = 0.0083). S. aureus (all methicillin-susceptible) was detected in at least one timepoint in 21/25 (84%) NSG-arm participants versus 9/25 (36%) HD-arm participants (McNemar p = 0.0005). Notably, one baseline nasal carrier, following an observed incomplete HD event, contaminated two co-workers via a shared manikin within 5 min, demonstrating HCW-to-HCW spread in the HD arm.Conclusions

Once-disinfected hands rapidly return to a stable resident microbiome level, whereas continued NSG use without glove changing leads to progressive microbial accumulation and substantially higher S. aureus carriage. NSG must not replace HD and require a change interval of 15-20 min, followed by HD after removal. HD must be performed correctly immediately before patient contact.

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Cite

BibTeXRIS
BibTeX
@article{walder2026hand,
  title = {{Hand hygiene versus continued glove use in simulated nursing care: a crossover study on microbial kinetics and unintended transmission.}},
  author = {G Walder and R Pörnbacher and L Knabl and P Suntinger and S Obererlacher and K Edrisi Maryan and B Faustini and C Bundschuh},
  journal = {Antimicrobial resistance and infection control},
  year = {2026},
  month = aug,
  doi = {10.1186/s13756-026-01801-z},
  url = {https://europepmc.org/article/MED/42972601},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Hand hygiene versus continued glove use in simulated nursing care: a crossover study on microbial kinetics and unintended transmission.
AU  - G Walder
AU  - R Pörnbacher
AU  - L Knabl
AU  - P Suntinger
AU  - S Obererlacher
AU  - K Edrisi Maryan
AU  - B Faustini
AU  - C Bundschuh
PY  - 2026
DA  - 2026/08/05
JO  - Antimicrobial resistance and infection control
DO  - 10.1186/s13756-026-01801-z
UR  - https://europepmc.org/article/MED/42972601
AB  - Background  Healthcare workers' (HCWs) hands are primary vectors for pathogen transmission. While non-sterile examination gloves (NSG) are intended to protect against contamination, they are often perceived as a substitute for hand disinfection (HD). This crossover simulation study in student nurses compared the microbial kinetics of once-disinfected bare hands versus continued NSG use and explored unintended Staphylococcus aureus transmission between participants.Methods  Using a crossover design, twenty-five student nurses performed standardised nursing tasks on manikins under both conditions in randomised order: (i) NSG worn continuously for 45 min without change; (ii) HD with an alcohol-based hand rub immediately before tasks (no gloves). Hand-impression cultures were taken at 0, 5, 15, 25, 35 and 45 min, plate-reading after 24 and 48 h. Counts > 100 CFU were capped at 100. Behaviour was video monitored. Group differences were analysed using the Wilcoxon signed-rank test with Bonferroni correction; S. aureus detection (≥ 1 positive timepoint per arm) was compared by McNemar's exact test.Results  In the HD arm, mean CFU increased from 1.7 ± 3.3 (baseline) to 31.8 ± 30.4 at 5 min and then plateauing around 40-45 CFU for 15-45 min. In the NSG arm, CFU progressively accumulated, reaching 76.7 ± 29.1, 77.1 ± 27.7 and 81.0 ± 27.7 at 25, 35 and 45 min, respectively. From 25 min onwards, NSG counts were significantly higher than HD counts (p = 0.0007, 0.0012 and 0.0003; Bonferroni-corrected α = 0.0083). S. aureus (all methicillin-susceptible) was detected in at least one timepoint in 21/25 (84%) NSG-arm participants versus 9/25 (36%) HD-arm participants (McNemar p = 0.0005). Notably, one baseline nasal carrier, following an observed incomplete HD event, contaminated two co-workers via a shared manikin within 5 min, demonstrating HCW-to-HCW spread in the HD arm.Conclusions  Once-disinfected hands rapidly return to a stable resident microbiome level, whereas continued NSG use without glove changing leads to progressive microbial accumulation and substantially higher S. aureus carriage. NSG must not replace HD and require a change interval of 15-20 min, followed by HD after removal. HD must be performed correctly immediately before patient contact.
SN  - 2047-2994
ER  -