Detailed Review

1. Abstract
   • Strengths: The abstract is concise, structured, and within JAN’s typical 250–300-word limit. It clearly states the aim (summarize evidence on non-sterile glove use for IV antimicrobials), design (scoping review), methods (five databases, grey literature), and key finding (no evidence found). The implications highlight the need for guidelines, aligning with JAN’s focus on practice-relevant outcomes.
   • Weaknesses: The results section contains an incomplete sentence (“Three papers selected. None non-sterile glove use during intravenous antimicrobial”), reducing clarity. The implications and impact sections are repetitive, both emphasizing guidelines, patient outcomes, costs, and sustainability, which dilutes their impact. The keywords (e.g., “planetary health”) could better reflect the paper’s focus.

Suggestions:
• Revise the results sentence for clarity, e.g., “Three studies were included, none directly addressing non-sterile glove use in IV antimicrobial preparation or administration.”
• Consolidate implications and impact sections to avoid redundancy, e.g., “This gap underscores the need for evidence-based guidelines to enhance patient safety, reduce costs, and promote sustainable healthcare.”
• Refine keywords to prioritize nursing-specific terms, e.g., replace “planetary health” with “nursing practice” or “hand hygiene.”

1. Introduction
   • Strengths: The introduction effectively establishes the problem: inappropriate non-sterile glove use undermines hand hygiene, increases healthcare-associated infections (HAIs), costs, and environmental harm. Citations (e.g., Loveday et al., 2014a; WHO, 2022) are relevant and support the rationale. The focus on IV antimicrobials as an understudied area is compelling and aligns with JAN’s emphasis on novel research gaps.
   • Weaknesses: The historical context of universal precautions (e.g., CDC, 1988) is slightly verbose and could be streamlined to focus on current practice. The claim of increasing glove use (Lindberg & Skytt, 2020) lacks specificity about IV antimicrobials versus general nursing tasks. The gap in guidelines for IV antimicrobial glove use is stated but not sharply defined.
   • Suggestions:
   • Concisely articulate the gap, e.g., “No guidelines specifically address non-sterile glove use for IV antimicrobial preparation/administration, despite its prevalence in nursing practice.”
   • Shorten the historical discussion (combine CDC, 1988, and Garner, 1996) to prioritize current evidence.
   • Clarify the scope of increasing glove use, e.g., “Lindberg & Skytt (2020) note rising glove use in nursing, though its relevance to IV antimicrobials is unclear.”

2. Methods
   • Strengths: The methods are robust, adhering to Arksey and O’Malley’s (2005) six-step framework and PRISMA-ScR guidelines, meeting JAN’s expectation for transparent reporting. The search across five databases and grey literature, conducted in January–February 2024, is comprehensive. The multidisciplinary team (nursing researchers, educators, IPC expert) and protocol registration on Open Science Framework (OSF) enhance credibility. The use of COVIDENCE and independent reviewers (PZ, WL, MTB) ensures rigor.
   • Weaknesses: The exclusion of non-English studies may limit global applicability, a concern for JAN’s international audience, and is only acknowledged in the limitations. The 2009–2024 date range is justified (post-WHO 2009 guidelines), but the rationale could be clearer. Table 1 (search strategy) is referenced but missing, hindering evaluation of keywords and Boolean operators. The Mixed Methods Appraisal Tool (MMAT) quality assessment is unnecessary for scoping reviews, which focus on evidence mapping, and may confuse readers.
   • Suggestions:
   • Strengthen the date range rationale, e.g., “Studies pre-2009 were excluded to align with WHO’s 2009 glove use guidelines, ensuring relevance to current practice.”
   • Include Table 1, detailing keywords (e.g., “glove*,” “antimicrobial*”), Boolean operators, and database results.
   • Clarify the MMAT’s exploratory role, e.g., “An optional MMAT assessment was conducted to contextualize study rigor, though not required by PRISMA-ScR.”

3. Results
   • Strengths: The results clearly report the search yield (757 records, 594 screened, 25 full-text, 3 included) and use a PRISMA flow diagram (Figure 1), meeting JAN’s reporting standards. The grey literature search and citation tracking (Figure 2, Table 5) demonstrate thoroughness. The key finding—no studies directly address non-sterile glove use for IV antimicrobials—is significant and clearly stated.
   • Weaknesses: The inclusion of only three studies, none directly relevant, limits the results’ depth. The supplementary findings (e.g., reasons for glove misuse, Wilson et al., 2017) are detailed but detract from the focus on IV antimicrobials. The MMAT quality assessment feels out of place for a scoping review and may confuse readers expecting a focus on evidence mapping. Tables 2–5 and Figures 1–2 are referenced but not provided, limiting evaluation.
   • Suggestions:
   • Emphasize the evidence gap in the narrative, e.g., “No studies provided primary evidence on non-sterile glove use for IV antimicrobial preparation/administration, underscoring a critical research need.”
   • Streamline supplementary findings to focus on IV-relevant insights (e.g., Wilson et al.’s 10.1% glove use for IV device manipulation) and move general glove misuse to the discussion.
   • Move the MMAT assessment to a supplementary appendix or note it as exploratory to align with scoping review norms.
   • Include Tables 2–5 and Figures 1–2, ensuring clear legends and JAN-compliant formatting.

4. Discussion
   • Strengths: The discussion effectively synthesizes the lack of evidence and its implications for nursing practice, patient safety, costs, and sustainability, aligning with JAN’s focus on impactful research. Citations (e.g., NHS Scotland, 2023; Gielen & Goossens, 2001) contextualize findings. The critique of educational resources (e.g., UCL video, Perry et al., 2015) and hospital policies is relevant and highlights practice gaps.
   • Weaknesses: The discussion repeats introduction points (e.g., environmental impact, costs) without adding new insights. The skin health discussion (Antunes et al., 2011) is limited by its indirect relevance, and the self-citation critique (Loveday, Wilson) feels speculative without supporting data. The exploration of educational resources is underdeveloped and could better connect to practice implications.
   • Suggestions:
   • Avoid repetition by focusing on new insights, e.g., why evidence is lacking (e.g., limited research funding, complexity of studying glove use).
   • Substantiate the self-citation critique, e.g., “Four of eight cited studies involved overlapping authors, indicating a concentrated research pool.”
   • Expand the educational resource critique, e.g., “Nursing texts (Perry et al., 2015) recommend glove use without evidence, necessitating curriculum updates.”
   • Propose specific research designs (e.g., observational studies, RCTs) to address the gap, enhancing the discussion’s utility.

5. Conclusion
   • Strengths: The conclusion concisely summarizes the lack of evidence and its implications, reinforcing the need for research. It aligns with JAN’s emphasis on advancing knowledge for practice and policy.
   • Weaknesses: The conclusion is brief and slightly repetitive of the discussion. It could better emphasize nursing-specific implications for JAN’s readership.
   • Suggestions:
   • Strengthen the nursing focus, e.g., “Nurses should prioritize hand hygiene over routine glove use for IV antimicrobials until evidence-based guidelines are developed.”
   • Add a call to action, e.g., “Nursing leaders must advocate for research to inform IPC protocols, enhancing patient safety and sustainability.”

6. References and Formatting
   • Strengths: The reference list is comprehensive, citing key IPC and nursing studies (e.g., WHO, 2022; Loveday et al., 2014a). The PRISMA-ScR checklist and OSF protocol registration enhance transparency.
   • Weaknesses: The reference style has inconsistencies (e.g., variable DOI formats, missing access dates for web sources), which may not meet JAN’s requirement for a consistent style. Missing tables (1–5) and figures (1–2) hinder complete evaluation.
   • Suggestions:
   • Standardize references (e.g., APA or Vancouver), ensuring complete DOIs and access dates for web sources (e.g., WHO, 2022).
   • Include all tables and figures with clear, JAN-compliant legends and numbering.

Recommendations for Revision for Authors;

• Focus on IV Antimicrobials: Highlight the evidence gap prominently in the results and discussion, minimizing supplementary findings (e.g., general glove misuse) unless directly relevant to IV antimicrobials.
• Reduce Repetition: Streamline overlapping content in the introduction, discussion, and conclusion. Consolidate abstract’s implications/impact sections.
• Clarify Methods: Include Table 1 and justify non-English exclusion and MMAT use explicitly. Move MMAT to an appendix to align with scoping review norms.
• Deepen Discussion: Analyze reasons for the evidence gap (e.g., research priorities, study complexity) and propose specific research designs (e.g., cross-sectional studies).
• Polish Formatting: Include all tables/figures, standardize references, and edit for conciseness and clarity to meet JAN’s standards.
• Enhance Nursing Relevance: Emphasize implications for nursing practice (e.g., hand hygiene protocols) and education (e.g., curriculum updates) to appeal to JAN’s readership.

Thank you for revising the manuscript based on my previous feedback.