What are the guidelines for double gloving (wearing two pairs of gloves) in medical procedures?

Guidelines for Double Gloving in Medical Procedures

Primary Recommendation

Double gloving should be routinely used in all high-risk surgical procedures, including major abdominal, trauma, fracture, burns, vascular, gynecological, and cardiovascular operations, as well as orthopaedic surgery when power tools are used, to significantly reduce the risk of hand contamination and percutaneous exposure to bloodborne pathogens. 1

When Double Gloving is Indicated

High-Risk Surgical Procedures

• Major abdominal surgery 1
• Trauma and fracture surgery 1
• Burns surgery 1
• Vascular surgery 1
• Gynecological surgery 1
• Cardiovascular operations 1
• Orthopaedic surgery involving power tools 1
• Emergency operations 1

High-Risk Patient Populations

• Patients with known or suspected HIV infection 1
• Patients with known or suspected hepatitis B virus infection 1
• All patients in areas of high HIV/hepatitis prevalence 1
• All emergency surgery patients in high-prevalence areas 1

Evidence Supporting Double Gloving Effectiveness

Protection Against Glove Perforations

Double gloving reduces the risk of innermost glove perforation by approximately 70-80% compared to single gloving (rate ratio 0.29,95% CI 0.23-0.37). 2 When the outer glove is perforated, the inner glove provides protection in 82-98.83% of cases. 3, 4

Protection Against Blood Contamination

Double gloving reduces blood stains on the skin by 65% (rate ratio 0.35,95% CI 0.17-0.70), with visible skin contamination occurring in only 22.7% of cases with double gloves versus 42.1% with single gloves. 3, 2

Undetected Perforations

An overwhelming 83.3% of glove perforations go unnoticed during surgery, making the protective barrier of double gloving critical even when surgeons are unaware of breaches. 3

Practical Implementation

Standard Double Gloving Technique

• Wear two pairs of standard latex gloves for routine high-risk procedures 5, 2
• Change gloves frequently if outer gloves become damaged 1
• No loss of dexterity occurs with double gloving, as outer glove perforation rates are similar between single and double gloves (rate ratio 1.10,95% CI 0.93-1.31) 2

Enhanced Protection Options

For particularly hazardous surgery, consider:

• Triple gloving (three pairs of latex gloves), which reduces perforation risk by 97% compared to double gloving (rate ratio 0.03,95% CI 0.00-0.52) 5, 2
• Fabric glove layer worn between two rubber gloves, which reduces perforations by 76% compared to standard double gloving (rate ratio 0.24,95% CI 0.06-0.93) 1, 5
• Glove liners between two pairs of latex gloves for joint replacement surgery, which significantly reduce innermost glove perforations 5
• Cloth outer gloves for joint replacement surgery, which significantly reduce innermost glove perforations 5

Indicator Glove Systems

Colored puncture indicator gloves (colored latex gloves worn underneath standard latex gloves) enable easier detection of outer glove perforations (rate ratio 8.64,95% CI 4.78-15.61) but do not reduce the total number of perforations or provide additional protection beyond standard double gloving. 5, 6 Use indicator systems when intraoperative detection of perforations is prioritized to allow timely glove changes. 6

Factors Associated with Higher Perforation Risk

Surgical Factors

• Deep or major surgery has higher perforation rates (16.0%) 4
• Longer surgical duration increases perforation risk 6
• Emergency operations have slightly higher rates (15.5%) versus elective surgery (14.3%) 4

Personnel Factors

• Registrars in training have the highest perforation rate (30.8%) 4
• Primary surgeons are more prone to perforations than assistants 6
• Index finger is the most common site of injury (42.1% of perforations) 4

Specialty-Specific Rates

• General surgery: 17.4% perforation rate 4
• Pediatric surgery: 14.6% perforation rate 4
• Urology: 13.9% perforation rate 4
• Neurosurgery: 11.7% perforation rate 4
• Plastic surgery: 10.6% perforation rate 4

Common Pitfalls to Avoid

Loss of sensitivity is not a valid concern for avoiding double gloving, as studies demonstrate no increase in outer glove perforations with double versus single gloves, indicating preserved dexterity. 1, 2 Double gloving is accepted by the majority of surgeons, especially with repeated use. 3

Do not reserve double gloving only for known high-risk patients, as screening tests are imperfect and many high-risk patients remain unidentified. 1 In areas of low HIV prevalence, the decision may be modified, but routine double gloving in high-risk procedures remains protective. 1

Steel weave gloves do not reduce innermost glove perforations compared to standard double latex gloves and should not be relied upon for enhanced protection. 5