Gloving Strategies for Efficiency in the Outpatient World

Increased sensitivity, dexterity and comfort in the latest designs make it easier than ever to get staff to buy into double-gloving.

Sharps injuries in the OR are on the rise, according to the National Institute for Occupational Safety and Health (NIOSH). A recent post in the NIOSH Science Blog cites a steady increase of sharps injuries in the OR through 2020, using data from hospitals in Massachusetts as an example. While reports of sharps injuries rose in several settings, more were reported in the OR than anywhere else.

Different source, same story

More recent data show similar results. Despite a decade of awareness and prevention efforts, needlesticks and other sharps injuries across all healthcare settings are up 16% from 10 years ago, according to EPINet data from The International Safety Center, a nonprofit advocacy group focused on healthcare workers’ safety.

In 2023, 42.8% of sharps injuries occurred in ORs, more than any other setting, the data shows. This isn’t a surprise to anyone in a perioperative setting who is directly exposed to needles, scalpels and other sharps, and who is at risk of exposure to patients’ blood and other potentially infectious bodily fluids.

Glove failure is a prime culprit in many sharps injuries. That’s why the American College of Surgeons, the CDC, The Joint Commission and AORN all recommend universal adoption of double-gloving. A solid body of research supports the safety rationale for double-gloving as well. For example, a 2021 review of seven randomized controlled trials comparing single- and double-gloving found double-gloving significantly reduced glove perforations.

Unfortunately, however, double-gloving isn’t always the norm. The practice can be unpopular with all OR team members, including surgeons at the head of the table who often report decreased tactile sensation while wearing two sets of gloves.

Make double-gloving standard practice

Despite pushback, outpatient facilities with strong policies, procedures and team feedback on which kinds of gloves to buy can achieve consistent double-gloving compliance. For instance, double-gloving has been standard practice at Lakeland (Fla.) Surgical and Diagnostic Center for more than 17 years, says Executive Director Nikki Williams, RN, CNOR. While the facility regularly trials different products from time to time, it has stayed with the same system for the last eight years. “The glove system is durable and doesn’t hinder dexterity at all,” says Ms. Williams.

Better dexterity and fit

Decreased dexterity is the top double-gloving complaint from many surgeons. Manufacturers have worked to address this concern over the last decade by producing gloves that are less bulky. Some brands offer different levels of dexterity and tactile sensitivity for inner and outer gloves.

Test for team satisfaction

Trialing surgical gloves is an important step to keep your team happy and can help transform your culture to include and embrace consistent double-gloving, says AORN Senior Perioperative Practice Specialist Emily Jones, MSN, RN, CNOR, NPD-BC.

“The ultimate goal is to find a double-glove system that checks the safety boxes and meets most team members’ satisfaction for use,” she says.

As with any trial, ASC leaders can optimize the outcome by setting clear goals for what the trial should achieve and finding a champion to reiterate why double-gloving is a crucial safety practice.

Lean on the evidence

Selling any new initiative should start with sharing research with your staff. Fortunately, research about double-gloving is abundant, says Ms. Jones. The following three recommendations in AORN’s Guideline for Sharps Safety are a good place to start:

• It is a regulatory requirement that perioperative personnel must use personal protective equipment such as gloves whenever there is a possible risk for exposure to blood, body fluids or other potentially infectious materials.
• High-quality evidence supports that scrubbed team members should wear two pairs of sterile surgical gloves and use a perforation indicator system.
• If a glove puncture occurs, the team member should inspect the underlying skin for any evidence of a percutaneous injury and follow recommendations in the AORN Guideline for Sterile Technique for monitoring and changing gloves.

Ms. Jones is currently reviewing the latest evidence to update AORN’s guideline. So far, more recent studies reinforce what has long been understood by safety experts. Double-gloving with an indicator system helps prevent sharps injuries and alerts the wearer when an outer glove perforation occurs to protect them from bloodborne pathogen exposure.

“Nothing is ever guaranteed, but the research is clear: Two pairs of sterile gloves are more protective than wearing just one pair of sterile gloves,” says Ms. Jones.

If you are looking to reinforce this with surgeons who are reluctant to don two sets of gloves, she points to a foundational systematic review in 2014 on gloving methods to prevent percutaneous exposure. The researchers noted 12 separate studies that showed the addition of a second pair of surgical gloves reduced the number of glove perforations by 71% compared to the use of one pair of gloves. They concluded that no additional research is required about the preventative effect of double-gloving on percutaneous exposure incidents in surgery.

One more way to reduce SSIs

To reinforce the need for double-gloving, it’s valuable to bring the safety of the practice back to the patient, suggests Ms. Williams. “Infection control is paramount to the patient, and we know that double-gloving is part of minimizing SSIs as well as protecting our providers and staff,” she says.

Case in point: A 2018 study at a hospital in Ontario investigated double- versus single-gloving in orthopedic and general surgeries as part of an SSI reduction bundle. Team members replaced their outer glove every 60 minutes. After the bundle was implemented, overall SSI rates dropped from 3.4% to 1.0%. The author notes that donning two gloves protects team members from potential bloodborne pathogens and protects the patient from the provider’s skin flora.

Worth the money

Cost should not be the most important consideration when considering purchasing a double-glove system. The cost of not double-gloving or going with a cheaper, less satisfying system is a risk Ms. Williams never wants to take for her surgical team.

“While the cost of the double-glove system we use might be a little pricier than some other brands, we feel satisfaction for providers and staff is important, as well as knowing that we have a high-quality glove that gives adequate protection,” she says. OSM

Note: This three-part article series is supported by Mölnlycke.