TWICE AS NICE Wearing 2 pairs of gloves can significantly lower your risk for contamination and punctures, yet many surgeons and staffers don't do so.

Are your staffers and surgeons double-gloving for most, if not all, cases? If they're not, they should be, with study after study touting the improved safety of double-gloving. Yet a recent Outpatient Surgery online survey of 114 surgical leaders shows more than three-fourths (77%) of respondents say their facilities have no double-gloving policies in place. Of those who do, the majority note it's a recommended practice, not a mandate.

The reasons why staffers and surgeons don't wear the extra gloves are abundant. It's too wasteful and expensive, some argue, while others say the decreased comfort and dexterity don't justify the extra layer of protection. But these reasons are no excuse, says Mary J. Ogg, MSN, RN, CNOR, a perioperative nursing specialist for AORN. "All facilities should have a policy and procedure for double-gloving," says Ms. Ogg. "It reduces the rate of injury so much that I encourage everybody to do it."

Inconsistency across the board
Double-gloving has been proven again and again to be more effective at preventing sharps injuries, yet many surgical team members still don't follow the practice for a majority of cases. One-third of our survey respondents say their surgical staffers double-glove for most or some cases (31% and 32%, respectively). Only 19% say they do it for all of their cases, and another 16% say they rarely or never double-glove.

When staff do double-glove, it's often only for specific cases. A large majority of respondents have staff double-glove for orthopedic cases (71%), while 30% to 40% of other managers say staff double-glove for general surgery, plastics, gynecology and GI cases. Aside from during orthopedic cases, double-gloving protocol lacked consistency. Many note it centers on the patient, not the procedure. One respondent says their double-gloving policy is "patient-specific rather than surgery-specific," while another notes they double-glove only in cases where there is "suspected C. diff."

PEEK-A-BOO Wearing an indicator glove is an effective way to show staff when the outer glove has been perforated.

This is problematic, since patients may not know if they're infected with a potentially harmful disease, says Ms. Ogg. Because of that risk, she notes, your policies and procedures should mandate that staff double-glove for every case involving the potential for exposure to blood, body fluids and other potentially infectious materials. This requirement can stand alone or be included in your sharps safety policy. Ms. Ogg adds that you can include some exceptions, like ophthalmology and neurology cases, when dexterity and tactile sensitivity are extraordinarily important.

Surgical managers list several common reasons why more OR staff don't double-glove. A majority of managers say that a lack of tactile sensitivity and comfort are the 2 biggest barriers to staff compliance, followed closely by dexterity issues. Others cite additional waste, expense, and extra time spent gloving and re-gloving.

There are ways to combat some of these obstacles, says Ms. Ogg. She suggests you address the biggest problems — comfort, dexterity and tactile sensitivity — by conducting a glove fitting. Contact the manufacturer of the gloves you stock and ask them to come in and size staff and surgeons for a comfortable fit. This can make a big difference, according to Ms. Ogg, who says some studies have shown that there is no loss of dexterity and tactile sensitivity when healthcare workers wear properly fitted gloves. "You might think that the rule is to wear a half-size larger outer glove," says Ms. Ogg. "It might be that way for some, but you might like a half-size larger glove on the inside or 2 same-sized gloves. Get a proper fit, and give it some time to see what feels best."

Ms. Ogg also notes that wearing a perforation-indicator-glove system lets staff "clearly see that a puncture has gone through" the outer layer, providing a convincing visual on why 2 gloves are better than 1. There are also other simple ways to increase rates of double-gloving. One respondent advises adding it to the evaluation of staff members, meaning their compliance could affect raises, while another suggests having surgeons list their glove sizes on preference cards.

One of the best ways to get your staff and surgeons on board are personal stories. "Testimonials by individuals that have been stuck are the most effective," says one respondent. Ms. Ogg agrees. She suggests reaching out to your staff members whom you know personally and who have a story, and see if they'd be willing to share their experiences. If you don't have anyone available, AORN offers an online webinar during which a former nurse discusses how a puncture changed her entire life. "I think hearing a personal story makes it more real to your staff," says Ms. Ogg.

VIRUS PROTECTION
More Evidence For Double-Gloving

DOUBLE PROTECTION Double-gloving helps keep workers safer when removing PPE, according to a new study.

Need another reason to double-glove? A recent study suggests it can make removing personal protective equipment (PPE) that much easier and safer.

The report (osmag.net/1smEYR) in the American Journal of Infection Control looked at virus transfer to healthcare workers' skin and clothing during removal of PPE when wearing single gloves versus 2 pairs of gloves.

In the study, participants donned PPE — contact isolation gowns, N95 respirators, eye protection and latex gloves — that was then covered with bacteriophage, a virus that infects bacteria. Participants removed the PPE, and the worker's hands, face and scrubs were sampled for the virus.

The study found that the transfer of the virus to the hands of the participants during PPE removal was significantly more frequent with single-gloving than with double-gloving. Not only that, the researchers say significantly more of the virus was found on participants' hands after single-gloving than double-gloving.

— Kendal Gapinski

Signs of improvement
Ms. Ogg says it's encouraging that double-gloving seems to be gaining momentum. More than half of our survey respondents say their staffers are double-gloving a little more or a lot more than they were 5 years ago, with about 36% saying it's stayed about the same. Only 7% are double-gloving less now than before.

A big reason for the improvement seems to be that most surgical team members understand that double-gloving is safer than single-gloving — even if they don't have a firm policy in place. More than 40% of the survey takers say double-gloving is the significantly safer choice. "I think it just makes sense that you have double protection when you do it," says a respondent.

"Personally, as a scrub nurse, I have been double-gloving for at least 15 years. I have always been extra cautious and feel much safer using this practice," says Kim Patrick, RN, AAAHC coordinator for Rousso Facial Plastic Surgery Clinic in Mt. Brook, Ala. "I encourage all staff to follow this practice as well, and feel like it gives you a second chance to stay safe."

Still, 8% of respondents say they feel the practice doesn't make much of a difference. Research has shown otherwise, according to Ms. Ogg. She notes that multiple studies have concluded that double-gloving provides an extra layer of protection against punctures and contamination. There is very strong research out there to support double-gloving, says Ms. Ogg.

"Double-gloving is literally putting personal safety into your own hands," she adds. "Using a neutral zone or safety scalpel may be dependent on other team members, but you make that decision to put on 2 pairs of gloves."