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Meta-Analysis
. 2006 Jul 19;2006(3):CD003087.
doi: 10.1002/14651858.CD003087.pub2.

Double gloving to reduce surgical cross-infection

J Tanner  1 , H Parkinson
Affiliations
Meta-Analysis

Double gloving to reduce surgical cross-infection

J Tanner et al. Cochrane Database Syst Rev. .

Abstract

Background: The invasive nature of surgery, with its increased exposure to blood, means that during surgery there is a high risk of transfer of pathogens. Pathogens can be transferred through contact between surgical patients and the surgical team, resulting in post-operative or blood borne infections in patients or blood borne infections in the surgical team. Both patients and the surgical team need to be protected from this risk. This risk can be reduced by implementing protective barriers such as wearing surgical gloves. Wearing two pairs of surgical gloves, triple gloves, glove liners or cloth outer gloves, as opposed to one pair, is considered to provide an additional barrier and further reduce the risk of contamination.

Objectives: The primary objective of this review was to determine if additional glove protection reduces the number of surgical site or blood borne infections in patients or the surgical team. The secondary objective was to determine if additional glove protection reduces the number of perforations to the innermost pair of surgical gloves. The innermost gloves (next to skin) compared with the outermost gloves are considered to be the last barrier between the patient and the surgical team.

Search strategy: We searched the Cochrane Wounds Group Specialised Register (January 2006), and the Cochrane Central Register of Controlled Trials (CENTRAL)(The Cochrane Library Issue 4, 2005). We also contacted glove manufacturing companies and professional organisations.

Selection criteria: Randomised controlled trials involving: single gloving, double gloving, triple gloving, glove liners, knitted outer gloves, steel weave outer gloves and perforation indicator systems.

Data collection and analysis: Both authors independently assessed the relevance and quality of each trial. Data was extracted by one author and cross checked for accuracy by the second author.

Main results: Two trials were found which addressed the primary outcome, namely, surgical site infections in patients. Both trials reported no infections. Thirty one randomised controlled trials measuring glove perforations were identified and included in the review. Fourteen trials of double gloving (wearing two pairs of surgical latex gloves) were pooled and showed that there were significantly more perforations to the single glove than the innermost of the double gloves (OR 4.10, 95% CI 3.30 to 5.09). Eight trials of indicator gloves (coloured latex gloves worn underneath latex gloves to more rapidly alert the team to perforations) showed that significantly fewer perforations were detected with single gloves compared with indicator gloves (OR 0.10, 95% CI 0.06 to 0.16) or with standard double glove compared with indicator gloves (OR 0.08, 95% CI 0.04 to 0.17). Two trials of glove liners (a glove knitted with cloth or polymers worn between two pairs of latex gloves)(OR 26.36, 95% CI 7.91 to 87.82), three trials of knitted gloves (knitted glove worn on top of latex surgical gloves)(OR 5.76, 95% CI 3.25 to 10.20) and one trial of triple gloving (three pairs of latex surgical gloves)(OR 69.41, 95% CI 3.89 to 1239.18) all compared with standard double gloves, showed there were significantly more perforations to the innermost glove of a standard double glove in all comparisons.

Authors' conclusions: There is no direct evidence that additional glove protection worn by the surgical team reduces surgical site infections in patients, however the review has insufficient power for this outcome. The addition of a second pair of surgical gloves significantly reduces perforations to innermost gloves. Triple gloving, knitted outer gloves and glove liners also significantly reduce perforations to the innermost glove. Perforation indicator systems results in significantly more innermost glove perforations being detected during surgery.

PubMed Disclaimer

Conflict of interest statement

JT and HP received payment from Regent Medical for disseminating the findings of the original version of this review. JT was involved in one of the studies included in this updated review.

Figures

1.1
1.1. Analysis
Comparison 1 Single gloves versus double gloves ‐ innermost, Outcome 1 Number of perforations in innermost gloves.
2.1
2.1. Analysis
Comparison 2 Single gloves versus double gloves ‐ outermost, Outcome 1 Number of perforations in outermost gloves.
3.1
3.1. Analysis
Comparison 3 Single gloves versus indicator systems ‐ proportion of perforations detected during surgery, Outcome 1 Proportion of perforations detected during surgery.
4.1
4.1. Analysis
Comparison 4 Double gloves versus indicator glove ‐ innermost, Outcome 1 Number of perforations in innermost gloves.
5.1
5.1. Analysis
Comparison 5 Double gloves versus indicator glove ‐ outermost, Outcome 1 Number of perforations in outermost gloves.
6.1
6.1. Analysis
Comparison 6 Double gloves versus indicator systems ‐ proportion of perforations detected during surgery, Outcome 1 Proportion of perforations detected during surgery.
7.1
7.1. Analysis
Comparison 7 Double gloves versus double plus liner glove ‐ innermost, Outcome 1 Number of perforations to innermost gloves.
8.1
8.1. Analysis
Comparison 8 Double gloves versus double plus liner glove ‐ outermost, Outcome 1 Number of perforations to outermost gloves.
9.1
9.1. Analysis
Comparison 9 Double gloves versus latex plus knitted glove ‐ innermost, Outcome 1 Number of perforations to innermost gloves.
10.1
10.1. Analysis
Comparison 10 Double gloves versus latex plus steel weave glove ‐innermost, Outcome 1 Number of perforations to innermost gloves.
11.1
11.1. Analysis
Comparison 11 Double gloves versus triple gloves ‐ innermost, Outcome 1 Number of perforations to innermost gloves.
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References

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Novi 1993 {published data only}
    1. Novi JM, Peters AJ, Ghosh TK. Single versus double surgical gloving: a risk assessment. Infectious Diseases: Issues and Challenges in Obstetrics and Gynecology. 1993:31‐9.
Panduro 1996 {published data only}
    1. Panduro Baron JG, Gamboa R, Gaxiola Castro R, Acevedolopez JA. Surgical glove perforation in caesarian section. Ginecologia y Obstetricia de Mexico 1996;64:430‐4. - PubMed
Patton 1995 {published data only}
    1. Patton LL, Campbell TL, Evers SP. Prevalence of glove perforations during double gloving for dental procedures. General Dentistry 1995;43(1):22‐6. - PubMed
Phillips 1979 {published data only}
    1. Phillips AM, Birch NC, Ribbans WJ. Protective gloves for use in high‐risk patients: how much do they affect the dexterity of the surgeon. Annals of the Royal College of Surgeons of England 1997;79:124‐7. - PMC - PubMed
Plucknet 1992 {published data only}
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Quebbeman 1992 {published data only}
    1. Quebbeman EJ, Telford GL, Wadsworth K, Hubbard S, Goodman H, Gottlieb MS. Double gloving: Protecting surgeons from blood contamination in the operating room. Archives of Surgery 1992;127(2):213‐6. - PubMed
Rogers 2000 {published data only}
    1. Rogers B, Goodno L. Evaluation of interventions to prevent needlestick injuries in health care occupations. American Journal of Preventive Medicine 2000;18(4 Suppl):90‐8. - PubMed
Rose 1994a {published data only}
    1. Rose DA, Ramiro NZ, Perlman J, Schecter WP, Gerberding JC. Two gloves or not two gloves? Intraoperative glove utilisation at San Francisco General Hospital. Infection Control and Hospital Epidemiology 1994;15(45):37.
Rose 1994b {published data only}
    1. Rose DA, Ramiro N, Perlman J, Schecter WP, Gerberding JL. Usage patterns and perforation rates for 6396 gloves from intraoperative procedures at San Francisco General Hospital. Prevention of Transmissional Pathogens in Surgery and Obstetrics, Atlanta. 1994.
Salkin 1995 {published data only}
    1. Salkin JA, Stuchin SA, Kummer FJ, Reininger R. The effectiveness of cut‐proof glove liners: cut and puncture resistance, dexterity and sensibility. Orthopedics 1995;18(11):1067‐71. - PubMed
Savitz 1994 {published data only}
    1. Savitz SI, Lee LV, Goldstein HB. Investigations of the bacteriological factors on cervical disk surgery. The Mount Sinai Journal of Medicine 1994;61(3):272‐5. - PubMed
Schwimmer 1994 {published data only}
    1. Schwimmer A, Massoumi M. Efficacy of double gloving to prevent inner glove perforation during outpatient oral surgical procedures. Journal of the American Dental Association 125;2:196‐8. - PubMed
Tokars 1994 {published data only}
    1. Tokars JI, Marcus R, Culver DH, Chmberland ME, McKibben PS, Bell DM. Glove use and blood hand contacts during surgical procedures. Conference on Prevention of Transmission of Bloodborne Pathogens in Surgery and Obstetrics, Atlanta. 1994.
Tokars 1995 {published data only}
    1. Tokars JI, Culver DH, Mendelson MH, Sloan EP, FarberBF, Flinger DJ, et al. Skin and mucous membrane contacts with blood during surgical procedures: risk and prevention. Infection Control and Hospital Epidemiology 1995;16(12):703‐11. - PubMed
Tomichan 2000 {published data only}
    1. Tomichan MC, Howell FR. Use of cut resistant glove liner in revision hip surgery. Annals of the Royal College of Surgeons of England 2000;82(1):43. - PMC - PubMed
Twomey 2003 {published data only}
    1. Twomey C. Double gloving: a risk reduction strategy. Joint Commision Journal on Quality and Safety 2003;29(7):369‐78. - PubMed
Upton 1993 {published data only}
    1. Upton LG, Barber MD. Double gloving and the incidence of perforations during specific oral and maxillofacial surgical procedures. Journal of Oral and Maxillofacial Surgery 1993;51(3):261‐3. - PubMed
Vaughan‐Lane 1993 {published data only}
    1. Vaughan Lane T, Shaw M, Newsom SWB. Punctures in surgical gloves. The Lancet 1993;432:8877. - PubMed
Watts 1994 {published data only}
    1. Watts D, Tassler PL, Dellon AL. The effects of double gloving on cutaneous sensibility, skin compliance and suture identification. Contemporary Orthopaedics 1994;29(6):407‐11.
Webb 1993 {published data only}
    1. Webb JM, Pentlow BD. Double gloving and surgical technique. Annals of the Royal College of Surgeons of England 1993;75(4):291‐2. - PMC - PubMed
Wigmore 1994 {published data only}
    1. Wigmore SJ, Rainey JB. Use of coloured undergloves to detect glove puncture. British Journal of Surgery 1994;81:1480. - PubMed
Williams 1997 {published data only}
    1. Williams RE. Natural rubber latex surgical gloves. Surgical Services Management 1997;3(3):44‐9.
Woods 1996 {published data only}
    1. Woods JA, Leslie LF, Drake DB, Edlich RF. Effect of puncture resistant surgical gloves, finger guards and glove liners on cutaneous sensibility and surgical psychomotor. Journal of Biomedical Materials Research 1996;33(1):47‐51. - PubMed
Wright 1993 {published data only}
    1. Wright KU, Moran CG, Briggs PJ. Glove perforation during hip arthroplasty. A randomised prospective study of a new taperpoint needle. Journal of Bone and Joint Surgery.British Volume 1993;75(6):918‐20. - PubMed
Zimmerman 1996 {published data only}
    1. Zimmerman C, Junghanns K. Use of a new perforation indication system in surgical routine. Hygiene Medicine 1996;21(9):486‐92.

References to studies awaiting assessment

Ganczak 2004 {published data only}
    1. Ganczak M, Bialecki P, Bohatyrewicz A. Double gloving in reducing the interoperative risk of blood borne pathogens. Chirurgia Narzadow Ruchu Ortopedia Polska 2004;69(4):249‐54. - PubMed
Gaujac 2007 {published data only}
    1. Gaujac C, Ceccheti MM, Yonezaki F, Garcia IR, Peres MP. Comparative analysis of 2 techniques of double‐gloving protection during arch bar placement for intermaxillary fixation. Journal of Oral and Maxillofacial Surgery 2007;65(10):1922‐5. - PubMed

Additional references

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