Evaluation of the effects on the tensile properties of medical gloves after repeated disinfection (2025)

Disposable medical gloves are an essential element of personal protective equipment (PPE) vital to ensuring the safety and well-being of healthcare workers. Proper utilization of these gloves prevents contamination, reduces the spread of infections, and helps deliver high-quality care. Traditionally, gloves are removed after a single use to avoid overuse and misuse¹. Similarly, repeated use of gloves is not suggested by the World Health Organization (WHO)².However, it is generally believed that gloves are often overused, especially when used without indication or improperly, such as not replacing gloves when needed^3,4,5.In these cases, contaminated gloves can increase the risk of cross infection³.

In order to reduce waste and promote sustainable use, researchers have recently suggested considering disinfecting gloved hands⁶.On the one hand,allowing glove disinfection is in order to facilitate the workflow, such as the continuous operation of venous blood collection work⁷; Or when changing between unclean and clean activities on the same patient⁸; On the other hand, a study found that hand hygiene compliance during aseptic operations has been improved from 50% to 75% in stem cell transplant wards by allowing glove wearing for hand disinfection, while also reducing the trend of severe infections⁹.

However, it is worth noting that disposable medical gloves are designed for single use only. The repeated use of disinfectants and wearing them for long periods through repeated hand hygiene may compromise the gloves’ protective capabilities. This raises concerns about the effectiveness of disposable gloves in maintaining infection control.

Previous researchers have examined the durability of glove materials following repeated disinfection^10,11. Specifically, it has been determined that the tensile strength of gloves decreases with each application of alcohol-based hand rub; the effectiveness of disinfection may vary based on the disinfectant/glove combinations. Additionally, various disinfection methods have been tested for their impact on the sustained use of gloves; it has been demonstrated that medical-grade gloves retain their mechanical, thermal, and thermomechanical properties even after undergoing 20 rounds of sterilization through dry heat, steam, ultraviolet radiation, and ethanol in a laboratory setting^12,13. The purpose of this study was to evaluate the effects of repeated application of EBHR and chlorine-containing disinfectant on the tensile properties of latex, nitrile, and PVC gloves. The results of the investigation could serve as a basis for the appropriate use of medical gloves and provide crucial insights for healthcare practitioners.

Gloves

This study used latex gloves, nitrile gloves, and PVC gloves as research objects. All gloves were 100% powder-free. Details on the gloves evaluated in this study are provided in Table 1. This includes information on the brand, country of manufacture (Malaysia or China), and use of gloves. Glove codes were assigned to each based on polymer type and brand.

Disinfectants

The most commonly used disinfectant solutions in medical institutions were selected for testing: (1) ethanol-based hand rub (85g ethanol/100g); (2) chlorine antiseptic of different concentrations (500mg/L; 1000mg/L; 2000mg/L; 5000mg/L).

Measures

A total of 182 pairs of gloves from each glove brand were examined. All gloves of each brand tested were chosen from the same batch to eliminate batch/batch variation from the glove population sample. There were five experimental groups for each disinfectant, and each group had seven pairs of gloves. Prior to the test, a glove was discarded if it had any visible defects or tears.

Disinfecting procedures were based on CDC and WHO guidelines for hand hygiene^2,14. A pair of gloves was worn by a test operator, with every study team including four test operators. The test operators were instructed to remove any rings from their fingers and have all fingernails filed short and smooth before donning gloves and conducting the following test procedures. This was necessary to avoid causing any potential damage to the tested gloves.

The test procedures involving EBHR or chlorine antiseptic of different concentrations are outlined in Table 2. Two pumps (approximately 4ml) of EBHR were dispensed onto the gloved hands. The EBHR was then rubbed onto the gloves by the test operators. Each application lasted approximately 90s of contact time until dry. After drying, the next EBHR exposure followed, or the gloves were removed for tensile testing.

A disinfectant containing chlorine with a sodium hypochlorite concentration of 4–6% was blended with running water in specific ratios to generate disinfectants with varying levels of chlorine potency, including 500, 1000, 2000, and 5000 mg/L effective chlorine concentrations. The study team put on the gloves and immersed their gloved hands into various dilutions of chlorine-based disinfectant for 1 min, ensuring complete palm coverage while keeping the wrist opening above the solution. Subsequently, the solution was left to dry for 1 min to guarantee complete decontamination. Afterward, the gloves were rinsed thoroughly with clean water and dry toilet paper was used to remove any excess disinfectant. This complete process was considered to be a single treatment.

Controls

Seven pairs of gloves from each brand were selected as the control group,and they were all put on and removed one time to stimulate the mechanical stress associated with typical glove use. No further treatment or manipulation was performed before the tensile test.

Tensile testing

To ensure consistency across samples, all gloves were cut using a mold according to ASTM D6287 to form a long strip (6 cm long and 1 cm wide) of the palm of the glove to be used as a test sample. The tensile test was conducted with reference to the standard ASTM D882-18, using a JHY-5KN digital display single-column electronic universal testing machine. The distance between the clamps was 5 cm, the sample was loaded correctly, and the separation speed between the clamps was 500 mm/min. Finally, until the sample broke, the test operator recorded the tensile strength and elongation at the break for statistical comparison.

Tensile strength represents the threshold that separates uniform plastic deformation from localized concentrated plastic deformation, and it is regarded as the ultimate bearing capacity of a material when subjected to static tensile conditions. The deformation is uniform as long as the maximum tensile stress has not been reached. However, beyond this point, the material undergoes necking, which indicates a concentrated deformation. In the case of brittle materials that do not exhibit significant uniform plastic deformation, tensile strength relates to the material’s fracture resistance.

Elongation at break occurs when a substance endures external force until it ruptures; the proportion of the elongation post-stretching to the original length pre-stretching is known as the elongation at rupture and is represented as a percentage. This variable is a gauge of the material’s suppleness and resilience. Elevated elongation at rupture values indicates superior pliability and elasticity.

Tensile testing is performed on test samples within one hour of treatment to ensure uniformity and to avoid the influence of environmental factors on gloves’ tensile characteristics. This is also in line with the reality of using gloves for a short time after disinfection.

Statistical analyses

The study results were described by means and standard deviation. All data were statistically analyzed using IBM SPSS Statistics 19 (IBM, Armonk, NY, USA). The sample size glove and treatment combination was 14 specimens cut from seven pairs of gloves; these were compared to 14 control samples using an independent sample t-test; this occurred among latex, nitrile, and PVC gloves, and the correlation between variables was determined using Spearman-related analysis. The results were statistically significant if the P value was ≤0.05.

Latex gloves

The changes in tensile strength and elongation at the break of latex gloves treated with different disinfectants are summarized in Table 3. The use of EBHR did not result in any significant changes in these experimental groups compared to the control group (P > 0.05) for these two latex gloves. However, significant increases in tensile strength, in the range of 24.5 to 39.39%, were observed with both the 1000 mg/L chlorine-based disinfectant and 5000 mg/L chlorine-based disinfectant, especially when performed for two treatments (P=0.01) or eight treatments(P=0.015).

The elongation at break was affected by antiseptics, and there was a significant change in both the effects of EBHR and chlorine-based disinfectant. However, the elongation at break of L1 latex gloves changed under the effects of EBHR, and the difference was statistically significant. For example, when disinfecting twice, the elongation at break decreased by 11.06% (P=0.02); After six rounds of repeated disinfection, it was observed that the elongation at break increased by 11.7% (P=0.014). No significant changes were observed in the elongation at break of L2 latex gloves. Under the influence of various concentrations of chlorine-containing disinfectants, the tensile properties of both types of latex gloves underwent changes. Specifically, the tensile strength of L1 latex gloves increased by a range of 24.5% to 39.39% when exposed to chlorine-containing disinfectants, whereas the elongation at break rose by 8.43% to 14.22%. For L2 latex gloves, repeated exposure to chlorine-containing disinfectants led to a tensile strength increase ranging from 37.7% to 64.47%, and an elongation at break increase of 14.96% to 27.77%. All of these differences were statistically significant.

To gain a deeper understanding whether disinfection frequency and the concentration of chlorine-containing disinfectants affect the tensile properties of gloves, we conducted a correlation analysis. It was discovered that the breaking elongation of L1 latex gloves showed a slight increase with the rise in disinfection times following treatment with EBHR. The correlation between these two was weak (rs = 0.391, P =0.013). However, there was no correlation observed between breaking elongation and disinfection times when subjected to chlorine-containing disinfectants. A significant positive correlation was seen between the concentration of chlorine-containing disinfectants and tensile strength after two treatments with chlorine-containing disinfectants (rs = 0.522, P =0.01), while a weak positive correlation was also noted with elongation at break (rs = 0.339, P =0.046). Meanwhile, the correlation analysis indicated that the tensile strength (rs = 0.345, P =0.027) and elongation at break (rs = 0.343, P =0.028) of L2 latex gloves exhibited a weak positive correlation with disinfection times when exposed to disinfectant containing 2000 mg/L chlorine. Moreover, after two repeated treatments with chlorine-containing disinfectant, it was found that the elongation at break (rs = 0.353, P =0.037) of L2 latex gloves experienced a weak positive correlation with the disinfectant concentration. Following four and eight treatments, the tensile strength and elongation at break of L2 latex gloves were observed to increase alongside the concentration of chlorine-containing disinfectant, and there was a weak correlation between the concentration and tensile strength (elongation at break).

N nitrile gloves

As shown in Table 4, The tensile strength of nitrile gloves was not markedly affected by the use of EBHR, but the elongation at break tended to rise with the number of hand hygiene sessions. A statistically significant increase in elongation at break was observed after eight hand hygiene sessions (P=0.023).

After applications of chlorine-containing disinfectant, the tensile strength of nitrile gloves increased significantly, up to a maximum of 2.31 times, while the elongation at break also increased significantly, up to 1.45 times. After conducting a correlation analysis, it was discovered that the tensile strength (rs = 0.56, P ≤0.0001) and elongation at break (rs = 0.50, P =0.001) of nitrile gloves subjected to 500 mg/L chlorine-containing disinfectant were positively correlated with disinfection times. Furthermore, both the tensile strength and elongation at break increased with higher concentrations of chlorine-containing disinfectant. Additionally, these two variables significantly correlated with the chlorine-containing disinfectant concentration.

PVC gloves

Table 5 summarizes the changes in tensile strength and elongation at the break of PVC gloves treated with different disinfectants. After the applications of the chlorine-containing disinfectant ranging from 1000 mg/L to 5000 mg/L, the tensile strength and elongation at the break of PVC gloves did not change significantly (P > 0.05). However, a reduction (P =0.004) in tensile strength and elongation at the break of PVC gloves was observed after four rounds of hand hygiene with EBHR,which was statistically significant. The tensile strength and elongation at break also decreased after six rounds of treatment with the 500 mg/L chlorine-containing disinfectant and had a statistically significant difference (P =0.01). After correlation analysis, it was found that after repeated treatments with 500 mg/L chlorine-containing disinfectant, there was a weak negative correlation between the elongation at break of PVC gloves and disinfection times (rs = -0.37, P = 0.019).

Latex has been employed as a material in the fabrication of gloves, affording medical staff and patients elevated levels of protection and bestowing upon workers optimal comfort to carry out their duties safely and proficiently¹⁵. Therefore, latex gloves are used more frequently in clinical practice. In this study, two brands of latex gloves were selected for experimentation, and ten rounds of hand hygiene with EBHR were performed. The testing revealed that neither the tensile strength nor the elongation at the break of the gloves was significantly impacted by the disinfectant. This is consistent with the findings of Phalen et al.¹⁶, who also showed no significant differences in the elastic modulus between the glove samples treated with disinfectant and the control group. Simultaneously, we observed a weak positive correlation between the elongation at break of L1 brand gloves and the times of repeated treatments with EBHR.If the number of treatments continues to increase, further investigation is needed to determine whether EBHR will have a greater impact on latex gloves.In a similar vein, Gao et al.¹⁷ discovered that exposure to alcohol-containing disinfectant led to the rise or unaltered state of latex gloves’ tensile strength while their stretchability increased; this signaled that after 10 repeated applications of EBHR, the elastic properties of latex gloves was barely altered, or even displayed an inclination towards enhancement.

Likewise, in this study, the presence of disinfectants containing chlorine has been found to enhance the tensile strength as well as the elongation at the break of latex gloves to varying degrees. As the frequency of disinfection and the concentration of disinfectant increase, both the tensile strength and elongation at break of latex gloves exhibit an upward trend.According to Phalen et al.¹⁶, latex examination gloves exhibited minimal impact after being repeatedly treated with diluted bleach ten times.

This data supports that latex gloves exhibit a certain level of durability when subjected to repeated disinfection, and after undergoing repeated disinfection processes, these gloves maintain good tensile properties, providing reliable protection for users.

Although latex gloves exhibit satisfactory mechanical properties, the allergenic substances present in their latex components are widely recognized. In recent years, occupational allergies resulting from latex have become a critical healthcare concern¹⁸. Accordingly, synthetic rubber gloves have emerged to address this need. Furthermore, among the various synthetic rubber glove options available, nitrile rubber gloves have gained significant popularity owing to their desirable features, such as exceptional elasticity, chemical resistance, and cost-effectiveness¹⁹. The nitrile exam gloves utilized in this study are thinner compared to sterile surgical gloves but are more commonly used in daily clinical practice. Findings from this experiment revealed that the tensile strength of nitrile gloves remains unaffected, mainly by EBHR. At the same time, the elongation at break displays a modest increase with the times of repeated treatments with EBHR. Conversely, exposure to different strengths of chlorine-containing disinfectants significantly enhances both the tensile strength and elongation at the break of the gloves. A positive correlation was found between disinfection duration and strength of the disinfectant to varying degrees, similar to the findings reported by Esmizadeh et al.¹³. Under the influence of the diluted bleach, the tensile strength and fracture elongation of nitrile gloves exhibited a slight increase. However, after being exposed to the diluted bleach for 20 cycles in this particular experiment, both the tensile strength and fracture elongation suffered a significant decrease¹³. It is worth noting that our experimental procedure did not involve 20 cycles, and we did not observe any substantial reduction in the aforementioned properties. In contrast, Garrido-Molina et al.¹⁰ reported that the tensile strength of a single nitrile glove brand decreased by 17% after being treated one time with 5000 mg/L chlorine containing disinfectant. The results reported by Phalen et al.¹⁶ appeared to be mixed after ten treatments; the percent changes in elastic modulus of one brand were not significant, another brand showed a reduction of 31%, and the third brand exhibited a 47% drop. The 47% reduction was accompanied by a 40% loss in tensile strength and a 5.5% increase in elongation at break.

The experiment’s outcomes may differ based on several factors, including the brand and storage time of the gloves and the batch-to-batch variability. Even though the tensile properties of this brand of nitrile gloves were not significantly affected by the disinfectants used in the test, we observed that the gloves faded after repetitive exposure to disinfectants. In addition, Esmizadeh et al.¹³ Reported significant surface microcracks on nitrile gloves post disinfection. Consequently, it is crucial to limit the frequency of disinfection and promptly replace the gloves to prevent any damage or penetration and mitigate the risk of exposure for healthcare workers during clinical practice.

Compared to PVC gloves,the observed results in tensile strength and elongation at the break of control gloves were also consistent with a study that reported that vinyl examination gloves tended to have poorer performance²⁰. After four repeated treatments with EBHR, the tensile properties of PVC gloves showed a significant drop, while similar results were observed when using 500mg/L chlorine-containing disinfectant. Elongation at break decreased with the increase in disinfection times using 500mg/L chlorine-containing disinfectant, and there was a negative correlation between the two variables. In contrast, Esmizadeh et al.¹³. Reported that there were no significant changes in tensile strength and elongation at the break of vinyl gloves from the baseline value after 20 consecutive cycles of sterilization with ethanol and bleach. Still, the vinyl gloves became clear and transparent after treatment, as observed in our experiments. At the same time, we also found that as the number of disinfections increased, the softness of the palm and finger parts significantly changed, leading to hardening, which may be a direct result of the leaching out of plasticizers under the treatment of chemical disinfectants²¹.

Based on the results of the current study and the available literature, the comfort and tensile properties of PVC gloves have decreased after repeated disinfection, so PVC gloves are instead more recommended for single use to avoid increasing the risk of infection exposure for medical personnel.

To align more closely with the practical use of gloves, during the procedures involving hand hygiene and the simulated application of chlorine-containing disinfectants, all investigators wore gloves for related operations. This increased the stress on the gloves, potentially influencing their tensile properties in our experiments.Although our experiment was not specifically designed to study the impact of hand movements on gloves, we found during simulated operations that latex gloves exhibited less variation in tensile properties, performing better than nitrile gloves and PVC gloves.The finds further improved the findings of Phalen et al.²², who reported that in tests examining the chemical permeation of organic solvents through disposable gloves due to hand movements, latex gloves outperformed nitrile and vinyl gloves. They were less affected by hand movements compared to nitrile gloves, and also exhibited superior chemical resistance compared to vinyl gloves.

This study had several limitations. First, considering that this study used only one brand of nitrile gloves and one brand of PVC gloves, the results may only apply to some brands of gloves. Consequently, further testing with other brands is necessary in the future. In addition, studies that have explored the use of disinfectant with gloves, especially PVC gloves, are limited in number, which makes comparing results difficult. However, the lack of data highlights the novelty of the topic. Finally, this study only included ten repeated treatments and tensile testing without conducting permeability and integrity testing. Thus, we can expand the research to include additional testing or more kinds of disinfectants to examine whether disinfectants may cause the deterioration of gloves. We could also analyze how antiseptics affect the performance of gloves to find the best disinfection treatments and the maximum disinfection times.

PVC:

Polyvinyl chloride

EBHR:

Ethanol-based hand rub

CDC:

Centers for disease control and prevention

PPE:

Personal protective equipment

WHO:

The World Health Organization

Authors and Affiliations

1. Department of Infection Control, Xiangya Hospital, Central South University, Changsha, China

   Meiling Luo&Chunhui Li

2. Department of Infection Control, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China

   Meiling Luo&Zhimei Chen

3. National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China

   Chunhui Li

4. Department of Infection Control, The First Affiliated Hospital of Nanchang University, Nanchang, China

   Xin He

5. Department of Infection Control, Xingguo People’s Hospital, Ganzhou, China

   Ting Xie

6. Department of Infection Control, Yiyang The First Hospital of T.C.M, Yiyang, China

   Wei Bo

7. Department of Infection Control, The Second Hospital of Dalian Medical University, Dalian, China

   Pengchao Fan

8. Department of Infection Control, Zibo Maternal and Child Health Hospital, Zibo, China

   Qinghong Bi

9. Department of Infection Control, The 921st Hospital of the Joint Logistics Support Force of the People’s Liberation Army of China, Changsha, China

   Qing Xia

Contributions

C.L. led the overall study, contributed to study design and manuscript edits. M.L. conducted the study, contributed to study design,the data collection,data analysis and wrote the manuscript. Z.C., X.H., T.X., W.B., Q.B. and Q.X. took part in study, contributed to data collection.PF contributed to study design and preliminary preparation for the study.All authors read, contributed to the research design, and approved the final manuscript.

Corresponding author

Correspondence to Chunhui Li.

Competing interests

The authors declare no competing interests.

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