Double Gloving in the OR

The idea of double gloving during surgery seems to be catching on. Earlier this year, a 24-month study published in the AORN Journal found the majority of healthcare providers in the study expressed favorable views toward the practice of donning not one pair of gloves in the operating room, but two.

In the article, Exploring the Benefits of Double Gloving During Surgery, study authors Denise Korniewicz, PhD, RN, FAAN, and Maher El-Masri, PhD, RN, wrote that OR staff who single glove more often find blood on their hands post-surgery than those who double glove. For double-glovers, breaches are more likely to occur in the outer glove than the inner glove.

“Double gloving by itself may protect the wearer’s skin from needle sticks,” they concluded.

Their findings are consistent with a number of previously published studies and subsequent recommendations from professional groups endorsing the practice. The Association of periOperative Registered Nurses, the American College of Surgeons, the American Academy of Orthopaedic Surgeons and the CDC all give double gloving the official thumbs-up.

“The consistent theme in the literature is the protection double gloving provides,” said Leilani A. Salimone, BSN, RN, CNOR, nurse manager of the OR at the Mayo Clinic in Jacksonville, FL. “However, acceptance and practice can be conflicting.”

Enhanced Barrier

A perioperative nurse for more than 15 years, Salimone is committed to double gloving to protect both patient and provider against infection. However, she noted her convictions aren’t always shared by other surgical staff.

“They intuitively know double gloving is beneficial to practice but may not embrace the recommendation for various reasons, namely reduced manual dexterity and tactile sensitivity,” she said.

In other words, the increased barrier between the provider, instrument and patient causes, well, an increased barrier between provider, instrument and patient. Some surgical staff resent that.

Salimone recommends surgical staff try and customize their best double-glove fit to preserve dexterity and sensitivity. Some, she said, prefer the inner glove to be a size larger than the outer glove. Meanwhile, others prefer the inner glove to be a size smaller or the same size as the outer glove.

Finding a fit that’s right for you may dissolve any perceived downsides of double gloving. A study published in the Journal of the American College of Surgeons in 2004 found an 88 percent acceptance rate among the group who double gloved – and 88 percent of them said they experienced no loss in tactile sensitivity.

Worthwhile Waste

Cost and waste are two other reasons surgical staff (or their managers) may dismiss double gloving. After all, if everyone uses two pairs of gloves, a hospital burns through twice the inventory, right?

That, said Paula Graling, DNP, RN, CNOR, CNS, is the wrong way to look at it.

“The cost of gloves is certainly less than the cost of lost work from employee injury,” said Graling, clinical nurse specialist for perioperative services at Inova Fairfax Hospital, Falls Church, VA, and AORN president from 2006-07. “It is standard at our hospital that employees double glove. I strongly support the practice.”

If managers are looking to save costs, they might do so by managing inventory more efficiently, she said. Reducing inventory on hand and keeping fewer, quality SKUs on the shelf are better cost-saving strategies than skimping on safety.

Waste in surgical settings is a concern to Julie Moyle, MSN, RN, a proponent of environmentally responsible practices in healthcare settings. She launched 1X1 Consulting in Boulder, CO, last year after opening and running the surgery department at nearby Boulder Community Hospital, the first LEED-certified hospital in the country.

But that doesn’t mean she’s against the practice of double gloving.

“There isn’t any doubt that healthcare providers should don gloves – single or double – when there is a risk of exposure to blood and body fluids,” said Moyle, who observes that the practice of double gloving is an individual choice based on case circumstances. Moyle also notes the importance of a sharps safety program to further reduce exposure to inadvertent needle sticks.

“In my experience, however, what should be given greater attention in terms of the use and waste of gloves is their use when there isn’t a risk of exposure,” she said. “Used as a means of avoiding proper hand hygiene, such practice is unnecessary and wasteful.”

Moyle added that the common practice of setting up a case in the OR and then “breaking” is also a waste of surgical gloves as well as gowns.

“Curbing these practices would certainly help offset the impact of double gloving, if not help lower use of gloves overall,” said Moyle, who notes that natural rubber latex gloves have less environmental impact than petroleum-based synthetic gloves due to the natural materials’ biodegradability.

Not a Rule, But Becoming the Rule

At Baltimore Washington Medical Center in Glen Burnie, MD, most nurses do opt to double glove, according to perioperative education specialist Toni Hughes, MA, RN, CNOR. It has become more or less the rule and not the exception over the years.

Young nurses learn to double glove in their training and tend to bring it with them into clinical practice. In addition, glove manufactures are offering more products geared toward double gloving, such as bright- or dark-colored inner indicator gloves that better show tears when worn in conjunction with lighter outer gloves.

This, in addition to the continued studies and recommendations confirming the validity of the practice, is transforming double gloving from a good idea in theory to a little-questioned reality in hospitals like Hughes’ facility.

“Our practice here is that we highly recommend it, although it is not mandated per se,” said Hughes. “But most of our OR nurses think it’s a realistic way to protect yourself and the patient. It’s just becoming habit – something that makes sense.”

Jolynn Tumolo

is a frequent contributor to ADVANCE.

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