It doesn't make much sense to settle for having a thin layer of neoprene between your hands and the dangers of surgery when doubling gloving has been proven to offer added protection against sharps injuries and bloodborne pathogens. But many surgeons and nurses still refuse to don an extra pair of gloves due to concerns about losing the dexterity and tactile sensitivity needed to perform surgery. Convincing them to give doubling up a try demands dangling a carrot, swinging a soft stick and finding gloves with just the right fit.

1. Emphasize its importance

The benefits and safety margin of double gloving are still not clear to many surgical team members, according to Mary J. Ogg, MSN, RN, CNOR, senior perioperative practice specialist at AORN. "Anytime you have a hole in your glove, you could be increasing the risk for surgical site infections," she says. "A double layer of gloves reduces the risk of exposure to bloodborne pathogens and also reduces the risk of healthcare workers transmitting any type of bloodborne pathogens to patients."

Jos H. Verbeek, MD, PhD, a senior researcher at the Finnish Institute of Occupational Health, says the evidence for double gloving's benefits is irrefutable. "The argument for double gloving is that it protects better against needlestick injuries," he says. "Dozens of randomized trials have shown that the number of perforations in inner gloves is greatly reduced compared with the number in single gloves."

If you've been doing something one way for many years, there's a reluctance to change. A lot of surgical professionals have always used single gloves and have never been injured. But that does not change the fact that double gloving improves safety for both patients and staff.

To make change happen, change the culture, suggests Ms. Ogg. "Your staff must understand that while they may not have had problems in the past, they could someday transmit something to a patient or could be affected by contracting something like hepatitis C."

2. Make it mandatory

If you require staff to wear an extra layer of gloves, you'll obviously get greater compliance, points out Ms. Ogg. "Initially you need to have strong administrative support for this initiative," she says. "There must be a policy and procedure in place that outlines the expectation that everyone will double glove."

That is just an initial step. "You're starting with that support from the top, but you have to have it both ways," points out Ms. Ogg. "You ultimately need the support of everyone on your staff for the movement to be successful."

She highlights the role staff education plays in that effort. "Once all the practitioners in the OR know about the risks of getting a sharps injury or being infected, and how that can affect their personal and professional lives forever, you'll get buy-in."

It's important to note that even without a mandatory policy in place, you can always double glove without depending on anyone else. "Another member of the team might say, "I don't want to use a safety scalpel,' or "I don't want to use the neutral zone,'" says Ms. Ogg. "But as a practitioner, you can say, "Yes, I want to double glove,' and just go ahead and do it. You can make the decision to don two pairs of gloves and afford yourself greater protection every time you scrub in."

3. Give it a chance

A common complaint among surgeons is that double gloving limits dexterity and dulls the sense of touch. Ms. Ogg says that is simply not true. "Studies show you do have the dexterity and you have that touch," she explains, and suggests you think back to how awkward and odd it felt to wear single gloves at the start of your training. "It's the same thing with double gloving — you just have to get used to it."

It takes around 2 weeks to grow accustomed to double gloving, according to Ms. Ogg. But however long it takes, the adjustment happens. "Go back to that time that you learned to do things with a pair of gloves on," she says. "I think you can do the same thing with double gloves."

Compliance with double gloving tends to be higher in orthopedics — which exposes the OR staff to more sharps than most specialties — so tap into surgeons, nurses and techs on ortho teams as a resource for promoting the use and benefit of wearing a second layer of protection.

4. Assess the feel and function

It's crucial to find gloves you're comfortable wearing. Be aware that the size you prefer might change when you slip on gloves made from different manufacturers. Ms. Ogg notes that glove companies are generally willing to set up and run a trial in your facility so staff and surgeons can try on different models in order to find the right fit.

Some surgical team members wear outer and inner gloves of the same size, some opt for a half-size larger inner glove and some wear a half-size larger outer glove. "It's about finding that combo that works best for you," says Ms. Ogg. "Once you get used to the correct feel, you won't feel right without it."

Double gloving systems are also being designed to form to wearers' hands in a more ergonomic way and with high levels of tactile sensitivity and dexterity. The right fit for your facility also includes finding the right price. Doubling the number of gloves your staff and surgeons wear can be expensive, but manufactures are offering a variety of premade double glove systems, including ones that let you slide on both gloves at once, that are more economical than simply doubling the number of gloves you purchase.

Some double gloving systems include outer and inner gloves of different colors, with the inner glove serving as an indicator of tears in the outer glove that might otherwise be difficult to spot. "You can see a hole in your outer glove quicker if you have that colored indicator under glove," says Ms. Ogg.

Dr. Verbeek says an indicator glove does not protect better in a physical sense, but alerts you when an immediate change into fresh gloves is needed to diminish potential exposure to bodily fluids and sharps. OSM