Double Gloving: Is it Necessary?
In the healthcare setting, every act of donning on medical gloves carries with it the faith and assurance by the wearer of its protective function. That trust is then reciprocated by years of expert glove manufacturing and technology ensuring that the medical gloves will live up to its optimal potential. What most people don’t know is that although most gloves live up to its promise, a number of medical gloves, including exam gloves and surgical gloves fall short of what is expected of them. In a recent study by Thomas, et.al. (2001), a minor percentage (3.75%) of the exam gloves delivered to hospitals had small perforations already present in them. This entailed a 7.5% chance that healthcare practitioners, especially those in contact with blood and secretions, may be contaminated. Some institutions acknowledged this risk by employing a method that to some is deemed as unnecessary, double gloving. Even The Center for Disease Control contested to its use as there is not enough evidence to prove of its usage. At the end of the day, we find many healthcare workers practicing the method of double gloving.
Double gloving is being employed in some institutions especially in operating rooms where procedures take more than an hour. Some healthcare facilities use double gloving especially when dealing with infectious material such as blood and body secretions. It’s even mandatory in some centers to use double gloving when handling patients with known infectious diseases that can be transmitted through blood and body fluids such as Hepatitis B and HIV. The mantra, better safe than sorry, prevails when it comes to safety. The Center for Disease Control had an estimated 500-600 healthcare practitioners that are hospitalized yearly due to hospital acquired infection from Hepatitis B with a mortality of more than 200 from liver cirrhosis and 40-50 from cancer of the liver (Mead,1989). By employing double gloving, the infection rate was shown to drop to 0.14% (Paulssen et.al, 1988).
The effectiveness of double gloving was reaffirmed in a recent study where it was employed in an operating room setting. After the operation, 83.3% had perforations in their outer medical gloves that went unnoticed and 82% of these had the inner glove to serve as the barrier from contamination. Only four subjects had inner glove perforation (Thomas et.al, 2001). When compared to those who only employed single gloving, subjects who wore double gloves had a lower incidence of apparent skin contamination. Although this study focused on medical gloves used in an operating room setting, we can conclude that double gloving with exam gloves can also provide additional barrier protection from perforations. More often than not, healthcare practitioners are unaware of small cuts and abrasions even while medical gloves are worn making them vulnerable in acquiring infection. Couple that with the possibility of using defective gloves, the risks of being infected from healthcare acquired infections is much higher than expected (Bennett, Duff, 1991).
It is important to recognize that medical gloves, though flexible and resistant, are not impenetrable. It is not uncommon for breaks to happen especially when nurses handle sharp objects resulting in needlestick injuries. In a 1964 study, Cole and Bernard stated that as many as 18,900 Staphylococcus aureus can pass through a minute-long perforation from a needle. According to Thomas, et.al (2001), when this happens, any tasks related to the disinfection process prior to gloving is neutralized which results in another trip being made to the scrubbing area.
If there are clear safety benefits to double gloving, you may be asking why this is not a universal practice in all healthcare facilities. One concern in double gloving is the loss of functionality in terms of ease and dexterity as compared to single gloving. By double gloving, the thickness of the medical glove is twice as thick. Certain tasks simply become more difficult for healthcare practitioners. This is not to say that double gloving is completely uncomfortable. In the same study by Thomas, et.al (2001), 62.2% of the subjects felt comfortable using double gloves and only 28.8% felt tightness and 9% felt looseness. This study showed that the functionality of double gloving is satisfactory in 63.6% of the cases even while 36.4% felt the loss of tactile sensation compared to single gloving.
With all this in mind, the benefits of double gloving particularly in surgery as well as in environments where handling infectious material is indisputable. All medical gloves are designed to protect you from bloodborne pathogens even if you not double gloving. If you are asking whether you should be double gloving vs single gloving, it’s up to you. At the end of the day, double gloving is not necessary, but it doesn’t hurt. If you are dealing with high-risk fluids, ease your mind and double glove… I probably would.