Do you operate a motorcycle without a helmet? Drive your car without using a seatbelt? Taking simple, commonsense measures such as wearing a helmet or putting on your seatbelt can make the difference between arriving safely and a catastrophe.
So why aren’t you double-gloving in the O.R.? It’s another commonsense way to protect both you and your patient. One study showed that up to 96 percent of glove failures may go unrecognized, while another showed bacterial migration in over half of micro-perforations. (1,2)Those are the same type of gloves that you are using in the O.R., so the potential dangers are real.
Many surgeons and O.R. staff believe that either their tactile sensitivity or manual dexterity will be compromised when double-gloving, but the literature does not support those concerns.
Here are 6 reasons why two gloves are better than one in the O.R.:
1. Protect yourself from needlestick injuries. A 2014 Cochrane meta-analysis that included 12 surgical trials found the healthcare worker risk of glove perforation is decreased by 71 percent when using double gloves compared to single gloves. (3) Literature reports that surgical team members are percutaneously exposed to blood, bodily fluids, or other infectious materials in as many as 50 percent of surgical procedures. (4)
2. Protect yourself from contamination. A 2006 meta-analysis of 14 low-risk surgical trials involving nearly 9,000 gloves found that single gloves incurred a 9 percent perforation rate while the inner gloves of doubled-gloved personnel incurred only a 2 percent perforation rate. Double-gloving lowered the perforation risk by a factor of four. (5) Essentially any blood-borne pathogen a patient may have can be transmitted to a healthcare worker through a perforation. A review of published literature has identified at least 60 different blood-borne pathogen that have been reported as being transmitted to healthcare workers due to accidental exposure. (6)
3. Decrease SSI rates among patients. Glove perforation increases the risk for Surgical Site Infections (SSIs). A two-year study demonstrated that patients undergoing procedures when a perforation occurred were twice as likely to suffer an SSI than patients where no perforations were evident. Among the subset of patients who were not given antibiotic prophylaxis, patients were four times more likely to suffer an SSI when glove perforations occurred. (7)
4. Follow Recommended Practices and Guidelines. The following societies support and recommend double-gloving in surgical procedures:
- Association of PeriOperative Registered Nurses (AORN)
- Centers for Disease Control and Prevention (CDC)
- American College of Surgeons (ACS)
- American Academy of Orthopaedic Surgeons (AAOS)
- Association for Perioperative Practice (AfPP)
- Association of Surgical Technologists (AST)
These organizations also recommend that surgical facilities have a written policy on double-gloving that includes the use of an indicator system.
5. Protect yourself without compromising loss of tactile sensitivity or dexterity. Several studies show manual dexterity and tactile sensitivity while double-gloving are not substantially impacted when compared to single-gloving. The American College of Surgeons used a standard 2-point discrimination test to measure influence of double-gloving on manual dexterity and tactile sensation of surgeons. Study results show that manual dexterity and tactile sensitivity are preserved while double-gloving. (8)
Adjusting to double-gloving can take anywhere from one to 120 days. However, in most cases, surgeons, whose compliance is typically low, were able to adjust to double-gloving within two days. (9,10) Thinner glove options are now available to help make double-gloving even more comfortable than ever. (11,12)
6. Increase protective benefits with an indicator glove. Wearing an indicator glove as the innermost glove enhances the protective benefits of double-gloving. Studies have shown that indicator gloves provide both accuracy and rapidity of identifying a puncture. In an oral maxillofacial surgery study, 1061 gloves used for 113 patients were examined. There were fewer unnoticed perforations in the indicator glove group than the standard surgical glove group (19 percent compared with 79 percent). (13)
Double-gloving – it just makes sense – for you, your coworkers and your patients.
Judith Seltzer is the surgical clinical director, national accounts for Mölnlycke Health Care and serves as an expert clinical specialist for acute and non-acute healthcare facilities, and hospital administrative professionals.
- Timler D, Kusinski M, Iltchev P, et al. Glove failure in elective thyroid surgery. A prospective randomized study. International Journal of Occupational Medicine and Environmental Health. 2015;28(3):http://dx.doi.org/10.13075/ijomeh.1896.00428.
- Hubner NO, Goerdt AM, Stanislawski N, et al. Bacterial migration through punctured surgical gloves under real surgical conditions. BMC Infectious Diseases. 2010;10:192.
- Mischke C, Verbeek JH, Saarto A, et al. Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel. Cochrane Database Syst Rev. 2014;3:CD009573.
- Childs T. Use of double gloving to reduce surgical personnel’s risk of exposure to bloodborne pathogens: an integrative review. AORN. 2013;98(6):585-596.
- Tanner J, Parkinson H. Double gloving to reduce surgical cross-infection. Cochrane Database of Systematic Reviews. 2006, Issue 3. Art. No.: CD003087. DOI: 10.1002/14651858.CD003087.pub2.
- Tarantola A, Abiteboul D, Rachline A. Infection risks following accidental exposure to blood or body fluids in health care workers: a review of pathogens transmitted in published cases. Am J Infect Control. 2006;34(6):367-75.
- Misteli H, Weber WP, Reck S, et al. Surgical glove perforation and the risk of surgical site infection. Arch Surg.2009;144(6):553-8.
- Fry DE, Harris WE, Kohnke EN, Twomey CL. Influence of double-gloving on manual dexterity and tactile sensation of surgeons.American College of Surgeons. 2010;1-6.
- Welc CM, Nassiry A, Elam K, et al. Continued non-compliance with the American College of Surgeons recommendations to decrease infectious exposure in the operating room: why? Surg Infect (Larchmt). 2013;14(3):288-92.
- Patterson JM, Novak CB, Mackinnon SE et al.: Surgeons’ concerns and practices of protection against blood-borne pathogens. Ann Surg 1998; 228: 266-72.
- Data on file, Mölnlycke Healthcare.
- MHC Clinical Study #G14-001.
- Avery CM, Taylor J, Johnson PA. Double gloving and a system for identifying glove perforations in maxillofacial trauma surgery. Br J Oral Maxillofac Surg. 1999;37(4):316-319.