Double-gloving to Reduce Cross-infection in Surgery

The invasive nature of surgery and its exposure to blood means that there is a high risk of transfer of pathogens. Both the patient and the surgical team need to be protected. This risk can be reduced by implementing protective barriers such as the use of surgical gloves. Wearing two pairs of surgical gloves, as opposed to one pair, is considered to provide an additional barrier and further reduce the risk of contamination. This Cochrane Review examined randomised controlled trials (RCT) involving single-gloving, double-gloving, glove liners or coloured puncture indicator systems.

Of the 18 RCT included, nine trials compared the use of single latex gloves with the use of double latex gloves (double gloving). Further, one trial compared single latex orthopaedic gloves (thicker than standard latex gloves) with double latex gloves;three other trials compared double latex gloves with the use of double latex indicator gloves (coloured latex gloves worn underneath latex gloves). Two more studies investigated double latex gloves versus double latex gloves worn with liners(an insert worn between two pairs of latex gloves), and another two trials compared the use of double latex gloves and the use of latex inner gloves worn with cloth outer gloves.Finally, one trial looked at double latex gloves compared with latex inner gloves worn with steel-weave outer gloves. The latter study showed no reduction in the number of perforations to the innermost glove when wearing a steel-weave outerglove.

The reviewers found evidence that in low-risk surgical specialties the wearing of two pairs of latex gloves significantly reduced the number of perforations to the innermost glove. Wearing two pairs of latex gloves also did not cause the glove-wearer to sustain more perforations to their outermost glove. Wearing double latex indicator gloves enables the glove wearer to detect perforations to the outermost glove more easily than when wearing double latex gloves. Nevertheless,using the double latex indicator system does not assist the detection of perforations to the innermost glove, nor reduce the number of perforations to either the outermost or the innermost glove.

Wearing a glove liner between two pairs of latex gloves when undertaking joint replacement surgery significantly reduces the number of perforations to the innermost glove, compared with the use of just double latex gloves. Likewise, wearing cloth outer gloves when carrying out joint replacement surgery significantly reduces the number of perforations to the innermost glove, again compared with wearing double latex gloves. Wearing steel-weave outer gloves to undertake joint replacement surgery, however, does not reduce the number of perforations to innermost gloves compared with double latex gloves.