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The Powerful Case for Double Gloving
How to convince your OR team to put an extra pair on.
Gail Guterl
Publish Date: September 30, 2013   |  Tags:   Staff Safety
double gloves 2 ARE BETTER THAN 1 Let your team know the many
reasons why this is so.

It's well proven that double gloving helps prevent surgical site infections. But in survey after survey, surgeons denounce double gloving because it reduces essential tactility during surgery. And let's face it: Your staff's probably not wild about wearing 2 pairs of gloves, either. Don't be deterred. Here are 4 evidence-based reasons for double gloving that might help convince your team to give the practice a try.

Reduce your risk for infection. Surgeons bear the brunt of needlestick exposures in the OR at 59%, with scrub personnel a distant second at 19%, according to research done by the International Healthcare Worker Safety Center at the University of Virginia School of Medicine. During 100 hours of surgery, surgeons normally have contact with patient blood for 42 of those hours. Studies show that glove perforations typically occur an average of 40 minutes into surgery, but go undetected in 83% of cases. Double gloving can mitigate a lot of that risk.

TACTILITY Surgeons are concerned that they won't be able to execute fine-motor tasks while wearing double gloves. double gloves

Debunking the myth of reduced tactility. While it takes anywhere from 1 to 120 days to adapt to using double gloves, most surgeons become comfortable in 2 days, according to Ramon Berguer, MD, FACS, and Paul J. Heller, MD, in the Journal of the American College of Surgeons. Drs. Berguer and Heller reported that surgeons who routinely doubled up on gloves mentioned decreased hand sensation less often than those who didn't double glove. So be patient and persevere.

For your protection. Much of what your team does in the OR is for the benefit of the patient. While double gloving provides patient safety, it also offers protection for the OR team. Wearing double gloves helps prevent surgical site infection and creates a double barrier preventing microbial transfer from team members to patients or vice versa. Studies say that anywhere from 600,000 to 800,000 percutaneous medical injuries occur annually in this country, but also point out this is an underestimate because many exposures go unreported.

Researched and proven. The CDC has endorsed double gloving. The 7 members of the Council on Surgical & Perioperative Safety, which includes the American College of Surgeons, AORN, the American Academy of Orthopedic Surgeons and the Association of Surgical Technologists, recommend double gloving. All these organizations have done copious research on the pros and cons of double gloving and several have issued recommended practice guidelines supporting the practice.

Patience and practice make a habit
That's all well and good, you might be saying, but what if your surgeons and staff still resist? Know that the No. 1 reason surgeons give for not wearing double gloves is hand sensitivity and dexterity. Yes, it requires an adjustment to become comfortable performing surgery while wearing double gloves, but not as long as you might think — as little as 2 days, according to studies.

At first, it'll be natural for your team to be concerned about how double gloves will feel. Suggest that they experiment with different sizes and types of gloves for the best fit and feel. "Remember the days when starting an IV with gloves felt awkward?" asks Sharon A. Van Wicklin, MSN, RN, CNOR, CRNFA, CPSN, PLNC, perioperative nursing specialist at AORN. "It affected the tactile feel and we complained we couldn't find the vein, but we learned to do it successfully with gloves."

You can also stress to the doubters that not all micro-perforations are obvious. The practice of double gloving by wearing a darker glove underneath a lighter glove provides an at-a-glance perforation indication system. In one study, more than three-fourths (77%) of 582 glove wearers who wore a color-coded double-glove system detected glove perforations. That includes micro-perforations, tiny holes that occur in gloves during surgery for numerous reasons, says Ms. Van Wicklin. Carefully inspect for glove integrity immediately after donning — the FDA allows a certain percentage of gloves to fail quality control testing — and regularly throughout surgery. AORN and other members of the Council on Surgical & Perioperative Safety recommend that all OR team members in the sterile field wear double gloves.

Do some cases run longer at your facility? Typically, glove perforations occur an average of 40 minutes into surgery, so the longer the surgery, the greater the risk that surgical gloves will be compromised. A study in The Annals of Thoracic Surgery showed perforations went undetected in 25% of gloves worn by the primary surgeon and 12% of all other gloves worn during a procedure. Additionally, the more instruments you use during surgery, the more you should be checking your gloves, says T. Forcht Dagi, MD, MPH, MPA, a neurosurgeon and chairman of the Committee on Perioperative Care for the ACS. AORN recommends gloves be changed every 90 to 150 minutes during a procedure.

Engineer the process
Engineering the process to promote a culture of safety is one of the best ways to encourage compliance. That's what Gonzalo M.L. Bearman, MD, MPH, professor of infectious diseases at Virginia Commonwealth University, discovered when he surveyed VCU surgeons. For example, make sure colored gloves and a variety of sizes are readily available to the surgeon and the surgical team, he says. VCU Medical Center has incorporated double gloving into its OR checklist, asking whether double gloves will or won't be worn for specific procedures.

Surgical residents who are mentored by surgeons who double glove will be more likely to continue to double glove throughout their careers, adds Dr. Dagi. "Get surgeon buy-in, find a surgeon champion who will advocate for double gloving and other safety issues," says Dr. Bearman.

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