Double Gloving: Myth Versus Fact

By Linda McNeilly

For healthcare professionals, their hands are their livelihood. It is important that they protect their hands and their health in order to protect the health of their patients. One proven step that better protects healthcare professionals hands from the dangers inherent in the operating room is double-gloving.

Many professional organizations, including the Centers for Disease Control and Prevention (CDC),¹ the Association of periOperative Registered Nurses (AORN),² the American Academy of Orthopedic Surgeons (AAOS),³ and the American College of Surgeons (ACS)⁴ recommend double gloving to create a safer working environment. And these are a few of the reasons why:

Myth: Glove barrier failure is rare.

Truth:

- Perforation rates as high as 61 percent for thoracic surgeons and 40 percent for scrub personnel have been reported. Double gloving decreases the risk of exposure to patient blood by as much as 87 percent when the outer glove is punctured.⁵

- A study conducted to estimate and compare the perforation risk in different categories of surgery found perforations in 203 out of 655 operations (31 percent), with frequencies of 44.5 percent in gastrointestinal surgery, 34.7 percent in orthopedic surgery, 31.1 percent in gynecology, 18.6 percent in vascular surgery and 9.2 percent in general surgery.⁶

Myth: Needlesticks and sharps injuries are uncommon events.

Truth:

- Cuts or needlesticks may occur in as many as 15 percent of operations.^7-8

- Up to 16 percent of injuries occur while passing sharps instruments hand-to-hand.⁹

- Suture needles are the most frequent source of injury and are involved in as many as 77 percent of total injuries. Most injuries are self-inflicted, but a notable number, perhaps as many as 24 percent, are inflicted by a co-worker.¹⁰

- Most, if not all, surgeons have encountered blood on their hands or fingers at the conclusion of a procedure without being aware of an injury or glove barrier breach by any other method (glove puncture, tear or failure). The practice of wearing two pairs of gloves offers a high degree of protection from this common event.¹⁰

Myth: The glove failure rate is equally high with double gloves as with single.

Truth:

- Double-gloving reduces the risk of exposure to patient blood by as much as 87 percent when the outer glove is punctured. Volume of blood on a solid suture needle is reduced by as much as 95 percent when passing through two glove layers, thereby reducing viral load in the event of a contaminated percutaneous injury.¹¹

- One study conducted a prospective, randomized, trial of 143 procedures involving 284 people and found the glove failure rate (i.e., blood contamination of the fingers) was 51 percent when one glove was worn but only 7 percent with double-gloving.¹²

Myth: Perforations in single-gloves are detected just as easily as with double-gloves.

Truth:

One study noted that perforations in single-gloves are often not detected during operations; this factor may increase the risk of transmission of bloodborne infections, particularly because the time of exposure may be long. Double-colored gloves make the intraoperative detection of perforations easier. Additionally, double-gloving is known to significantly reduce the perforation risk. Therefore, the use of doublecolored gloves is recommended in all categories of surgery.⁶

Myth: Wearing two pairs of gloves will cause a dangerous decrease in tactile sensitivity.

Truth:

- One study reported an 88 percent acceptance rate in the group that wore double-gloves; of those, 88 percent did not perceive any decrease in tactile sensitivity.¹¹

- Another study compared double-gloving and single-gloving and the effects on tactile sensitivity and dexterity. The testing included three scenarios: wearing the same glove size inside and out, the larger glove on the inside, and the larger glove on the outside (the consensus found this to be the most comfortable). Surgeons were evaluated on their ability to tie surgical knots and with the moving two-point discrimination test. The findings showed no alteration in the ability to tie knots or in the discrimination test.¹³

- It has also been suggested that the surgeon who is just beginning to use double-gloves should try various combinations; when a comfortable fit is found, perceived hand sensitivity will likely improve with increased experience using double-gloves.¹⁴

- Finding the right balance of protection, tactility and dexterity may take as little as two days (in most cases) or as long as 120 days. Surgeons who routinely double-glove report decreased hand sensation much less frequently than those who rarely double-glove.¹³

Myth: Double-gloving should only be used in special cases.

Truth:

Research on the protective effects of double-gloving provides compelling evidence that surgical personnel should double-glove during all surgical procedures.¹⁵

For example:

- The difference in the frequency of injury of inner and outer gloves when double-gloving during obstetric procedures was found to be highly significant; routine double-gloving is recommended to decrease the potential for patient fluids contact.¹⁶

- Double-gloving effectively prevented cutaneous blood exposure and this should become a routine for the thoracic surgeon to prevent transmission of infectious diseases from the patient to the surgeon.17

- Perioperative personnels risk decreased by 70 percent when double-gloving in comparison to wearing a single-glove.¹⁸

Double gloving is a change for the better adding protection, increasing safety and creating peace of mind. It makes sense to adopt behaviors that will create a better, safer experience for healthcare professionals and their patients. Double gloving makes the operating room safer for everyone.

Linda McNeilly is a member of the Surgical Products team at Cardinal Health, which offers a complete portfolio of surgical gloves, including Esteem® Blue with Neu-Thera®, that help provide clinicians "protection to the power of two." Clinicians interested in CE programs to help their teams learn more about double gloving should visit www.cardinalhealth.com/education

References

1. Centers for Disease Control and Prevention. Guideline for prevention of surgical site infection, 1999. Infection Control and Hospital Epidemiology, April 1999, 20(4):247-278.

2. Recommended practices for prevention of transmissible infections in the perioperative practice setting. 2010 Perioperative Standards and Recommended Practices. AORN, Inc. Last revised June 2006.

3. ST-58: Statement on sharps safety. Bulletin of the American College of Surgeons. October 2007; 92(10). http://www.facs.org/fellows_info/ statements/st-58.html

4 Information statement 1018: Preventing the transmission of bloodborne pathogens. American Academy of Orthopedic Surgeons, http://www.aaos.org/ about/papers/advistmt/1018.asp

5. Sadat-Ali M, Al-Habdan I, Al-Bluwi M, Corea JR, Al-Othman A, Shriyan D, Moussa M, Al-Dhakheel D, Al-Omran A. Can double-gloves improve surgeon-patient barrier efficiency? International Surgery. 2006; 91(3): 181-184.

6. Hagen GØ, Arntzen H. The risk of surgical glove perforation. Tidsskr Nor Laegeforen. 2007;127(7): 856-858.

7. Gerberding JL, Littell C, Tarkington A, et al. Risk of exposure of surgical personnel to patients blood during surgery at San Francisco General Hospital. New England Journal of Medicine. 1990;322:1788-1793.

8. Quebbeman EL, Telford GL, Hubbard S. et al. Risk of blood contamination and injury to operating room personnel. Annals of Surgery 1991;214:614-620.

9. Berguer R, Heller PJ. Preventing sharps injuries in the operating room. Journal of the American College of Surgeons. 2004;199(3):462-467.

10. Tokars JM, Bell DM, Culver DH, et al. Percutaneous injuries during surgical procedures. Journal of the American Medical Association. 1992;267:2899-2904.

11. Berguer R, Heller P. Preventing sharps injuries in the operating room. Journal of the American College of Surgeons. September 2004;199(3):462-467.

12. Quebbeman EJ, Telford GL, Wadsworth K, Hubbard S, Goodman H, Gottlieb MS. Double-gloving: Protecting surgeons from blood contamination in the operating room. Archives of Surgery. 1992; 127(2): 213-217.

13. Patterson JM, Novak CB, Mackinnon SE, Patterson GA. Surgeons concern and practices of protection against blood borne pathogens. Annals of Surgery 1998;228:266-272.

13. Webb JM, Pentlow BD. Double-gloving and surgical technique. Annals of The Royal College of Surgeons of England. 1993;75(4): 291-292.

14. Edlich RF, Wind TC, Hill LG, Thacker JG. Resistance of double-glove hole puncture indication systems to surgical needle puncture. Journal of Long Term Effects of Medical Implants. 2003;13(2): 85-90.

15. Thomas-Copeland J. Do surgical personnel really need to double-glove? AORN Journal. 2009;89(2):322-328.

16. Chapman S, Duff P. Frequency of glove perforations and subsequent blood contact in association with selected obstetric surgical procedures. American Journal of Obstetrics and Gynecology. 1993;168(5):1354-1357.

17. Hollaus PH, Lax F, Janakiev D, Wurnig PN, Pridun NS. Glove perforation rate in open lung surgery. European Journal of Cardio-Thoracic Surgery. 1999;14:461-464.

18. Greco RJ, Garza JR. Use of double-gloves to protect the surgeon from blood contact during aesthetic procedures. Aesthetic Plastic Surgery. 1995;19(3):265-267.