Double gloving reduces exposure risk to bloodborne pathogens

AORN Journal,  Sept, 2007  by Mary Ogg

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QUESTION: A nurse from a large metropolitan teaching hospital was hired recently to work in our OR. The new nurse said we should be double gloving to protect ourselves from hepatitis and HIV. Is this true? Does double gloving reduce our exposure risk to these bloodborne pathogens?

ANSWER: Double gloving has been shown to reduce the risk of exposure to bloodborne pathogens during surgical procedures. (1,2) In a study of glove perforation rates during orthopedic procedures, surgeons who wore a single set of gloves were 13 times more likely to experience a perforation and contamination than surgeons who wore a double set of gloves. (3) Furthermore, the likelihood of glove perforations increases with the length of the surgical procedure. (3)

Surgical team members wear sterile gloves to protect the patient from infection, but gloves also are an important barrier to decrease the risk of exposure and transfer of bloodborne pathogens, including hepatitis B, hepatitis C, and HIV, to surgical team members. (1,4)

A Cochrane Collaboration review of 20 clinical trials of single versus double gloving involved the surgical specialties of dental, obstetrics and gynecology, abdominal, plastic, gastrointestinal, general, arthroscopic, orthopedic, and vascular surgery. The review included trials of single gloving, double gloving with two pairs of latex gloves, and double gloving using an indicator system. An indicator system is defined as colored gloves worn under the outermost pair of gloves, enabling the perioperative team to detect a perforation more quickly. (1) Glove perforations were reduced when either two pairs of latex gloves or the perforation indicator system were used versus when a single pair of latex gloves was used. More perforations were detected with the indicator system. (1)

AORN's "Recommended practice for prevention of transmissible infections in the perioperative setting," advocate for the practice of double gloving during invasive procedures. (5) This position also is supported by the CDC, American Academy of Orthopedic Surgeons, and American College of Surgeons. (6-8)

The highest incidence of glove perforations occurs during procedures that involve bone, metal, and deep cavities and that last one hour or longer. (1) It is advisable to always double glove because the presence of bloodborne pathogens may be unknown. (9)

REFERENCES

(1.) Tanner J, Parkinson H. Double gloving to reduce surgical cross-infection. Cochrane Database Syst Rev. 2007:(2):CD003087. http://www.cochrane.org/re views/en/ab003087.html. Accessed July 3, 2007.

(2.) Thanni LO, Yinusa W. Incidence of glove failure during orthopedic operations and the protective effect of double gloves. J Natl Med Assoc. 2003;95 (12):1184-1188.

(3.) Laine T, Aarnio P. Glove perforation in orthopedic and trauma surgery. A comparison between single, double indicator gloving and double gloving with two regular gloves. J Bone Joint Surg BR. 2004; 86(6):898-900.

(4.) Centers for Disease Control and Prevention. Exposure to blood: what health-care personnel need to know. http://www.cdc.gov/ncidod/dhqp/pdf /bbp/Exp_to_Blood.pdf. Accessed July 3, 2007.

(5.) Recommended practices for prevention of transmissible infections in perioperative practice setting. In: Standards, Recommended Practices, and Guidelines. Denver, CO: AORN, Inc; 2007:707-717.

(6.) American Academy of Orthopedic Surgeons. Advisory statement--preventing the transmission of bloodbome pathogens, http://www.aaos.org/about /papers/advistmt/1018.asp. Accessed July 3, 2007.

(7.) Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR; Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999;20(4):250-278.

(8.) Berguer R, Heller PJ. Preventing sharps injuries in the operating room. J Am Coll Surg. 2004;199(3): 462-467.

(9.) Tanner J. Surgical gloves: perforation and protection. J Perioper Pract. 2006;16(3):148-152.

MARY OGG

RN, MSN, CNOR

PERIOPERATIVE NURSING SPECIALIST

AORN CENTER FOR NURSING PRACTICE

COPYRIGHT 2007 Association of Operating Room Nurses, Inc.
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