A comparison of the effect of different surgical gloves on objective measurement of fingertip cutaneous sensibility

Abstract

Ann R Coll Surg Engl 2011; 93: 95-98 95In the wake of challenging global economic circumstances, government reforms in nationalised health systems such as the NHS require the delivery of efficient, high-quality services while reducing costs. 1 The careful selection of surgical equipment can deliver significant cost savings; for example, a recent national audit identified that the NHS in Scotland alone spends approximately £2.6 million on surgical gloves per annum.2 National procurement directives encouraging open competition between glove suppliers would enable the potential saving of £534,000 per annum.2 However, the choice of sterile surgical glove represents a controversial area; although cost savings are possible it is important that surgical technique is not compromised at the expense of patient care. Alterations in surgical glove procurement which were driven purely by cost without regard for clinical factors have faced wide-spread criticism. The prudent selection of surgical gloves can deliver significant efficiency savings. However, objective data are lacking to compare differences in cutaneous sensibility between competing gloves. Therefore, the present study examined the use of a single comparable model of sterile surgical glove from two competing providers, Gammex PF HyGrip ® (Ansell Limited, Red Bank, NJ, USA) with Biogel ® (Mölnlycke Health Care AB, Göteborg, Sweden). SUBJECTS AND METHODS Cutaneous pressure threshold, static and moving two-point discrimination were measured as indices of objective surgical glove performance in 52 blinded healthcare professionals. RESULTS The mean cutaneous pressure threshold was 0.0680 ± 0.0923 g for skin, 0.411 ± 0.661 g for Ansell gloves and 0.472 ± 0.768 g for Biogel gloves. Skin was significantly more sensitive than Ansell (P < 0.0001) or Biogel (P < 0.0001) gloves (Wilcoxon signed rank test). There was no statistical difference between Biogel and Ansell gloves (P = 0.359). There was no significant difference between static or moving 2-point discrimination of skin and Ansell gloves (P = 0.556, P = 0.617; Wilcoxon signed rank test), skin and Biogel gloves (P = 0.486, P = 0.437; Wilcoxon signed rank test) or Ansell and Biogel gloves (P = 0.843, P = 0.670; Wilcoxon signed rank test). CONCLUSIONS No demonstrable objective difference was found between competing gloves in the outcome measures of cutaneous sensibility and two-point discrimination. However, a difference in subjective preference was noted. Untested factors may underlie this discrepancy, and further research should employ more sophisticated measurements of surgical performance using competing models of surgical glove.

Do your surgical glove characteristics and wearing habits affect your tactile sensibility?

“…However, our results are in contrast to Bucknor et al (2011) [ 5 ], who reported no objective difference between different glove types regarding static and dynamic 2PD, although a difference in subjective preference was observed [ 5 ]. Studies comparing the tactile performance of different glove types, using the SW-monofilaments [ 2 , 5 ] and Roughness Discrimination Test [ 6 ], did not find significant differences between them, either [ 2 ]. In contrast, we noticed that Gammex Latex Sensitive™ gloves provide significantly better tactile sensibility than the other glove types.…”

“…As studies using existing sensibility tests (SW-monofilament, 2PD) already found, gloved hands have a lower cutaneous sensibility than bare hands [ 5 , 9 ]. This we were able to confirm.…”

“…At the same time, a daily dependent market price analysis of size 7.0 gloves showed, that the significantly better sensibility may come with higher financial expenses. One must bear in mind, that careful choices in surgical equipment can significantly reduce costs, as a national audit of the NHS in Scotland showed: They spend approximately £2.6 million per year on surgical gloves alone [ 5 , 10 ]. Therefore, the choice of glove must remain well balanced between cost and clinician preference.…”

“…Double-gloving did not affect 2PD- and SW- discrimination in our study. In many different specialties, surgeons use double gloving, as it effectively reduces the risks of needlestick injuries and blood contact during surgery and thus the transmission of infections between the surgeon and patient [ 5 , 6 , [11] , [12] , [13] ]. Most glove manufacturers also advertise double gloving without significantly reduced sensibility.…”

“…Over the years, using surgical gloves to prevent surgical site infections and protect the surgeon has become common practice [ 3 ]. However, presumed disadvantages, such as diminished manual dexterity and tactile sensibility, stand in contrast to these safety advantages [ 5 , 6 ]. Although the importance of glove use for infection control is commonly accepted, studies have shown that compliance with glove use guidelines may vary, depending on the user's confidence in glove performance [ 2 ].…”