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Infection Control
Does a Double Layer of Surgical Gloves Enhance Infection Control Measures?
a report by
Denise M Korniewicz, PhD, RN, FAAN
Professor and Senior Associate Dean for Research, School of Nursing and Health Studies, University of Miami, and
Professor, Department of Epidemiology, Miller School of Medicine, University of Miami
Infection control measures within the operating room (OR) include annually over a 30-year period and injures him- or herself once every 40
conditions associated with the physical environment, healthcare workers cases in a community with an HIV prevalence of one in 100, the cumulative
(HCWs), equipment cleaning, HCW training, and surveillance of surgical site risk of infection is one in 100.
5
With an HIV prevalence of 10%, the
infections (SSIs). Often, the OR environment has been made into a cumulative risk of infection is one in five.
6
Currently, more than 5,000 HCWs
complicated maze in order to promote infection control and monitor all of are infected with HBV each year from the patients they treat, and about 250
the issues associated with the surveillance of infectious disease outbreaks. of these die from liver failure, cirrhosis, or cancer. Approximately 30% of—
However, the recent guidelines from the Centers for Disease Control and mostly senior—surgeons are not vaccinated against HBV and therefore are
Prevention (CDC)
1
for tracking SSIs and the 1991 recommendations of the susceptible to infection with this virus.
6
National Institute of Occupational Health and Safety (NIOSH)
2
for enhancing
HCW protection mean that most infection control practitioners (ICPs) have The hand is the most common site of injury and blood contamination
the ability to promote safe and effective OR environments with few risks of among OR personnel. Gloves prevent the transmission of pathogens from
associated infections for either patients or HCWs. patient to surgeon, and many studies have measured glove leak rates and
skin–blood contact rates. However, to date there are no data that measure
The most important task for ICPs during surgery is to control the risk the protection afforded by gloves in terms of actual disease prevention.
of HCW exposure to bloodborne pathogens such as hepatitis B or C virus Since infections are transmitted from patients to HCWs and also vice versa,
(HBV, HCV) and HIV, as HCWs who work in the OR continue to be at the the likelihood of transmission depends on the nature of the injury during
highest risk because they are prone to needlestick injuries, cross- the operative procedure: it is important to note that this depends on the
contamination with infectious agents, and injuries associated with ‘infectivity’ of the bloodborne virus, the frequency at which the injuries
equipment failure; also, due to the nature of surgery, there is a high risk of occur, and the rate of infection between patient and HCW groups.
transfer of bloodborne pathogens from direct contact between the patient
and the surgical team, contact among various surgical team members, or Double-gloving Practices
contact with contaminated instruments or equipment. All of these scenarios OR personnel continue to demand better or improved protective gear such
increase the occupational risk to HCWs and have an impact on the safety of as gowns, gloves, and masks because of their increased risk of exposure to
HCWs and patients undergoing surgery. bloodborne pathogens. It has been demonstrated that the risk of
contamination from bloodborne pathogen exposure is decreased by 70%
Risk of Injury to Healthcare Workers when using two pairs of gloves.
7
Furthermore, the use of double gloves may
Current World Health Organization (WHO) statistics show that “among the reduce SSIs during the intra-operative phase because of the reduction of
35 million health workers worldwide, about three million receive needlestick injuries that perforate the inner gloves.
8
The use of double-
percutaneous exposures to bloodborne pathogens each year; two million of gloving as a mechanism for managing the potential risk of exposure to
those to HBV, 0.9 million to HCV, and 170,000 to HIV.”
3
The risk of infection needlestick/sharp injury or cross-contamination during surgery has been
to HCWs following a hollow-needlestick injury is about 30% for HBV, 10% documented to range from 70 to 78%. One study reported by Florman et
for HCV, and 0.3% for HIV.
4
For a surgeon who operates on 350 cases al.
9
noted that for every 10 minutes of surgery the risk of breach increases by
1.1%, while McDaniel et al.
10
reported a 51% hand contamination rate for
those who single-gloved compared with 7% for those who double-gloved.
Denise M Korniewicz, PhD, RN, FAAN, is a Professor and Senior
Associate Dean for Research at the University of Miami School
of Nursing and Health Studies and School of Medicine, The majority of double-gloving studies among surgeons have demonstrated a
Department of Epidemiology. Her chief areas of expertise and
lower frequency of inner-glove perforation and visible blood on the surgeon’s
responsibility include research, grant development, graduate
student mentoring, and assistance to medical device companies
hands when double-gloves are worn; however, factors associated with
in the development of patient safety equipment. She is a Fellow contamination to the surgical field, rate of needlestick/sharp injury, and
of the American Academy of Nursing (AAN) and has been
perception of risk associated with bloodborne pathogens has not been clearly
the recipient of several national and international awards.
Dr Korniewicz is the author or co-author of over 75 books and scientific journal articles, and
investigated.
11,12
Much of the research into surgical gloves has focused on holes
conducts research into infection control and evidence-based practice related to patient safety. created during surgery. One report cites a puncture rate of 11.5% after use
during surgery,
13
while other studies point to increased puncture rates in gloves
worn for more than three hours;
14
it will be no surprise to peri-operative
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