GLOVE STORY Studies suggest that double-gloving can improve safety without impeding dexterity or fine motor skills.

Double-gloving limits the likelihood that sharps will breach both layers and break skin, and wearing different-colored gloves makes it easier to notice when the outer layer has been pierced. But some surgeons still refuse to double down on reducing the risk of cross-contamination. You've likely heard some or all of these objections from docs who prefer to work with a single, thin layer between themselves and patients:

• "Double-gloving is a waste of time, money and resources."
• "It's more important and cost-effective to teach providers and staff how to safely pass, dispose of and clean sharp instruments."
• "Why should we double-glove? Show me evidence that it reduces infection risks."

If you've run up against the counter-arguments, you know that resistance is most likely to center on 3 primary concerns: sensitivity, dexterity and comfort. Experts agree that some disciplines — those that demand extraordinary tactile sensitivity, such as ophthalmology and neurology — may warrant exceptions to recommended double-gloving policies. But organizations such as the American College of Surgeons (osmag.net/kqd3nk), the Association of periOperative Registered Nurses (osmag.net/nw6mgx) and the Association of Surgical Technologists (osmag.net/p9bnbw) increasingly recommend double-gloving in virtually all cases that involve potential exposure to blood, bodily fluids and other potentially infectious materials.

You could paper your facility's walls with the volume of literature that recommends double-gloving for staff and surgeons (see "Studies Offer Support for Layered Protection"). If it can be shown that double-gloving clearly provides greater protections, while having little or no negative impact on fine motor skills or dexterity, why is it such a difficult sell?

Undoubtedly, much of the resistance has to do with surgeons' inherent resistance to change. It's based on habits. Those who start double-gloving tend to keep doing it, and those who don't are reluctant to start. In other words, it may be doubly hard to convince older practitioners that they should be double-gloving.

If your staff and surgeons don't want to protect themselves (and their patients) by wearing an added layer of protection, does it make sense to insist? "The surgical team must follow our policy on gloving," says Robin Webb, RN, CNOR, the supervisor of surgical services at Bayshore Medical Center in Pasadena, Texas. The policy, she says, requires sterile team members to wear 2 pairs of surgical gloves during invasive procedures with the potential for glove perforation or exposure to blood, bodily fluids, or other infectious materials.

Those who refuse are made to undergo "counseling" to ensure compliance. That goes for physicians, too, says Ms. Webb, who are "required to follow all hospital policies if they have privileges at our facility."

RESEARCH REVIEW
Studies Offer Support For Layered Protection

EVIDENCE-BASED Studies clearly recommend double-gloving for staff and surgeons.

There's plenty of compelling data to back up your efforts to convince your staff and surgeons to double-glove, including a recent study (osmag.net/ytfg4t) that found that most glove perforations "go unnoticed by the surgeons and other members of the surgical team," but that "the incidence of perforation of double inner gloves is significantly low as compared with single gloves."

How much added protection does that inner glove provide when the outer glove gets punctured? Another recent study (osmag.net/7mvwpx) found that the perforation rate with double gloves was 27.5%, but that the perforation rate from the outer glove to the inner glove was only 1.17%. In other words, even when punctures happened, the double-glove wearer was protected by the inner glove in roughly 96% of occurrences.

That's all well and good, you might say, but what about the dexterity issue? This study (osmag.net/jhq8eg) involved medical and dental school students who were asked to perform a delicate microsurgical task, both with 1 pair of gloves and with 2 (alternating the order). There was no significant difference in the rate at which they improved at the task, say the researchers, suggesting that "wearing 2 pairs of surgical gloves does not negatively affect the speed at which a microsurgical procedure may be performed [and lends] support to the practice of double-gloving, even in the setting of microsurgical fine motor tasks."

And then there's this, from a Cochrane review (osmag.net/4uzjgn) of numerous studies: "There does not appear to be an increase in the number of perforations to outermost gloves when two pairs of gloves are worn, suggesting that wearing two pairs of gloves does not reduce dexterity to the extent that the glove wearer sustains more perforations."

— Jim Burger

Compliance isn't a problem, she says, but that doesn't mean the policy was an overnight success. "As with most changes, it was difficult in the beginning," explains Ms. Webb. "It takes time to get used to the feel of wearing two pairs of gloves and most everyone was resistant at first."

A similar policy requiring double-gloving is in effect at Rusk County Memorial Hospital in Ladysmith, Wis. "Staff cannot refuse," says Pat Somerville, RN, the hospital's surgical services coordinator. "Surgeons are requested to double-glove, but we still have 2 older surgeons who don't comply with the policy."

Other surgeons have seen the benefits and come around, she says. "We've had incidents where a staff member was stuck with a needle and felt the stick, but it did not penetrate the gloves," she says. "That had a positive effect on surgeons, who then decided to try double-gloving."

Both Ms. Webb and Ms. Somerville say manufacturers are making the hard sell a little easier with technological improvements that have improved comfort and dexterity. "We tried 3 companies," says Ms. Somerville. "The important factors for us were fit, durability, quality and cost. The quality and the fit do seem better." OSM