Practical Tips for Glove Use

Infection Prevention

By: Dan Mayworm

Published: 10/28/2008

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How to select and manage gloves depending on your needs.


Surgical glove selection is based on the clinical requirements of the procedure, exposure risk, anticipated physical stress on the hand, as well as personal preferences of the surgeon ' all within the confines of purchase agreements. Here's help for using gloves in accordance with good infection control practices.

Selecting the right glove
The following questions might help in selecting the right glove for the surgical procedure:

  • Is a single latex glove sufficient? Specialty gloves can make this a possibility.
  • Will double-gloving be necessary? Studies show it to be a recommended practice. I'll discuss this more later.
  • Will the procedure require more protection than latex can provide? There are options beyond double-gloving.
  • What are the correct procedures for donning and removing the gloves that are chosen? There are steps you can take to ensure these processes don't leave you open to potential infection.
  • What is the material and powder content of the glove? See "About Your Glove Material Choices" for more.

Single- or double-gloving?
Wearing two pairs of surgical gloves, as opposed to one pair, provides an additional barrier and is considered to further reduce the risk of contamination. But will the outside glove ' which is made of the same thin latex as the inner glove ' be enough protection from sticks, cuts and wear for the particular procedure?

10 Practical Glove Pearls

  • Use correctly sized gloves.
  • Wash hands before donning gloves (the inner glove is not a substitute for handwashing in double-gloving).
  • Wash hands after removing gloves.
  • Change gloves when barrier is compromised.
  • Change gloves frequently in long procedures.
  • Change gloves when changing tasks on the same patient.
  • Keep fingernails trimmed.
  • Use lotions and moisturizers as needed.
  • Remove gloves when writing, using a computer or a cell phone.
  • Store gloves where they won't be exposed to temperature extremes, sunlight, or ultraviolet or fluorescent light.

' Dan Mayworm

Studies show that, while there is no difference in the number of perforations between single gloves and the outermost pair of the double gloves, the number of perforations to the innermost double-glove was significantly reduced when two pairs of latex gloves were worn. Therefore, wearing two pairs of latex gloves in low-risk surgical specialties ' those that do not include orthopedic joint surgery ' is highly recommended.

One complaint is that double-gloving reduces surgeons' feel for instruments. I've seen one good solution to this: a high-sensitivity, double surgical glove that has two separate layers originating from a single cuff at the wrist. This might be more comfortable and save you time, because you only have to don once. They come in powder-free latex or polymer.

One study that compared single latex orthopedic gloves (thicker than standard latex gloves) with double latex gloves showed no difference in the number of perforations to the innermost gloves when wearing double latex gloves compared with a single pair of latex orthopedic gloves.1 Researchers also found that, while the thicker orthopedic gloves were more expensive than double-gloving, "surgical dexterity is minimally compromised" in the former. So for more rigorous surgeries in which you would usually double-glove, this might be a way to single-glove and still get the recommended protection.

About Your Glove Material Choices

When it comes to protecting against disease transmission, there is perhaps no personal protective equipment more important than gloves. Understanding barrier protection and allergen content will help you choose the right medical glove for your purposes.

Barrier protection
The level of barrier protection ' protection from cross-infection ' a glove affords is directly related to the following features:

  • Cross linking is the chemical bonding structure of the glove that provides a continuous interlocked molecular structure; a cross-linked glove film is very strong.
  • Tensile strength is the measure of the force required to stretch a glove until it breaks; measured in pounds per square inch, a higher number means a stronger glove.
  • Elongation is how far the glove film will stretch before breaking; given as a percentage, higher numbers indicate a stronger glove film.
  • Modulus refers to how much a glove squeezes the hand in a stretched state. It is a measure of the force required to double a glove sample's length and indicates comfort.

A glove should provide a continuous and durable layer of material between the clinician's hand and the patient. This layer should be flexible, free from holes, breaches and cracks, and should be strong enough to prevent breakage during normal use.

Allergen content
Allergen content refers to the amount of natural rubber latex proteins found in the glove. Lower levels of protein allergens are thought to reduce potential allergic sensitization.

Ironically, the gold standard for quality, barrier protection, fit and economy in gloves ' latex ' can pose a safety threat because of its protein allergen content. The good news is that manufacturers have made great strides in reducing protein and chemical allergen levels in latex gloves. Low-protein, powder-free gloves are probably your best choice in the latex arena and are recommended by the National Institute for Occupational Safety and Health.

Alternative materials
For healthcare workers allergic to natural rubber latex, there are several others choices of synthetic materials from which to choose that will maintain an appropriate barrier.

  • Nitrile. A petroleum-based, cross-linked film, nitrile is manufactured much the way latex is and exhibits many of the same properties. With a tensile strength of 3,000 psi and an elongation rate of 500 percent, nitrile provides a very strong glove. It fits somewhat tighter than a latex glove, so you might want to go up a size. Nitrile comes in examination gloves only, and therefore should only be used in pre- and post-op.
  • Neoprene or polychloroprene. This petroleum-based, cross-linked film provides barrier protection similar to that of latex. Unbroken neoprene is strong (tensile strength around 3,000 psi and elasticity of 750 percent) and resistant to many chemicals. With a modulous very similar to latex's, it is very comfortable to wear for long periods of time. Available in both exam and surgical gloves.
  • Polyisoprene. The newest material on the market, polyisoprene's barrier properties are fair to good, and it is durable (2500 psi). Its elasticity and comfort are similar to that of latex, though polyisoprene is slightly stiffer. This material comes in surgical gloves.
  • PVC. Commonly known as vinyl, PVC is not molecularly cross-linked, which makes it the weakest of available glove films; tensile strength is under 2000 psi and elongation is less than 500 percent. Studies have shown that 63 percent of vinyl exam gloves leak after normal use, compared with 7 percent of latex exam gloves. PVC is available only in exam gloves.

' Janie Thomas, RN, BSN, MA

Ms. Thomas ([email protected]) is a clinical consultant with Ansell Healthcare.

Adding materials
Wearing a glove liner between two pairs of latex gloves for more rigorous procedures such as joint replacement surgery significantly reduces the number of perforations to the innermost glove compared with double latex gloves only. Also, wearing cloth outer gloves for joint replacement surgery significantly reduces the number of perforations to the innermost glove.

In an effort to visibly detect holes in gloves, some surgeons prefer to wear indicator gloves (colored latex gloves) under latex gloves. This lets the glove wearer see perforations to the outermost glove. However, an indicator glove doesn't assist with detection of perforations to the innermost glove, nor does it reduce the number of perforations to either the outer or inner glove.

Steel-weave gloves worn on top of latex gloves as added protection during joint replacement surgery have shown no reduction in the number of perforations to the innermost glove. They do, however, provide the surgeon better protection against blade cuts than double latex (either regular or orthopedic).

Donning and removing gloves
How you put on and take off the gloves is key to preventing breaches in the glove material that can potentially expose you to infection.

Before you don, you should open the gloves in a clean place, then scrub in. When donning, remember to handle the gloves as little as possible to reduce the risk of contamination. Therefore, you should pick up the first glove only by the cuff and ease your hand in. Once you've got a single glove on each hand, feel free to adjust for fit and comfort. Repeat for the second set of gloves.

Before you remove surgical gloves, rinse to remove bioburden or body fluids. When taking them off, keep the outside surface of the gloves from contacting your skin by rolling them off inside-out slowly, so they don't snap and disperse any leftover contaminants into the environment.

Informed decision-making
The very nature of surgery, with its increased exposure to blood, means there is a high risk of transfer of pathogens that could result in post-op infections in patients or bloodborne infections in the surgical team. You can reduce this risk by following the tips for glove use I've given you here.

Reference
1. Turnquest MA, How HY, Allen SA, Voss DH, Spinnato JA. "Perforation rate using a single pair of orthopedic gloves vs. a double pair of gloves in obstetric cases." J Matern Fetal Med. 1996 Nov-Dec;5(6):362-5.

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