Sustainable glove use of nurses and midwives when administering injections: A scoping review

Every day, nurses and midwives around the world perform a simple, vital task: they give injections. Whether delivering a vaccine, a dose of pain relief, or a life-saving medication, the act is routine. For decades, a common habit has shaped how this procedure is done. Many healthcare workers put on a fresh pair of disposable plastic gloves before every single injection, believing it is the safest way to protect both themselves and their patients. This practice is so ingrained that it often happens without a second thought, a reflex born from a desire to prevent infection. However, this routine habit carries a hidden cost that extends far beyond the clinic walls. The production and disposal of billions of these single-use gloves contribute significantly to the global climate crisis, generating massive amounts of carbon emissions and medical waste. At the same time, medical experts have long suspected that wearing gloves when they are not strictly necessary might actually be counterproductive, potentially leading to less frequent hand washing and a higher risk of spreading germs between patients.

The question of when gloves are truly necessary has become a focal point for those trying to make healthcare safer and more sustainable. Major health organizations, including the World Health Organization, have issued clear guidance stating that for standard muscle or fat injections, gloves are not routinely required if the skin is intact and there is no risk of bleeding. The logic is straightforward: the risk of infection from a clean injection is low, and the best defense against germs is thorough hand washing, not a plastic barrier. Yet, despite these clear instructions, the reality on the ground tells a different story. To understand why this gap exists between official advice and daily practice, a team of researchers from the University of Sydney and the Clinical Excellence Commission in Australia conducted a broad review of existing studies. They set out to map the landscape of how nurses and midwives actually behave, what they believe, and what drives their decisions when they pick up a syringe.

The researchers gathered and examined thirty-one different pieces of evidence from nine countries, ranging from scientific studies and hospital audits to educational textbooks and official guidelines. They looked for any information that could explain the habits of healthcare workers during intramuscular and subcutaneous injections. What they found was a world of confusion and inconsistency. While the official guidelines were united in their message that gloves are not needed for routine injections, the educational materials designed to train new nurses were sending mixed signals. Some textbooks and training articles insisted that gloves were mandatory, treating every injection as an invasive procedure that required protection. Others suggested that gloves should only be worn if a specific risk was identified, but these resources often failed to explain clearly how to make that judgment. This lack of a single, consistent voice meant that a nurse trained in one country or even one hospital might follow a completely different set of rules than a colleague working just down the hall.

The review revealed that this confusion translates directly into wildly different behaviors in the real world. In some hospitals, researchers observed that nurses wore gloves for only a small fraction of injections, while in others, gloves were worn for the vast majority of them. In one study, nearly three-quarters of nurses reported always wearing gloves, while in another, fewer than five percent said they did the same. The variation was not just a matter of personal preference; it was deeply rooted in the environment and the training these workers received. The researchers identified three main forces that drive this behavior. First is capability, which refers to what a worker knows and understands. Many nurses simply did not know that gloves were unnecessary, or they misunderstood the concept of risk, believing that a glove was needed for every procedure to be safe. Second is opportunity, which involves the social and physical context. If a nurse sees their senior colleagues wearing gloves, or if patients expect to see gloves as a sign of cleanliness, the pressure to conform is strong. In one study, nearly two-thirds of the public said they preferred to see nurses wearing gloves, creating a powerful social incentive to keep the habit alive. Finally, there is motivation, the internal drive to act. For many, the motivation is a deep-seated desire for self-protection. Wearing gloves provides a sense of security, a feeling that one is shielded from harm, even if that feeling is based on a misconception.

The consequences of this widespread, often unnecessary glove use are more than just environmental. The review found evidence that relying on gloves can actually make things less safe. When nurses wear gloves, they are less likely to wash their hands before and after the procedure, a critical step in preventing infection. One study observed that when gloves were used, the moments for hand hygiene were frequently missed. Furthermore, gloves can create a false sense of security, leading workers to reuse them or fail to change them between patients, which increases the risk of cross-contamination. The data suggests that the plastic barrier does not stop needle-stick injuries, a common fear among staff, but it does interfere with the most effective infection control measure: clean hands. The researchers noted that while the feeling of safety is real for the worker, the actual safety benefit is questionable, and the environmental cost is undeniable.

Ultimately, this review highlights a significant disconnect between what medical science knows and what healthcare workers do. The guidelines are clear, but the path to following them is blocked by conflicting education, social expectations, and deeply held beliefs about safety. The researchers suggest that fixing this problem requires more than just issuing new rules. It requires a shift in how nurses and midwives are trained and how they are supported. By understanding the specific reasons why workers reach for gloves—whether it is a lack of knowledge, a desire to meet patient expectations, or a need for personal reassurance—hospitals and health systems can design better interventions. These could include clearer training that explains the science of risk, strategies to align staff behavior with patient expectations, and a renewed focus on the importance of hand hygiene as the true guardian of safety. The goal is not to remove the gloves entirely, but to ensure they are used only when they are truly needed, creating a healthcare environment that is both safer for patients and kinder to the planet.