A Planning Playbook for Opening a New Orthopedic ASC
The ASC market continues its rapid growth. In 2023, roughly 116 new ASCs opened in the U.S., many of which were orthopedic-specific in nature....
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By: Mark Davis
Published: 10/10/2007
OR workers have to mentally multitask when sharps are in use, focusing simultaneously on patient and worker safety. The human tendency is to devise a pecking order, and most often, patient safety comes first. Even if there is unexpected bleeding during a procedure, and speed becomes a factor, patient safety is still at the fore, right? This is by no means wrong - it's just that you must give worker safety nearly as much attention.
Wearing two rather than one pair of gloves won't prevent needlesticks or scalpel cuts. But studies clearly and repeatedly show that double-gloving significantly reduces occupational exposure to blood during surgical procedures. Many studies also suggest the traditional use of a single pair of latex gloves can't provide an effective barrier during most surgical procedures. A rundown of some of the proof:
Where, when and how
Several factors should influence gloving practices: Type and length of procedure, the stresses gloves will be exposed to, and the individual needs and preferences of surgical team members. Most surgical procedures easily lend themselves to double-gloving, including gynecologic, general and cosmetic/plastic surgical procedures, where the expectation for exposure to blood is always high.
Sometimes, switching might be the best route. Based on my observation of a series of coronary artery bypass graft and other cardiothoracic procedures, I believe these procedures lend themselves to a combination of single and double-gloving - and that was one of my recommendations as a consultant for that facility. Opening and closing the chest, where stresses on gloves are considerable, clearly call for double-gloving. On the other hand, where cardiothoracic surgeons may feel that double gloving would unduly compromise tactile sensation during delicate vessel anastomosis, they might want to perform this portion of the procedure wearing a single pair of gloves.
Clock Ticks and Glove Rips | |
Here's a look at the likelihood of glove failure in correlation to length of procedure, based on a study of 3,018 gloves from 800 surgical procedures. |
|
Length of procedure | Glove-failure rate |
Less than one hour | 13% |
One to three hours | 27% |
Three to five hours | 47% |
Over five hours | 58% |
And here's the failure rate of single versus double gloves, based on the same study. | |
Gloves used | Glove-failure rate |
Single gloves | 38% |
Double gloves, outer layer | 27% |
Double gloves, inner layer | 4% |
Adapted from Cohn GM, Seifer DB. Blood exposure in single versus double gloving during pelvic surgery. Am J Obstet Gynecol 1990;162;715-717. |
Overcoming obstacles
Some materials lend themselves to double-gloving better than others. Latex gloves, which have traditionally provided maximum sensitivity, may have an advantage in this regard. Because of concerns about latex allergy, however, there is an increasing shift to non-latex gloves. We need to further explore opportunities to double-glove with synthetic materials.
Glove size may vary slightly from manufacturer to manufacturer. Although it takes a little time and effort, every member of the OR team can benefit from experimenting with different brands, materials and sizes to facilitate effective double-gloving.
Other glove-safety tips
Some other things to consider.
Safe donning and removal
Remember, healthcare worker and patient safety don't begin and end in the OR. Here are three final tips to keep in mind:
Personal protective equipment (PPE) is essential in preventing transmission of bloodborne pathogens - in either direction - between patients and operating room professionals. One key component of PPE is the surgical glove.
Bloodborne pathogens can be transmitted to ORPs due to needlestick injury, mucous membrane exposure and even exposure of unprotected chapped or abraded skin. For many reasons, the skin of ORPs' hands may often be chapped or abraded, making selection of an effective glove barrier extremely important.
Double-glove Q&A | |
Here are some frequently asked questions from my surgical audiences. | |
Q | Is double-gloving necessary during a minor procedure with low expectation of exposure to blood, such as a diagnostic dilatation and curettage? |
A | Not necessarily, but bear in mind you might occasionally encounter emergencies during minor procedures. If you have to convert to a major procedure, double-gloving should then become routine protocol. |
Q | Should scrub personnel double-glove? |
A | If they're assisting the surgeon, they certainly should. But I see no disadvantage to the scrub person's routinely double-gloving during any major procedure or where exposure to blood is anticipated. |
Q | What size gloves should I use when double-gloving? |
A | In my personal experience - after some experimentation - I found that using my regular size for both layers of gloves worked reasonably well. Others have recommended a smaller or larger size for the outer layer of gloves. Base your preferences on experimentation with various brands and sizes of gloves. |
- Mark S. Davis, MD |
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