Prioritize Double-Gloving to Reduce Infections, and Sharps Safety to Keep Staff Protected

This combination is a cornerstone of safe care for patients and staff alike.

Double-gloving and sharps safety are separate but equally important measures. Unfortunately, both areas can present major problems for leaders. Specifically, insufficient hand-to-wound barrier protection can increase the risk of postoperative surgical site infections (SSIs), making double-gloving a vital preventative measure.

With sharps safety, a single needlestick can have a devastating effect on everyone involved, including the healthcare worker and their family, the OR team and facility leadership. These injuries are traumatic, time-consuming and flat-out dangerous for healthcare workers — life-altering, even. In fact, according to WHO, a person who experiences one needlestick injury from a needle used on an infected source patient has risks of 30%, 1.8%, and 0.3%, respectively, of becoming infected with HBV, HCV and HIV. Here are some proven strategies to evaluate, monitor and educate staff on the importance of these safety and preventative measures.

All about culture

Standardized evidence-based policies and clear communication are the means to prevention of needlestick injuries. This starts with a leadership-driven culture of safety, says Raghu Reddy, chief administrative officer of SurgCenter of Western Maryland in Cumberland. “Ensure that infection control protocols and compliance are woven into the cultural fabric of your ASC,” he says. “This requires consistent messaging and modeling staff behaviors. Nurse and surgeon leaders must lead by example and reinforce the importance of proper safety and infection prevention practices.”

• Double-gloving advances. Molly Kucera, MBAHC, BSN, RN, CNAMB, CNOR, associate director of a hospital outpatient department at University of Iowa Healthcare in Iowa City, has long been a strong proponent of double-gloving. She sees the practice as a natural part of any facility’s multipronged approach to prevent SSIs. It’s a practical way to create an additional barrier between providers’ hands and the patient’s wound, while simultaneously bolstering the safety of OR teams who work under intense conditions with an array of dangerous sharps in rotation. As Ms. Kucera succinctly puts it: “Double-gloving places patients at the center of care, and it keeps OR teams safe.”

Seems like double-gloving is an easy sell, right? Yes and no. While most decision makers understand its importance — and have policies in place to reflect this — cost can be a factor. And there will always be certain surgeons who insist the practice hurts their dexterity and decreases their tactile feel. Still, Ms. Kucera believes recent technological advances coupled with proven safety features can help make newer two-in-one gloving systems a fairly easy sell to holdouts who have only ever donned a single pair of gloves. “Make it a standard, and frame it as a way to protect yourself and your patients,” she says. “It’s so common for a glove to be penetrated without a staff member even realizing it. Double-gloving protects you in those situations.”

With gloving systems, Mr. Reddy urges leaders to focus on end users. “Staff and surgeons need to have input,” he says. “They will have insight into the gloves that best meet their needs, so make sure they play an active part in the selection process.”

“Institute and monitor ongoing double-gloving compliance with audits, secret surveys, coaching and feedback.”
Raghu Reddy

To make the process as engaging as possible, consider stealing a page from this New York-based hospital’s playbook. The facility combatted low double-gloving numbers by overhauling its selection and purchasing process with a creative take on a traditional trial. It capitalized on its annual skills fair to gather as many providers as possible to assess glove choices for protection, quality, fit and comfort.

Once staff had ample opportunity to try out various gloves, the vendors the hospital decided to trial supplied evaluation forms for staff to fill out, which 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 in the trial, which uncovered the need for further education to boost compliance with double-gloving practices.

Of course, leaders can’t sit back after a purchasing decision and simply expect double-gloving compliance to take care of itself. It requires clear communication about your facility’s expectations about donning and doffing the doubles. “Staff should be educated on when double-gloving is necessary and when it is optional,” says Mr. Reddy. “This clarity will facilitate increased compliance. Lack of clarity, on the other hand, creates confusion and ultimately increases human errors.” Like all preventative processes, double-gloving requires regular reviews and refreshers. “Institute and monitor ongoing double-gloving compliance with audits, secret surveys, coaching and feedback,” says Mr. Reddy, emphasing the importance of the coaching and feedback. “A strong support system for staff and peer-to-peer mentoring is the best way to achieve compliance.”

• Sharps safety standards. Prevention of needlestick and scalpel injuries often comes down to adequate training, the aid of safety-engineered devices, proper expectation-setting and consistent communication about the best practices that prevent sharps injuries in the first place, such as hands-free passing. While “neutral zone” — a designated area or location where sharps only may be placed and retrieved — is a standard term, subtle variations in how different facilities handle and pass sharps often lead to problems.

Ms. Kucera says that with so many different circumstances in the OR, newer providers in particular may be unclear about how to pass items correctly. “Sometimes you need to call out problems in real time,” she says. “You need to be willing to have a vulnerable conversation, saying, ‘Hey, my hand was right there’ when it’s needed.” A safe OR, Ms. Kucera says, is a place where communication is seamless. “Staff are continually calling out ‘Needle coming back!’ or ‘I don’t have the needle’ and everyone is exactly where they should be, and they know exactly what they should be doing,” she says. OSM

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