Sterile Gloving: Closed, Open, and Assisted Techniques

Why Sterile Gloving Matters

Sterile gloves are the last physical barrier between the surgical technologist's hands and the sterile field. A break in glove technique is a break in the sterile field — one that can introduce microorganisms directly into an open wound. Because patient safety depends on an uninterrupted sterile barrier, the Association of Surgical Technologists (AST) and the Association of periOperative Registered Nurses (AORN) both identify correct gloving as a foundational competency. Every surgical technologist must be able to perform three distinct methods and know when each is appropriate.

The Three Techniques at a Glance

Closed-glove technique is used when the surgical technologist (scrub) has just donned a sterile gown and the gown cuffs have not yet broken the sterile plane. The hands remain hidden inside the gown sleeves throughout the entire gloving process. Because bare skin never touches the outer glove surface, this method offers the highest level of sterility and is the standard technique for the initial scrub at the beginning of a surgical procedure.

Open-glove technique is used when a sterile gown is not being worn — for example, during bedside procedures, urinary catheter insertion, or when a glove must be changed mid-case without re-gowning. The gloves are opened onto a clean flat surface, and the bare dominant hand picks up the first glove by touching only its folded inner cuff. The second glove is then handled glove-to-glove. Because bare skin briefly contacts the inner cuff of the first glove, this method is considered slightly less protective than closed technique and must not be used as the primary method for the initial scrub in the OR.

Assisted-glove technique (also called assisted or team gloving) is used when a sterile team member helps another team member who has already donned a sterile gown. The assisting scrub opens and holds the glove wide — fingers down, thumbs out — so the recipient can plunge their hand straight in without touching the exterior. This technique is useful for regloving mid-case after a contamination event when a second sterile team member is present.

Step-by-Step: Closed-Glove Technique

1. After performing the surgical hand scrub, accept the sterile towel without touching the gown exterior.

2. Don the sterile gown with circulator assistance, keeping hands inside the sleeves; do not push fingers through the cuffs.

3. Open the inner glove wrapper onto the sterile field using only the gown sleeve as a barrier.

4. Using your right sleeve-covered hand, grasp the cuff of the left glove. Lay it palm-up on your left forearm with the glove fingers pointing toward your elbow.

5. Fold the glove cuff over the sleeve cuff and work your fingers into the glove, pushing through with the sleeve still covering the wrist.

6. Repeat the mirror image process to glove the right hand, this time using the now-gloved left hand to hold and position the glove.

Step-by-Step: Open-Glove Technique

1. Open the outer glove package and drop the inner foil pouch onto a clean surface.

2. Peel the inner package open without touching the gloves.

3. With your dominant hand, grasp the folded inner cuff of the opposite glove (non-dominant first). Touch only the inner cuff surface.

4. Slide the non-dominant hand into the glove without unrolling the cuff.

5. Slip the gloved dominant fingers under the outer cuff of the second glove (glove-to-sterile-glove contact only) and don it.

6. Interlock fingers to seat both gloves fully and unroll cuffs last.

Step-by-Step: Assisted-Glove Technique

1. The assisting scrub picks up the glove with fingers inside the cuff, stretching it wide, thumbs facing outward and away from the recipient.

2. The recipient plunges their hand straight into the opening in one smooth motion.

3. The assisting scrub releases the cuff by rolling it up over the gown sleeve — never unrolling it downward toward bare skin.

4. Repeat for the second glove.

Glove Integrity Check

Even an undamaged-looking glove can have a pinhole defect from manufacturing or handling. The water-fill method — filling the glove with water and observing for leakage — is a practical lab exercise to demonstrate why gloves must be inspected and why double-gloving is recommended for high-risk procedures. In clinical practice, if a glove is punctured, torn, or contaminated during a case, it must be changed immediately; the scrub steps away from the field, the circulator assists removal, and a sterile replacement is donned using the closed or assisted method.

Critical Safety Rules

• Bare skin must never touch the outer sterile surface of any glove. Any contact contaminates the glove and the sterile field.
• Gown cuffs are not sterile — they become contaminated after the hands pass through. The glove cuff must always cover the gown cuff.
• If you are uncertain whether a glove has been contaminated, treat it as contaminated and change it.
• Latex allergy is a documented patient-safety issue. Always confirm patient and team member latex sensitivity; use latex-free gloves when indicated.
• Double-gloving is recommended for procedures involving bone cutting instruments, sharps-heavy cases, or when handling tissue from patients with known bloodborne pathogens.

Connection to the CST Credential

The NBSTSA CST examination tests knowledge of aseptic principles throughout the exam. Understanding when and why each gloving method is used — not just how to perform it mechanically — is the level of mastery required for both the exam and safe clinical practice.