Intraoperative glove perforation—single versus double gloving in protection against skin contamination

Abstract

Surgeons have the highest risk of contact with patients' blood and body fluids, and breaches in gloving material may expose operating room staV to risk of infections. This prospective randomised study was done to assess the eVectiveness of the practice of double gloving compared with single gloving in decreasing finger contamination during surgery.In 66 consecutive surgical procedures studied, preoperative skin abrasions were detected on the hands of 17.4% of the surgeons. In the double gloving pattern, 32 glove perforations were observed, of which 22 were in the outer glove and 10 in the inner glove. Only four outer glove perforations had matching inner glove perforations, thus indicating that in 82% of cases when the outer glove is perforated the inner glove will protect the surgeon's hand from contamination. The presence of visible skin contamination was also higher in perforation with the single gloving pattern (42.1%) than with the double gloving pattern (22.7%).An overwhelming majority of glove perforations (83.3%) went unnoticed. Double gloving was accepted by the majority of surgeons, especially with repeated use. It is recommended that double gloves are used routinely in all surgical procedures in view of the significantly higher protection it provides. (Postgrad Med J 2001;77:458-460) Keywords: gloves; skin contamination; surgery Surgeons and operation room personnel have the highest risk of contact with patients' blood and body fluids. Since medical history and examination cannot reliably identify all patients harbouring blood borne pathogens, universal precautions during exposure to blood and body fluids are now mandatory. Intact surgical gloves will prevent this transmission, but breaches in gloving material may expose the operating room staV to risk of infections, particularly if there are cuts or abrasions on the skin. Breached gloves not only indicate the potential for infection via skin, but also bear witness to the possibility of there having been a needlestick injury and thus potential inoculation of infected blood. Double gloving is generally adopted by surgical teams when operating on high risk cases. There are varying opinions regarding the necessity of wearing double gloves routinely for added protection, and the ability to operate when wearing double gloves. The Center for Disease Control, however, does not recommend routine use of double gloves in surgery, as there are not enough studies to show that double gloves definitely have a higher protection rate. Subjects and methodsThe aim of our present study was to assess the frequency of glove perforation, and subsequent blood or body fluid contact, associated with common general surgical operations, and to assess the eVectiveness of the practice of double gloving in decreasing finger contamination with blood and body fluids during surgery as compared with single gloving.This prospective randomised study was performed in the department of general surgery, Lady Hardinge Medical College and associated Srimati Sucheta Kriplani Hospit...

Occult Glove Perforation During Adult Elective Orthopaedic Surgery

“…The mean risk of transmission of HIV infection after one major percutaneous exposure was reported as 0.3% and this increases markedly with larger inoculums of blood and higher titre of HIV in the blood of source patient. Further in a study by Thomas et al [19] 40 pairs of unused gloves were examined and a 3.75% (3/80) rate of perforation was detected implying that in 3 out of 40 cases (7.5%) a surgeon using single gloves was more likely to have blood contamination of his hands …”

Glove perforations during open surgery for gynaecological malignancies

“…The rate varies from 2-7.5%. [20][21][22] Surgeons using single gloves are more likely to have contamination from patient's body fluids because of this background risk. Furthermore, the perforation rate of the inner of double gloves is lower than that of single gloves.…”

Prävention postoperativer Wundinfektionen

“…OP-Handschuhe schützen darüber hinaus auch den Träger. Bei bekanntem oder wahrscheinlichem Übertragungsri-siko für HIV oder Hepatitisviren (oder andere blutübertragbare Infektionserreger) vom Patienten sollte ein "double gloving-System" mit Indikator gewählt werden, weil dadurch der innere Handschuh im Vergleich zum einschichtigen Handschuh signifikant seltener perforiert wird [132][133][134]. Alternativ kommen OP-Handschuhe mit zusätzlicher antimikrobieller Barriere in Betracht [135].…”