Using double gloves in surgical

procedures: a literature review

Mohammed Abdullah Al Maqbali

higher risk of adverse exposure to blood and

body fluid (Mallolas et al, 2006; Perry et al,
Abstract 2006; Venier et al, 2007; Myers et al, 2008).
This article will present a critical review of the literature relating to the use of Nurses have a responsibility to find the most
double gloves during surgery in order to identify best practice by using available recent evidence to improve the quality of care
resources and to improve health care. During surgery there is an increased risk of and protect patients’ lives.
exposure to blood and, as a result, pathogens can be transferred through contact
between the patient and surgical team. Health professionals working in the operating Literature review
room are prone to frequent exposure to patients’ blood and body fluids (Davanzo et A literature review highlights the problem and
al, 2008; Au et al, 2008; Myers et al, 2008). Several researchers have also demonstrated gathers information to solve it (Mateo and
that the highest incidence of blood and body fluid exposure is in the operating Kirchhoff, 2009). This will provide the best
room during surgical procedures (Ganczak et al, 2006; Myers et al, 2008; Naghavi available evidence on this topic, which enables
and Sanati, 2009). change in the clinical area to be more effective,
Key words: Body fluids ■ Needlestick injuries ■ Surgical gloves and to convince health professionals of the
■ Cross infection ■ Operating rooms need to change the practice. The philosophy
of evidence-based practice is to support

T
he use of gloves during surgical
procedures was first introduced in
1758 by the German physician, Johann
Walbaum. The gloves were made from
the bowel of a sheep and were used for carrying
out gynaecological operations (Dyck, 2000).
The main purpose of gloves was to protect
the practitioner from infection. Gloves were
used for the first time in the UK by surgeon
John Lynn Thomas, in Cardiff in 1905 (Ayliffe
and English, 2003). Since then, sterile gloves
have been worn during surgical procedures
to protect against the two-way transmission
of pathogens between the patient and surgical
team. This practice reduces the risk of
surgical-site infections (SSIs) and blood-borne
diseases during surgery by providing a barrier
against the transmission of microorganisms
such as Staphylococcus aureus and Staphylococcus
epidermidis from surgical teams to the surgical
site (Tanner, 2008).
Occupational exposure management in
the USA is expensive at between $71 and
$4838 per patient even if the patient is not a
known carrier (O’Malley et al, 2007). These
costs can be reduced through cost-effective
interventions, such as the use of double
gloves. Sterile surgical gloves provide physical,
chemical and biological protection, but they
can be perforated like all rubber materials
(Tanner, 2006). Once perforated, the barrier
breaks down and germs can be transferred.
Surgical procedures involve contact with sharp
needles or instruments that can potentially
compromise the protection offered by single
gloves. Punctures and tears sustained by single
gloves during surgery account for most blood
contacts (Smoot, 1998).
There are increasing numbers of blood-
borne pathogens, increasing the occupational
hazards to healthcare providers. There are
recommendations from different sources to
use double gloves, in order to minimise
blood-borne pathogen transfer (Mangram et
al, 1999; Pratt et al, 2007). Despite this, several
studies report that the majority of surgical
teams do not routinely use double gloves
(Patterson et al, 1998; St Germaine et al, 2003;
Moghimi et al, 2009).
Evidence suggests nurses should encourage
the use of double gloves in surgical procedures
(Thanni and Yinusa, 2003; Caillot et al, 2006;
Lancaster and Duff, 2007).The risk of exposure
to blood and body fluids is high during
healthcare systems to use their resources, and
ensure cost-effectiveness (Perra, 2000). Taylor
and Allen (2007) suggest that nurse leaders
have an obligation to examine evidence for
validity and applicability in order to provide
guidelines based on therapeutic knowledge.
Research strategy
Searches were undertaken using different tools
to gather information from the following
electronic databases: Cochrane Library,
CINAHL, PubMed, Medline, and the British
Nursing Index. The following search terms
were used: double gloves, double gloving,
gloves, single gloves, gloves perforation, gloves
and infection. Additional literature articles
were used by backward chaining from available
articles. Backward chaining, also called footnote
chasing, is a search technique that uses other
authors’ references or bibliographies to find
additional articles on the chosen topic (Booth,
2008). Initially, 3500 hits were found; this was
reduced by limiting the search to English-
language texts only, setting the time limit to
5 years and then extending it to 10 years for
analyses of randomised control trials (RCTs).
The criteria for selecting research were
quantitative studies, systematic review, and
meta-analysis. To avoid repetition of the trials,
© 2014 MA Healthcare Ltd

Mohammed Abdullah Al Maqbali, Senior Staff Nurse,

Al-Buraimi Hospital, Al-Buraimi, Oman surgery (Jagger et al, 2011). Only elective cases ten RCTs were excluded because they were
with signs or symptoms of HIV or hepatitis B already in the systematic review. In summary,
Accepted for publication: October 2014 infection are screened (Branson, 2007; Weber the research consisted of one systematic review,
et al, 2013). Therefore the surgical team has a three RCTs and nine different study categories.

1116 British Journal of Nursing, 2014, Vol 23, No 21

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 Critical appraisal
Critical appraisal of the studies can determine
the effectiveness of the results of those
studies and the applicability to practice.
The studies were conducted in different
countries, two studies were from the UK
and two from the USA, while one study was
conducted in each of the following: Hong
Kong, Germany, Finland, Austria, France,
India, Nigeria and Japan. Only two studies
gave specifications about obtaining ethical
approval (Caillot et al, 2006; Guo et al, 2012).
Ethical approval is important to ensure that
the ethical rigour is acceptable (Rees, 2011).
In addition, approval not only ensures the
participants’ own ethical principles are met
but also ensures the study has an appropriate
methodology (Navaneetha, 2011). Six of the
studies used Biogel® gloves, two used gloves
made by Ansell and one study used both
Biogel and Ansell gloves. Two studies did not
report the glove manufacturer and one study
used gloves manufactured by SurgiCare.
Different methods were used to detect
glove perforation. Manjunath et al (2008)
used air to fill the gloves, submerged them
in water and observed for bubbles. Nine of
the studies tested for perforation by using the
EN 455 water inflation test. In the EN 455
test, the gloves are filled with 1000 ± 50  ml
of water at 20°C and observed for 2 minutes
to detect water leakage (Rotter, 2004). This
test is approved by European Standards for
its reliability and validity of test performance.
Fain (2004) explained that reliability is the
consistency of measurement and validity is the
accuracy of measurement.
Glove perforation
The use of gloves during surgery is to protect
the patient and the surgical team from
microbial contamination. Most gloves are
made of natural rubber latex, a material that
can easily be perforated. A number of factors
are involved in the rate of perforation, such as
duration of surgery and the type of operation.
Tanner and Parkinson’s (2006) systematic
review provided data on glove perforation
rate from 31 trials. However, different types of
gloves were used for double gloving, meaning
that the trials lacked uniformity. The findings
from the systematic review are described below.
Single- compared to innermost
double-glove perforations
A total of 20 trials compared single
gloves with double gloves for numbers of
perforations. All the trials reported that the
use of double gloving reduces the risk to the
1118
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health professional as the innermost glove was
not perforated and therefore provided better
protection in comparison to single-glove wear.
Data from 14 trials, giving a total sample size
of 8885 gloves, was meta-analysed. Of the
single gloves, 9% had perforations, compared
with 2% of the innermost double gloves. All
of these 14 trials were carried out in low-risk
surgical specialties.
Single- compared to outermost
double-glove perforations
In total, 13 of the 20 trials had evaluable data.
There was no statistically significant difference
in the number of perforations between single
gloves and outermost double gloves in all
subgroups, except in one trial, where the
number of perforations in single orthopaedic
gloves was compared with double outermost
gloves. In this study, perforations to single pairs
of orthopaedic gloves were significantly fewer
than the outermost double glove layer.
Proportion of perforations detected
during surgery by the glove wearer
Two meta analyses showed that glove wearers
detected more perforations when using a
perforation indicator system. The perforation
indicator system is visible green fluid that can
be detected immediately when perforation
occurs in the outer gloves.
Additional glove measures
evaluated in this review
Additional glove measures evaluated in this
review were triple gloves, glove liners and
knitted chosen gloves (those gloves are made
of a knitted fabric, such as cloth, extended-
chain polyethylene fibres, long molecule
chains of poly-paraphenylene terephthalamide
(Kevlar®) or steel and polyester weave) provide
significantly more protection than standard
double gloving.
Caillot et al (2006) evaluated perforation
under the glove indicator system in a
randomised study of 100 visceral surgical
procedures. The indicator system, based on
a coloured detector, used green gloves for
inner and normal latex for outer gloves to
visually identify perforations in the outer-
gloves. The conclusion of the study was
that the chance of a surgeon’s skin being
exposed to body fluids appeared significantly
higher with single gloving, and the indicator
system allowed detection of an outer glove
breach in real time. The aim of the study
was to investigate the indicator under-
glove system to warn the surgical team
about the perforation. The sample size was
99  procedures from different specialties.
However, the distribution of the procedures
was not equal among the specialties.
Further comparison
Al-Maiyah et al (2005) investigated whether
the changing of gloves at specific periods could
reduce perforations in total hip arthroplasties.A
total of 50 patients were included, distributed
equally among two groups. Both groups
wore double gloves. In one of the groups the
outer pair was changed every 20  minutes.
In the second group changes for the outer
pair of gloves were made after draping and
before cementation of components in surgery.
In addition to this, in both groups gloves
were changed whenever a visible perforation
was detected. Changing gloves after intervals
decreased the incidence of perforations and
bacterial contamination.
A prospective audit done by Manjunath
et al (2008) found that the glove-perforation
rate was 13% per pair of gloves. There were
fewer inner-glove perforations (5/139, 4%),
compared to single-glove (26/154, 17%). In a
prospective cohort study, Lancaster and Duff
(2007) examined the perforation rate in single
compared to double gloves in obstetric and
gynaecological procedures. The number of
perforations was significantly higher in single
(11%) compared to double gloves (2%). Surgical
nurses sustain the most glove perforations
among surgical teams with 19%, presumably
because of loading and unloading of needles
and surgical blades (Lancaster and Duff, 2007).
Another prospective study, undertaken by
Malhotra et al (2004) tested 156 procedures
in obstetrical and gynaecological procedures.
Out of 1120 gloves tested, perforations to
inner gloves were 82/892 (14%), and 70/528
(13%) to outer gloves. Although this result was
not statistically significant (P>0.05), health
professions in 32 procedures wore single
gloves and 124 wore double gloves.
Thanni and Yinusa (2003) conducted a
study in orthopaedic surgery to determine the
usefulness of double gloves. Overall there were
73 instances of perforations (12%) identified
but exposure of blood to skin occurred in
only 13% of those. This could have occurred
in 84%, had it not been for the double gloves
worn by the surgeons (Thanni and Yinusa,
2003). However, the groups were not equally
distributed, and it was not an RCT. The
indication of when the perforations occurred
© 2014 MA Healthcare Ltd
was not identified, either during or after the
operation. Guo et al (2012) conducted RCTs
and concluded that perforation to inner gloves
in the double-glove groups was significantly
British Journal of Nursing, 2014, Vol 23, No 21
 CLINICAL FOCUS

lower, compared to both single gloves and 2003), cardiac surgery has 48% (Eklund et Double gloves and SSIs
outer gloves in double gloves. al, 2002), obstetric and gynaecology 23% Several researchers have studied the relationship
All studies concluded that double gloves (Malhotra et al, 2004), and general surgery between SSIs and glove perforation. Tanner
were of greater benefit in preventing exposure 27% (Caillot et al, 2006) (Table 1). It appears and Parkinson (2006) indicated the incidence
to blood and body fluids. Single gloves from these studies that the highest risk of of SSI in patients as a primary outcome in
might tear during surgery and blood could perforation is with orthopaedic procedures, a systematic review. There was no direct
contaminate the skin without a second layer most likely because they involve bones, and evidence to support that an additional pair
to protect the hands of surgical staff. However, heavy and sharp instruments. of gloves reduced SSI. However, there were
systematic reviews by Tanner and Parkinson Apt and Miller (1992) examined glove only two studies conducted, and they did not
(2006) found no evidence to support the perforation in 454 ophthalmic surgical provide enough statistical power to arrive at a
claim that double gloving reduced SSIs. procedures and found that 22% of gloves were conclusion.
perforated. This suggests that all specialties Harnoss et al (2010) investigated the
Duration of surgery have a considerable risk of glove perforation. concentration of bacteria passing through
Glove perforation increases dramatically with Nevertheless, all surgical procedures use glove punctures under surgical conditions.
the length of surgery, as does the bacteria sharp instruments or needles during surgery. The study included 20 surgical procedures and
count on the hands of surgical teams. Eklund Therefore, using double gloves irrespective of overall the perforation rate was 21% (27/128)
et al (2002) took 800 bacterial samples from 23 any speciality would give additional protection for outer gloves, and 15% (18/122) for inner
surgeons after 116 cardiac procedures. A total to the surgical team. gloves. Of those, 82% (37/45) of perforations
of 39% (154/400) of gloves had perforations
after the operation. Perforation of gloves and
bacteria counts increased from 30% in 3-hour Table 1. Samples of study and specialty
surgeries to 65% in longer surgeries. Study Sample size Single-glove Double-gloves Participants Specialty
Unnoticed glove perforation was studied perforation perforation
by Kojima and Ohashi (2005), who found (inner gloves)
unnoticed glove perforations in 25% of Caillot et al n=638 18% 0% Surgeons Visceral
thoracoscopic procedures, and in 12% of all (2006) DG=342 surgery
gloves used during a procedure. A 19–25% SG=296
increase in perforation rate was observed when Manjunath n=462 16.8% 3% All surgical Gynaecological
gloves were worn for more than 2  hours. et al DG=18 team* malignancies
Thanni and Yinusa (2003) also found that (2008) DG indicator=154
after 2 hours of surgery, the rate of perforation SG=290
increased significantly. Manjunath et al (2008) Al-Maiyah n=250 21% 14.8% All surgical Hip
found that the perforation rate was three times et al Inner G =122 team* arthroplasty
higher after more than 5  hours of surgery. (2004) Outer G =128
Most of the studies suggest that gloves should Lancaster n=1000 10% 11% All surgical Obstetric and
be changed after every 2 hours of surgery. et al DG=675 team* gynaecological
Partecke et al (2009) evaluated the risk of (2007) SG=325
glove perforation with the duration of wear in Thanni et n=596 13% 16% All surgical Orthopaedic
a prospective study. The gloves were separated al (2003) DG=512 Total perforation team* operation
into three groups, according to duration SG= 84 86%
of surgery: 1-90  minutes, 91-150  minutes, Malhotra n=1120 13.8% 13.2% All surgical Gynaecological
and >150 minutes. The microperforation rate et al Inner G =592 team* surgery
increased dramatically, with increasing duration (2004) Outer G =528
of surgery and was 15% (46/299) in the first Harnoss et n=250 21.1% 14.8% All surgical Visceral
group, 18% (54/299) in the second, and al (2010) Inner G =122 team* surgery
24% (71/300) in the third. The incidence of Outer G =128
microperforations were statistically significant Eklund et n=400 Total perforation Surgeon Cardiac surgery
with the duration of glove usage (P=0.05). al (2002) Inner G =200 48% and surgical
Outer G =200 assistant
Type of surgery
Another important factor affecting glove Guo et al n=218 8.93% 0% Nurses Different
perforation is the type of operation. Glove (2012) DG=106 surgical
perforation has been studied in different SG=112 department
surgical sub-specialties. Partecke et al (2009) Systematic review
found that cardiothoracic surgery has a higher Tanner and n=8885 9% 2% All surgical Different
© 2014 MA Healthcare Ltd

perforation rate (32%) than abdominal surgery Parkinson DG=4408 team* surgical
(12%). Other studies have shown different (2006) SG= 4477 department
perforation rates. Orthopaedics has an 84% Key: DG=double gloves, SG=single gloves, DG indicator=double gloves with indicator system
glove-perforation rate (Thanni and Yinusa, *All surgical team includes scribe nurses, first assistant and surgeon

British Journal of Nursing, 2014, Vol 23, No 21 1119

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 went unnoticed by surgical staff during the
procedures. The passage of microorganisms
through the perforations was demonstrated in
5% (6/128) of the outer gloves examined. The
study used the modified Gaschen bag method
to test migration of microorganisms from
patients to the hands of surgical staff through
micro-perforations in gloves.
A retrospective study involving 863 patients
was conducted to determine the effectiveness
of double gloving on the incidence of
infection rate of cerebrospinal fluid (Tulipan
and Cleves, 2006). The infection rate was
16% for the single gloves group, and only
7% in the double gloves group (P=0.00005)
(the homogeneity of samples were checked).
Cullum et al (2008) suggest that homogeneity
of the sample shares the same characteristic.
Gårdlund (2007) suggests that double
gloving during surgery is a different strategy
that can be used to minimise the bacterial
contamination of a surgical site and the
surgical team’s hands.
In their prospective observational cohort
study, Misteli et al (2009) investigated the
relationship of SSIs to incidence of glove
perforation in 4147 general surgery patients.
The glove perforation rate was 16%, and
the rate of SSI was 8%. However, 4% of SSI
was in the non-perforated group. Misteli
et al concluded that in the absence of
antimicrobial prophylaxis, glove perforation
is a risk factor, and recommended wearing
double gloves and routinely changing gloves
during lengthy operations. However, this
study has several limitations, such as 22% of
patients had missing data (the state of asepsis
during surgery was not recorded) and non-
validated techniques were used to detect
glove perforation.
Although the incidence of SSIs associated
with the perforation of gloves is very low,
Eagye and Nicolau (2009) have estimated
the cost of treating each infected patient
as around $42 516 ± $39 972 This study
considered the length of hospitalisation and
medications that will be used in case of
infection. Leaper et al (2004) reviewed 48
studies and estimated the cost of treatment
for SSI in Europe to be within the range of
€1.47-19.1 billion a year.
Tears in surgical gloves risk direct
contamination of the surgical site by surgeons’
hands, and vice versa.Therefore, it is important
to protect the surgical wound from any
possibility of bacterial contamination during
surgery. Further research is required to
determine whether wearing double gloves
can reduce costs and minimise the risk of SSIs.
1120
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Gloves and the risk of exposure
to blood-borne pathogens
The very nature of surgery increases the
exposure of the surgical team to blood and
bodily fluids. The risk of transmission of
blood-borne pathogens is high and this can
lead to infection in both patients and surgical
teams. Human immunodeficiency virus (HIV),
hepatitis B and C viruses, and around another
60 different blood-borne pathogens can be
transmitted through blood fluids (Tarantola
et al, 2006a). In China, the average blood and
body fluid exposure to health professionals was
66.3/100 per year in 2007 (Zhang et al, 2009).
There are other risk factors in the
contamination of blood between patient and
health professional, for example needlestick
and sharp instrument injury. According to the
Centers for Disease Control and Prevention,
around 385 000 needlestick injures occur each
year in the US (Panlilio et al, 2004). In the UK
a survey conducted by the Royal College of
Nursing (RCN), which surveyed 4407 nurses,
reported that 48% had received needlestick
injuries from a needle or sharp instrument
that had been used on a patient (RCN, 2008).
In a survey conducted in 52 Iranian hospitals
involving 1555 nurses, almost 50% had
sustained at least one sharp injury (Askarian et
al, 2007). Shanks and al-Kalai (1995) reported
107 needlestick injuries in one hospital in
Saudi Arabia during a 4-year period, the
majority being among nurses (65%). Prüss-
Ustün et al (2005) reported the incidence of
infections that occured through percutaneous
injuries in 2000 were: approximately 16 000
cases of hepatitis C, 66 000 of hepatitis B
and 1000 of HIV among health professionals
worldwide. Safety for both patient and surgical
team is very important, and wearing double
gloves could provide a barrier against the
transmission of blood-borne pathogens.
In a retrospective cohort study Myers et
al (2008) analysed the blood and body fluid
exposure in operating rooms in different
surgical procedures.The sample size was 60 583
cases, and they reported 6.4 exposures per
1000 surgical procedures. However, increased
duration of surgery and more members in the
surgical team increased the rate of exposure.
In another prospective study, reported from
375 medical centres, with 13 041 blood and
body fluid exposures, needlestick injury
was the highest with a 72% incidence rate
(9396/13 041), and HIV status among the
patient population was 21% (2759/13 041)
(Venier et al, 2007).
During surgical procedures, the surgical
team can also transmit blood-borne pathogens
to their patients. Esteban et al (1996) provided
evidence that a cardiac surgeon with hepatitis
C may have transmitted the virus to his
patients; in the majority of cases through
glove perforation (6/222). Ross et al (2000)
and Perry et al (2006) support the idea that
blood-exposure risk is equal between patients
and health professionals. Mallolas et al (2006)
reported one case of transmission of HIV-1
from an obstetrician to a patient during a
caesarean section by accidental needlestick
injury during the surgery.
Wittmann et al (2009) evaluated the risk
of infection by needlestick injuries through
surgical gloves using an automated puncturing
device. The study measured if double gloves
reduced the risk of infection from needlestick
injury.The double gloves provided a significant
reduction in the transferred volume of blood
(0.028  µL) to surgical teams, compared with
single gloves (0.141  µL) when perforated by
needles. They recommended the use of double
gloves for all surgical procedures to minimise
the risk of infection.
Manson et al (1995) investigated the
resistance of gloves with one and two layers
by using a computer system. The finding was
that double gloves offered more resistance
than single gloves. Similarly, Krikorian et al
(2007), Lefebvre et al (2008) and Lönnroth
et al (2003) found that double gloves offered
better protection against blood and body fluids
from needle punctures compared with single
latex gloves.
Despite this large body of evidence, most
operating room staff and surgeons do not
use double gloves during surgery. In an
observational, multi-centre survey involving
260 operating staff in 20 French hospitals,
Tarantola et al (2006b) found that only 19%
of staff were using double gloves during
all surgical procedures. These studies provide
evidence to support the use of double gloves
for all procedures to protect surgical teams
from the possibility of cross infection.
Risk management
Despite demonstrating the effectiveness of
double gloves in reducing the risk of blood-
borne disease transmission, many health
professionals are not adopting this technique.
Moghimi et al (2009) reported that only
13% of 430 surgeons used double gloves, and
that their main reasons for not using them
were difficulty in hand movement (72%), and
© 2014 MA Healthcare Ltd
decreased hand sensation (43%). St Germaine
et al (2003) conducted questionnaires with
170 participants, 97 (57%) of whom did
not use double gloves. The most common
British Journal of Nursing, 2014, Vol 23, No 21

reason for this was decreased dexterity (78%)
discomfort (62%) and the habit of not using
double pairs (45%).
With protocols existing for double gloves
for all major obstetrical and gynaecological
procedures, Malhotra et al (2004) conducted
a study into 156 procedues, of which 32
were carried out with single gloves. The main
reason stated for not wearing double gloves
was that 56% of participants did not believe in
the added protection of double gloves. Others
complained of difficulty in tying surgical
knots, lack of dexterity (24%), and 20% found
that double gloves proved too tight. Fry et al
(2010) studied dexterity and tactile sensation
with double gloves and found that was no
significant difference in manual dexterity
and tactile sensitivity between double gloves
compared to single gloves, or no gloves.
Even if wearing double gloves were to
reduce hand sensation or dexterity, when
taking into account the risk of contamination,
the use of double gloves would appear
to be more beneficial than using single
gloves alone. However, it seems some health
professionals do not believe in the protection
provided by double gloves, and this may be
because of a lack of knowledge regarding
available evidence.
Recommendations
Based on the evidence gathered from this
literature review, to protect health professionals
and patients from transmission of blood-
borne infection, there is a need to raise
awareness about the protection and safety
double gloves offer. In addition, new policy
and protocol guidelines should incorporate
recommendations for the use of double gloves,
stating that:
■■ Double gloves must be worn in all surgical
procedures to reduce blood and body fluid
contamination
■■ Gloves should be changed frequently during
surgical procedures, at least every 2 hours
■■ To reduce the discomfort of wearing two
gloves, a larger size may be worn inside, and
the correct size outside.
Most professional organisations are
supportive of the use of two pairs of surgical
gloves during surgery for scrubbed team
members and require that gloves are changed
every 90–150  minutes during a surgical
procedure. These organisations include: The
Association of PeriOperative Registered
© 2014 MA Healthcare Ltd
Nurses (AORN) (2012), the Association for
Perioperative Practice (AfPP) (2011), and
the Australian College of Operating Room
Nurses (ACORN) (2012).
British Journal of Nursing, 2014, Vol 23, No 21
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KEY POINTS
n During surgery there is an increased risk of exposure to blood and body fluid. As a result,
pathogens can be transferred between the patient and surgical team
n Glove perforation can lead to direct contract between health professional and patient, which
could result in transmission of infection
n Double gloving can provide additional protection for both the patient and surgical team
n Wearing double gloves can reduce the risk of surgical-site infections, but further research is
needed into this area
Additionally, in case of pandemic influenza,
the World Health Organization (2007)
recommended the use of double gloves
in order to enhance protection for health
professionals and patients.
Evidence supporting the use of glove
practices must be updated every 3–4 years. In
addition any further study should use a robust
research design, such as RCTs, and should
measure rates of SSIs.
Conclusion
It is important to identify the sources of risk
factors to establish safe practice guidelines.
Identifying the risk factors associated with
blood-borne infection requires the provision
of guidelines and policies. Wearing double
gloves has a proven record of reducing contact
with blood and body fluids through glove
perforation. The risk of SSIs may also be
minimised through the practice of wearing
double gloves, although direct evidence for
this is yet to be established. Knowledge and
understanding of the risk of exposure to
blood-borne infection can increase awareness
among health professionals, and motivate them
to change their attitudes and practices. Nurse
leaders play an important role in effecting
change with appropriate plans for change
management, along with an emphasis on the
seriousness of the problem. The evidence
linking bacterial contamination of the
surgical wound and the practice of single
or double glove use is lacking in statistical
power and additional research is required.
At an institutional level, a new evidence-
based strategy to improve awareness among
health professionals that promotes the practice
of wearing double gloves during surgical
procedures is required. This can be done
through continuing education workshops,
conferences and educational materials such as
informational handouts. Although the chance
of transmission of blood-borne pathogens
from the surgical team to the patient is rare,
CLINICAL FOCUS
health professionals must take precautions to
protect their patients and themselves. BJN
Conflict of interest: none
For a summary of the methods and results of the
studies considered in this systematic review, please
contact the editor.
Al-Maiyah M, Bajwa A, Mackenney P et al (2005)
Glove perforation and contamination in primary total
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