Increase Double-Gloving Compliance

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Raising awareness of its importance and empowering staff to own the change will create a lasting culture shift.


The jury's been in on double-gloving for quite some time now. Wearing two layers of protection is an easy, cost-saving and low-tech way to reduce risks of cross-contamination and sharps injuries. Plus, the latest double-gloving systems are designed with sensitivity, dexterity and comfort in mind.

Many facilities, however, have difficulties getting an otherwise engaged staff to comply with double-gloving practices. That hasn't been the case at Bassett Medical Center in Cooperstown, N.Y., where the compliance rate reached nearly 100% and needlestick injuries were reduced by one-third a year after staff began a transition to double-gloving. The facility also saved approximately $40,000 on glove purchases by buying one model instead of several. Efforts to achieve these positive results began with awareness, advanced with acceptance and have been sustained with accountability.

Understanding the importance

Educating staff about the effectiveness of double-gloving was important on several fronts, according to Rachel Nolan, RN, BSN, CNOR, Bassett's perioperative quality and safety nurse. The facility's leadership had significant concerns about occupational safety hazards from needlesticks and other sharps injuries, as well as seroconversion after blood contamination. Obviously, the potential for patients becoming exposed to infectious fluids through glove punctures was also worrisome.

"Provide plenty of details about why double-gloving is considered an evidence-based best practice in surgical settings," says Ms. Nolan, noting that the practice is endorsed by the CDC, the World Health Organization, the American College of Surgeons, AORN, OSHA, the American Academy of Orthopedic Surgeons and the International Safety Center.

Ms. Nolan says the staff was told the volume of blood on a suture needle is reduced by as much as 95% when it passes through two glove layers, thereby reducing viral load in the event of a contaminated percutaneous injury. The risk of exposure to a patient's blood is reduced by 87% when the outer glove is punctured if an indicator underglove is used. The reason: Colored undergloves make tiny perforations to outer gloves easier to notice, often at the time of the incident, so staff can quickly don a fully intact pair.

"Some staff members thought using a single, thicker orthopedic glove offered more protection than the dual layers of two thinner gloves," says Ms. Nolan. "And many of those who were double-gloving used two outer gloves, which is a costlier solution than donning gloves designed for double-gloving and doesn't take advantage of the bi-color puncture indication system, a key safety feature. Ultimately, you need to convey the importance of double-gloving, and make sure your team does it correctly."

SHARPS SURVEILLANCE
National Injury Report Reveals Mixed Results
DOUBLING DOWN The number of healthcare workers who opt to double-glove appears to be in the rise.

Current sharps safety practices in surgical settings provide reason for hope and cause for concern, according to Amber H. Mitchell, DrPH, MPH, CPH, president and executive director of the International Safety Center (ISC). The ISC, a nonprofit organization dedicated to improving the safety of healthcare workers, issues annual reports about needlesticks and other sharps injuries based on data from the Exposure Prevention Information Network (EPINet) surveillance system.

Its most recent report, which includes 2019 data, shows slight improvements in sharps safety practices from the year before. The percentage of healthcare workers who were wearing double gloves when they suffered a needlestick rose by 3.3%, from 32.1% in 2018 to 35.4% in 2019. Other highlights include a 2.6% reduction in sharps injuries that occurred in operating and recovery rooms, from 44.3% to 41.7%. The sharps injuries that took place in procedure rooms also declined by 0.7 %, from 6.2% to 5.5 %.

Progress is better than regression, but Dr. Mitchell sees plenty of room for improvement. She believes the overall level of noncompliance to sharps safety practices is "horrifying and avoidable." She also notes that the evidence on the effectiveness of double-gloving has been overwhelming for a long time, and increasing compliance with this practice would decrease the overall number of sharps injuries.

Dr. Mitchell is hopeful that the soon-to-be-analyzed sharps safety data collected during 2020 will be better across the board, especially because last year marked the 20th anniversary of the Needlestick Safety and Prevention Act — legislation that requires facilities to identify, evaluate and implement safer medical devices.

"We're really hoping for starkly different results," says Dr. Mitchell. "We anticipate that better safety practices due to the pandemic might have contributed to a banner year for sharps safety improvements."

—Adam Taylor

Frontline feedback

If your team pushes back against double-gloving, Ms. Nolan suggests trying the "just culture" concept to address the issue. It's a shared-accountability model that holds organizations and staff responsible for finding effective solutions to problems.

"As we dove into the causes of our low double-gloving numbers, we realized that the types of gloves that were purchased wound up in ORs with little to no input from the team members who wore them," says Ms. Nolan. "We realized it's important to have staff and surgeons trial multiple types and makes of new gloves. Getting their buy-in before deciding which ones you'll buy leads to a higher level of acceptance among your team." Try to reach as many providers as possible during trials of new glove models, suggests Ms. Nolan. "We capitalized on our hospital's annual skills fair to give as many surgical providers as possible the chance to assess new glove choices for protection, quality, fit and comfort," she says. "Their feedback helped us identify the models we'd ultimately trial."

DOUBLING DOWN Switching to non-latex gloves when implementing a double-gloving policy adds an additional safety feature to your facility's practices.   |  MercyOne Medical Center

Glove vendors should be more than happy to explain the pros and cons of their models and might even help you organize and run trials. Bassett's vendor, for example, spent two weeks discussing various glove models instead of trying to go through all the information in one long meeting.

Once Bassett decided on which latex- and powder-free gloves to trial, the gloves' vendor supplied evaluation forms that the trial's participants filled out. The forms included a space where they could note likes or dislikes that had not been addressed in the form's questions. In all, 34 surgeons, 39 staff members and three anesthesiologists participated. They learned that more than half the surgeons and one-third of the staff members weren't double-gloving. The trial helped the facility identify which gloves they'd purchase, and also highlighted the need for education aimed at increasing compliance with double-gloving practices.

Willing converts

Allowing your clinical team to have control over which double-gloving system they'll use goes a long way toward making them accountable for doubling up on layers of protection to increase staff and patient safety. Educating staff and surgeons on best practices and professional guidelines will also empower them to comply with double-gloving protocols. Show them the evidence and let them own the solution, and you'll find that even those who were most resistant to change will double-glove without hesitation because the new practice will become a regular part of the workday. OSM

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