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Evid Based Nurs 10:18 doi:10.1136/ebn.10.1.18
  • Treatment

Review: double gloving during surgery prevents perforations of the inner glove, but its effect on infection is unknown


 
 Q Does double gloving during surgery prevent infection in patients or the surgical team and perforations of the inner glove?

METHODS

GraphicData sources:

Cochrane Wounds Group Specialised Register (includes searches of Medline, CINAHL, and EMBASE/Excerpta Medica) (January 2006), Cochrane Central Register of Controlled Trials (Issue 4, 2005), American Journal of Infection Control (1990–2000), conference proceedings, reference lists, glove manufacturing companies, and professional associations.

GraphicStudy selection and assessment:

randomised controlled trials (RCTs) that compared ⩾2 types of gloving systems worn by members of the surgical team in any surgical specialty. 31 RCTs met the selection criteria. Assessment of methodological quality was based on randomisation, allocation concealment, inclusion and exclusion criteria, baseline comparability of groups, blinded assessment, and power calculation.

GraphicOutcomes:

surgical site infection, blood borne infection in patients or surgical team, glove perforations detected by the wearer during surgery, and glove perforations detected at the end of surgery.

MAIN RESULTS

2 RCTs comparing double latex gloves with single latex gloves with a cloth outer glove (n = 50 patients) or with double latex gloves with a cloth liner (n = 75 patients) reported no surgical site infections in either group. No RCTs reported on blood borne infection. Double latex gloves were less likely than single latex gloves to have perforations in the inner glove (table) but not in the outer glove (13 RCTs, n = 8531 gloves). The wearer was more likely to detect perforations during surgery with double latex gloves with an indicator system (coloured inner glove) than with either single or standard double latex gloves (table), but inner and outer glove perforation rates were similar to those with standard double gloves (2 RCTs, n = 396 gloves). Compared with double latex gloves, systems with a single latex glove with a cloth outer glove, a cloth liner between 2 latex gloves, or triple latex gloves were less likely to have perforations in the inner glove (table). A single RCT (n = 223 gloves) showed no difference in inner glove perforation rate between a single latex glove with a steel weave outer glove and double latex gloves.

CONCLUSIONS

Double latex gloves reduce the risk of perforation to the inner glove compared with single gloves. Gloving systems involving cloth liners or outer gloves provide additional protection. Indicator systems enable wearers to more readily detect perforations during surgery. No evidence was found regarding the efficacy of double gloving to prevent infection.

Commentary

  1. Eileen M Scott, RGN, PhD
  1. University of Durham, Stockton-on-Tees, UK

      The well designed review by Tanner and Parkinson removes many uncertainties around “gloving” in the operating room and provides a synthesis of the evidence on which to base this important dimension of perioperative practice.

      The prevention of infection to ensure patient safety is a fundamental principle of perioperative practice and provides the rationale for the specialised design of operating suites with stringent environmental standards, restricted access, and specialised clothing. Infection control dictates the use of sterile instruments, and members of the operating team “scrubbing up” and wearing sterile gowns and gloves.

      In all procedures, there is a risk of glove puncture by blade or needle. In my experience, however, some operations, such as orthopaedic or dental procedures, carry a greater risk because of sharp, and sometimes very fine, bony fragments that result from drilling and sawing; such punctures may go unnoticed.

      Preventing surgical infection is a complex issue, and many variables should be taken into account. Research using wound infection as an outcome is difficult to perform because patient follow up must extend into the postoperative period. This barrier may explain why Tanner and Parkinson identified only 2 eligible RCTs that included infection as an outcome (secondary to their primary outcome of glove perforation). These studies also had poor quality. However, based on the principles of cross infection, it is reasonable to use glove perforation as a surrogate outcome.

      Further research on surgical gloving systems should include wound infection as a primary outcome. Also, as cost-benefit analyses were not included in the review, the economic implications could be investigated. Furthermore, given that most of the gloves tested were latex, research is needed to test the durability of latex free gloves, which are essential when allergies are present in either staff or patients.

      Comparisons of different types of latex gloving systems to prevent perforations during surgery*

      
 
 Q Does double gloving during surgery prevent infection in patients or the surgical team and perforations of the inner glove?

      Footnotes

      • For correspondence: Dr J Tanner, Derby City General Hospital, Derby, UK. judith.tanner{at}derbyhospitals.nhs.uk

      • Sources of funding: National Association of Theatre Nurses UK and Theatre Nurses Trust Fund UK.

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