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Meta-Analysis
. 2014 Mar 7;2014(3):CD009573.
doi: 10.1002/14651858.CD009573.pub2.

Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel

Christina Mischke  1 , Jos H Verbeek, Annika Saarto, Marie-Claude Lavoie, Manisha Pahwa, Sharea Ijaz
Affiliations
Meta-Analysis

Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel

Christina Mischke et al. Cochrane Database Syst Rev. .

Abstract

Background: Healthcare workers are at risk of acquiring viral diseases such as hepatitis B, hepatitis C and HIV through exposure to contaminated blood and body fluids at work. Most often infection occurs when a healthcare worker inadvertently punctures the skin of their hand with a sharp implement that has been used in the treatment of an infected patient, thus bringing the patient's blood into contact with their own. Such occurrences are commonly known as percutaneous exposure incidents.

Objectives: To determine the benefits and harms of extra gloves for preventing percutaneous exposure incidents among healthcare workers versus no intervention or alternative interventions.

Search methods: We searched CENTRAL, MEDLINE, EMBASE, NHSEED, Science Citation Index Expanded, CINAHL, NIOSHTIC, CISDOC, PsycINFO and LILACS until 26 June 2013.

Selection criteria: Randomised controlled trials (RCTs) with healthcare workers as the majority of participants, extra gloves or special types of gloves as the intervention, and exposure to blood or bodily fluids as the outcome.

Data collection and analysis: Two authors independently assessed study eligibility and risk of bias, and extracted data. We performed meta-analyses for seven different comparisons.

Main results: We found 34 RCTs that included 6890 person-operations as participating units and reported on 46 intervention-control group comparisons. We grouped interventions as follows: increased layers of standard gloves, gloves manufactured with special protective materials or thicker gloves, and gloves with puncture indicator systems. Indicator gloves show a coloured spot when they are perforated. Participants were surgeons in all studies and they used at least one pair of standard gloves as the control intervention. Twenty-seven studies also included other surgical staff (e.g. nurses). All but one study used perforations in gloves as an indication of exposure. The median control group rate was 18.5 perforations per 100 person-operations. Seven studies reported blood stains on the skin and two studies reported self reported needlestick injuries. Six studies reported dexterity as visual analogue scale scores for the comparison double versus single gloves, 13 studies reported outer glove perforations. We judged the included studies to have a moderate to high risk of bias.We found moderate-quality evidence that double gloves compared to single gloves reduce the risk of glove perforation (rate ratio (RR) 0.29, 95% confidence interval (CI) 0.23 to 0.37) and the risk of blood stains on the skin (RR 0.35, 95% CI 0.17 to 0.70). Two studies with a high risk of bias also reported the effect of double compared to single gloves on needlestick injuries (RR 0.58, 95% CI 0.21 to 1.62).We found low-quality evidence in one small study that the use of three gloves compared to two gloves reduces the risk of perforation further (RR 0.03, 95% CI 0.00 to 0.52). There was similar low-quality evidence that the use of one fabric glove over one normal glove reduces perforations compared to two normal gloves (RR 0.24, 95% CI 0.06 to 0.93). There was moderate-quality evidence that this effect was similar for the use of one special material glove between two normal material gloves. Thicker gloves did not perform better than thinner gloves.There was moderate to low-quality evidence in two studies that an indicator system does not reduce the total number of perforations during an operation even though it reduces the number of perforations per glove used.There was moderate-quality evidence that double gloves have a similar number of outer glove perforations as single gloves, indicating that there is no loss of dexterity with double gloves (RR 1.10, 95% CI 0.93 to 1.31).

Authors' conclusions: There is moderate-quality evidence that double gloving compared to single gloving during surgery reduces perforations and blood stains on the skin, indicating a decrease in percutaneous exposure incidents. There is low-quality evidence that triple gloving and the use of special gloves can further reduce the risk of glove perforations compared to double gloving with normal material gloves. The preventive effect of double gloves on percutaneous exposure incidents in surgery does not need further research. Further studies are needed to evaluate the effectiveness and cost-effectiveness of special material gloves and triple gloves, and of gloves in other occupational groups.

PubMed Disclaimer

Conflict of interest statement

Christina Mischke none known.

Jos H Verbeek none known.

Annika Saarto none known.

Marie‐Claude Lavoie none known.

Manisha Pahwa none known.

Sharea Ijaz none known.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
4
4
Funnel plot of comparison: 1 Double versus single, outcome: 1.3 Inner glove perforations
1.1
1.1. Analysis
Comparison 1 Double versus single gloves, Outcome 1 Inner glove perforations.
1.2
1.2. Analysis
Comparison 1 Double versus single gloves, Outcome 2 Matched inner glove perforations.
1.3
1.3. Analysis
Comparison 1 Double versus single gloves, Outcome 3 Needlestick injuries.
1.4
1.4. Analysis
Comparison 1 Double versus single gloves, Outcome 4 Incidences of blood contamination.
1.6
1.6. Analysis
Comparison 1 Double versus single gloves, Outcome 6 Dexterity: outer glove perforations.
2.1
2.1. Analysis
Comparison 2 Triple versus double gloves, Outcome 1 Inner glove perforations.
3.1
3.1. Analysis
Comparison 3 Double special versus double normal, Outcome 1 Inner glove perforations.
4.1
4.1. Analysis
Comparison 4 Triple special versus double normal, Outcome 1 Inner glove perforations.
5.1
5.1. Analysis
Comparison 5 Thicker versus thinner, Outcome 1 Inner glove perforations.
5.2
5.2. Analysis
Comparison 5 Thicker versus thinner, Outcome 2 Matched perforations.
6.1
6.1. Analysis
Comparison 6 Thick versus glove combinations, Outcome 1 Inner glove perforations.
7.1
7.1. Analysis
Comparison 7 Double indicator versus standard, Outcome 1 First glove: inner perforations.
7.2
7.2. Analysis
Comparison 7 Double indicator versus standard, Outcome 2 First glove: matched perforations.
7.3
7.3. Analysis
Comparison 7 Double indicator versus standard, Outcome 3 All used gloves: inner glove perforations.
8.1
8.1. Analysis
Comparison 8 Subgroup analysis: prevalence, double versus single, Outcome 1 Inner glove perforations.
9.1
9.1. Analysis
Comparison 9 Subgroup analysis: income of countries, double versus single, Outcome 1 Inner glove perforations.
10.1
10.1. Analysis
Comparison 10 Subgroup analysis: exposure, double versus single, Outcome 1 Inner glove perforations.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD009573

References

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Brunton 2000 {published data only}
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