IN GOOD HANDS Surgeons and techs who double up enjoy improved comfort and dexterity thanks to newer glove designs.

Double-gloving during surgery reduces cross-contamination risks and protects against needlesticks, but many surgeons and techs fear that they'll lose touch and maneuverability around the surgical site if they don a second pair. Here are 5 compelling reasons to convince them otherwise.

Better, time-saving barriers. Wearing 2 pairs of different-colored gloves makes it easier to see breaches in glove layers, according to a study in the March 2012 AORN Journal (tinyurl.com/8gwyy5a). The study found that surgical team members observed blood on the skin of their hands more often after surgery when they wore single gloves instead of double-gloves. Double-gloving also lets wearers remove the outer glove during expected cases of contamination, thereby saving time by eliminating re-gloving, notes the study. (The authors discovered that surgical team members who wore dark pairs of gloves under lighter pairs changed gloves more often than team members who wore 2 pairs of same-colored gloves.)

Surgeons can adapt. We all know surgeons loathe change, but they can adapt to new practices when the right approach is backed by clinical evidence. While a 2004 report by the American College of Surgeons (tinyurl.com/cd85fvl) concedes surgeons' acceptance of double-gloving is lacking despite data supporting the practice, it notes most surgeons who always or usually double-glove report adapting to the new sensation in as little as 2 days. In addition, the AORN study notes a majority of surgical team members expressed favorable views about double-gloving.

So talk to surgeons about the increased protection double-gloving offers to them, the rest of the surgical team and, most importantly, their patients. Know that many surgeons have overcome the sensation of decreased manual dexterity and tactile sensation, and point out that orthopedic surgeons have been double-gloving for years. A study published in the February 2003 issue of the American Journal of Surgery (tinyurl.com/c5qaj8p) evaluated surgeons' gloving practices. Of the 170 surgeons and resident respondents, 57% did not double-glove (none of the urologists did, as compared to 87% of the orthopedists). The common reason stated in the study for steering clear of double-gloving was a decrease in manual dexterity. The study also stated that "even with good evidence of efficacy, few surgeons contemplate adopting safety techniques." (Editor's note: See our poll results on the facing page for a snapshot of today's double-gloving practices.)

Protection from sharps. The ACS report says the FDA concedes 2.5% of new and unused sterile gloves fail standardized quality control testing, but that "the practice of wearing 2 pairs of gloves offers a high degree of protection for this event." The study also notes that intraoperative perforation of a glove occurs an average of 40 minutes into a procedure and goes unnoticed by surgeons in as much as 83% of cases. While the perforation of a single glove layer is not uncommon, punctures to both inner and outer glove layers are rare, according to the study. In fact, the research says surgeons who wear double gloves are 87% less likely to be exposed to patients' blood when the outer glove is punctured. Additionally, the volume of blood on suture needles is reduced by as much as 95% when they pass through 2 glove layers.

Fewer cross-contamination risks. By donning gloves, surgical team members render their hands sterile. If a glove is compromised, the patient is at risk for contamination from surgical team members' skin. Double-gloving adds a layer of protection over a single glove, therefore decreasing the likelihood that a perforation will harm the patient. Should double-gloving be used during all surgeries or just during high-risk cases? It's better to be consistent in practice since double-gloving does have mutual benefits for staff and patients, and not all patients are routinely tested for bloodborne pathogens, so your surgical team is often unaware if individuals carry infectious diseases. Are surgeons the only ones who should double up? No. AORN, the Association of Surgical Technologists and the CDC all support double-gloving for personnel who assume the scrub role. In addition, some organizations have policies that require or strongly recommend double-gloving for all scrub techs.

Improved glove designs. Several of today's gloves and undergloves are designed with improved comfort and manual dexterity for technicians and surgeons who choose to double-glove. And glove manufacturers are always willing to share research pertaining to their products and provide samples for use during trials. But your awareness of the importance of double-gloving and willingness to conduct periodic education on sharps safety goes hand-in-hand with improved glove designs. Conduct regular in-services on how to safely handle blades, sutures and sharp instruments. Review all sharps injuries that occur, make sure you modify practices that caused the injuries and monitor the updated practices to ensure they're effective.