Critical investigation of glove-gown interface barrier performance in simulated surgical settings

Abstract

The barrier properties of personal protective equipment are vital to healthcare personnel to protect themselves from possible infectious body fluids. Intraoperative exposure of healthcare personnel to body fluids can be substantial in both inpatient and outpatient settings. The glove-gown interface is known as one of the weakest points of the whole personal protective equipment system. However, there is a lack of scientific research designed to investigate the problem. This paper reports the results of experiments using a new testing methodology developed to quantify fluid leakage through the glove-gown interface while simulating surgical settings in terms of operating room personnel activities, exposure types, exposure durations, and physical stresses applied on the interface. This study represents one of the first efforts investigating the amount of fluid leakage through the glove-gown interface for a number of surgical gown and glove models while considering glove material differences and single vs. double gloving. The test results showed that there is a significant difference in fluid leakage amounts between three gown models and four glove models studied. The results also demonstrated that double gloving significantly reduced the fluid leakage compared to single glove use. The mean fluid leakage was lower in the double synthetic glove configurations (M = 2.76g) compared with all other configurations (3GLV, M = 8.3g; 4GLV, M = 9.49g; 5GLV, M = 3.08g; 6GLV, M = 20.03g; double latex, M = 5.22g). Findings highlighted a significant interaction between glove and gown designs, which suggests that gown and gloves should be designed together as a system to minimize or eliminate the fluid leakage.

Keywords: Glove; gown; interface; penetration; personal protective equipment; surgical settings.

Figure 1.

The sketched area is the interface between glove and gown. The channels formed underneath the glove cuff.

Figure 2.

Gown sleeve and cuff designs and dimensions. *A, C, and E are the circumference measurements at marked locations. B = 6 inches for all gown models and it is the end point for the surgical glove when donned. The best fitting gowns were selected for robotic arm as x-large for 8G and large for 7G and 9G.

Figure 3.

The physical properties of surgical gloves. 4GLV is recommended to use as inner-glove with 3GLV and 6GLV is with 5GLV by the manufacturer.

Figure 4:

Mean fluid leakage by surgical glove configuration and surgical gown model. The error bars represent the 95% confidence interval of the mean. The mean fluid leakage was derived and examined from 10 experiments for each of the three surgical gown models within each of the six glove configurations resulting in a total of 180 experiments.