Double gloving: A good idea just got easier to implement

There’s a long list of reasons why many nurses don’t double glove prior to a procedure or invasive examination. Yet most healthcare practitioners and safety leaders agree that double gloving is an effective practice. It’s time to put an end to this conundrum. Nurses General Nursing Article

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Not enough time, poor feel, poor fit, discomfort, and loss of agility are often cited as reasons nurses choose not to double glove. Yet most of us agree that double gloving is an effective practice in protecting against exposure to blood and bodily fluid transmission in the OR and/or ER.

The issue is similar to the American public's resistance to wearing seat belts. Most everyone agrees that seat belts save lives and reduce the severity of injuries. And today, approximately 90 percent of the population regularly use them, according the National Highway Safety Administration. But any nurse who has treated an automobile accident victim that wasn't wearing a seatbelt can tell you that number is still too low.

However, it's much better than the 15 percent of the population that used seat belts back in 1984. Mandatory use is one reason for the increase, but making these safety devices more comfortable and easier to use, plus public education about the benefits, has certainly helped. Another, more obvious reason for adaptation is the pinging noise one hears if one's seat belt isn't fastened.

Consider this article your "ping" regarding double gloving. It's a fact: studies indicate that double gloving reduces the risk of inner glove perforations by 71 percent over only single gloving.

Yes, it's tough to break old habits, but facts are facts. Personal protective equipment (PPE), properly used, provides the safeguards for which it is intended - keeping the worker and patient safe. It's time for double gloving to be a necessary practice, not only a convenience.

However, we also must take double gloving a step further. Simply donning two gloves doesn't completely address all safety risks. Accidents can still happen, and many existing glove options are not optimal for healthcare risks. A tear in an outer glove might not be seen if both gloves are the same color. That raises the risk of fluid exposure. In a busy OR environment, a nurse may not realize that one layer of protection is gone until it's too late. How can we make double gloving both easier to implement and effective?

PPE innovations are the answer to developing a double gloving system that provides the best protection possible. What if a pre-donned glove-in-glove system that uses proven, existing non-latex glove technology were available? Simply unwrap, one don, and you're done, eliminating the lag in donning time.

What if the outer and inner gloves were also pre-aligned at the fingertips? That would address comfort, agility and dexterity concerns.

And what if the outer and inner gloves come in different colors - say, a semi-transparent outer glove and a green inner glove? That would allow any tears to the outer glove to be readily visible.

And what if there is no "what if?" What if these types of gloves innovations were available today? The technology exists and is now commercially available. Would that change your mind about double gloving?

Innovations in glove formulation and packaging are also making double gloving more user and environmentally friendly. New gloves feature non-latex diphenylguanidine-free (DGP-free) and cetylpryidinium chloride-free (CPC) construction, eliminating the risk of Type I latex allergies and minimizing chemical Type IV allergies and skin sensitivities. Furthermore, new double gloving solutions that come pre-donned also allow two gloves to be packaged in one inner-wrap and one poly-pouch, reducing packaging by 50 percent and eliminating waste that would go into a landfill.

Double gloving is certainly not a new concept by any stretch. But stretching the thinking behind double gloving just made it a lot easier to do it the next time you need to don.

Edited by allnurses to add:

For information about the GAMMEX PI Glove-in-Glove System, go to the overview in the allnurses Product Directory.

Ansell said:
Many leading healthcare organizations support double gloving as an effective safety precaution, including the Association for periOperative Registered Nurses, the World Health Organization and the International College of Surgeons

My hospital also supports employees never calling out and no sugary snacks or drinks of any kind ever but that does not mean it is mandated . There is a big difference between those too.

Two pairs of gloves at all time would greatly impact patient care for the worse. I can't even imagine trying to start an IV with two pairs on let alone have the dexterity to give IV meds. I think hospitals and health care organizations have forgotten, in most situations, that the best line of defense in simple hand washing.

Of course I have worn two pairs of gloves for messy situations, however, when the mess is cleaned up, I like the take off the top pair and put in the trash so I have a clean pair underneath to finish the job without having to stop and put on another pair.

I already have to wear two pairs of thicker chemo gloves when I am giving chemo, and I can not even pick up a pen to write. When is it going to end, two pair, three pairs, metal gloves. This product frustrates me so.

0 Votes
Specializes in Critical Care.
Ansell said:
Many leading healthcare organizations support double gloving as an effective safety precaution, including the Association for periOperative Registered Nurses, the World Health Organization and the International College of Surgeons

Sorry but that's not correct. Neither of those organizations, nor any other organizations, "support double gloving as an effective safety precaution".

Those organizations do however support double gloving as an effective safety precaution while performing surgery. This does not apply to all the various situations where we wear gloves as your statement suggests, only to surgical procedures.

I would hope that if AN is allowing articles to be used for promotional purposes that they would prohibit intentionally misleading or false statements intended to sell their product.

1 Votes
Specializes in NICU.

Always for body fluids I have used double or triple gloves,as I approached the newly clean site I removed the dirtiest layer and continue like that until I am at a clean site with clean gloves or just switch gloves since they all have microscopic holes.

1 Votes
Ansell said:
Hi Adelinna,

The GAMMEX PI Glove-In-Glove system offers many benefits. Primarily, it provides dedicated breach detection notification. The two gloves are not combined; they are two individual gloves pre-donned and aligned at the finger tips, making the process of double gloving faster and easier. With the top glove being semi-transparent and the bottom glove being dark green, if the top glove is compromised, the wearer will immediately be able to see this breach and be able to promptly change their gloves. This is in addition to providing a thicker level of barrier protection as you alluded to, providing the protection of two gloves for improved patient and healthcare worker protection.

For more information, please visit ansell.com/gloveinglove.

Joe-

Thanks for the link to your website.

You have posted on a nursing website, advocating a change in practice.

What we really need to see is the evidence that we should change our practice. When should I double glove? Every time? When am I at risk using the currently accepted practices taught by nursing schools, and mandated by infection control policies?

Are schools and infection control departments behind on the current research?

I went to your website, and could not find the evidence that we, as nurses, should change our practice. I can understand how this product might benefit those who double glove for certain procedures. But, I saw no claims that there should be more double gloving happening.

But, your OP states "Yes, it's tough to break old habits, but facts are facts. Personal protective equipment (PPE), properly used, provides the safeguards for which it is intended - keeping the worker and patient safe. It's time for double gloving to be a necessary practice, not only a convenience."

So- please show the specifics of when and why. As you said, "fact are facts". Clearly facts are facts. So- what are the facts?

Two separate issues:

1- Double gloving is now a "necessary practice".

2- Your product is what should be purchased now that there is a new necessary practice.

For the sake of discussion, lets assume #2 is correct.

Please expound on #1.

BTW- I am pretty sure double gloving has never been a convenience.

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hherrn said:
Joe-

Thanks for the link to your website.

You have posted on a nursing website, advocating a change in practice.

What we really need to see is the evidence that we should change our practice. When should I double glove? Every time? When am I at risk using the currently accepted practices taught by nursing schools, and mandated by infection control policies?

Are schools and infection control departments behind on the current research?

I went to your website, and could not find the evidence that we, as nurses, should change our practice. I can understand how this product might benefit those who double glove for certain procedures. But, I saw no claims that there should be more double gloving happening.

But, your OP states "Yes, it's tough to break old habits, but facts are facts. Personal protective equipment (PPE), properly used, provides the safeguards for which it is intended - keeping the worker and patient safe. It's time for double gloving to be a necessary practice, not only a convenience."

So- please show the specifics of when and why. As you said, "fact are facts". Clearly facts are facts. So- what are the facts?

Two separate issues:

1- Double gloving is now a "necessary practice".

2- Your product is what should be purchased now that there is a new necessary practice.

For the sake of discussion, lets assume #2 is correct.

Please expound on #1.

BTW- I am pretty sure double gloving has never been a convenience.

I was going to reply but I can see you already did that for me! Thank you hherrn.

0 Votes
Fairlisa said:
I do not know anything about the new double gloves that are called GAMMEX PI, but state rules and guidelines in most states do not allow double gloving; except under special circumstances. As a bedside nurse, ICU, ER etcetera. You should never double glove unless directed by your immediate supervisor. It would be a policy violation. This is per State and Federal Guidelines. It will cause you to obtain an IJ or some might call it a tag or to be written up. I would only double glove if it was expressed as a policy by your facility on the floor that you work on. I have been doing travel nursing for the last 10 years so I have been in many states and numerous floors and in every orientation I have been told to NEVER double glove for any reason. I am a ER nurse so I deal with getting my gloves dirty very quickly and numerous times a shift. Please check with your facility about the exact policy before you don double gloves. Just an FYI. Thanks.

The intended audience is primarily those working in a procedure area / operating room staff.

I agree - most hospitals frown upon double gloving in MOST patient care areas. All three of the places I worked as a floor nurse or nurse's aide discouraged it.

However, in the OR, it's a bit different. I scrub. Handling instruments and implants (screws, other firm metal hardware) presents opportunities for a "break" in your gloves. Even if a "first layer" perforation occurs, double gloving allows you to notice it. Some people use a blue or green under glove - and those make it easier to notice when you have a hole. Not that it's impossible to notice if someone wears the same gloves (white on white). It is encouraged for our staff, and providers to double glove.

I have heard the sales pitch in person and tried the product - both in my preferred size and a sample size (I was at AORN this year). I found that these were not significantly easier to don than two pair of gloves independently. A coworker and I "played" with a sample we were sent and tried it as with each other as if we were gloving a resident or attending...this product does not seem to be that great for that. It seemed significantly more difficult to get the pre-layered gloves "wide" enough to easily allow others to slide their hands in.

It's not like you can reduce the amount of gloves on the shelf - you would need to have these gloves plus replacements for the outer gloves. Not only that - this only comes with specific types of gloves, and not all surgeons (or staff) prefer to wear those gloves. The package is, as expected, roughly twice as thick as a regular package and undoubtedly there are fewer per box.

Additionally, these gloves are pre-matched by size. Not everyone wears the same type of size gloves - not everyone follows the 0.5 size larger under glove than outer glove. Many people wear two of the same size or flip and wear smaller as the under and larger as the outer. This reduces flexibility of sizing to find an appropriate and workable fit. Even if the packages were customized - then what? Order a box per staff member or surgeon's size specifications? Because any hospital has an abundance of storage space for sterile supplies? Personally, I tried the half size larger on the under glove and that means I have way too much extra glove in the tip of my fingers making it near impossible to determine if I've developed a hole in my glove(s).

Anyhow, I'm sure someone will buy into this and switch their facility. I like the idea far more than I like the application at this time. There's nothing for me to use to sell for my facility - not a savings of space, not a truly easier option, nothing. Undoubtedly it's a higher cost...likely even considered that the cost per package should equal about two pair of gloves at a facility's current pricing contract.

1 Votes
Specializes in Nephrology, Cardiology, ER, ICU.

From the WHO:

Double gloving in countries with a high prevalence of HBV,

HCV and HIV for long surgical procedures (>30 minutes), for

procedures with contact with large amounts of blood or body

fluids, for some high-risk orthopaedic procedures, is considered

an appropriate practice.

http://www.who.int/gpsc/5may/Glove_Use_Information_Leaflet.pdf

From the Annals of Maxillo-Facial Surgery:

Double gloving technique using sterile gloves can be used as an effective means of infection control for all major and minor surgical procedures, especially high-risk procedures involving patients who maybe suffering from or carriers of blood-borne infections.

Efficacy of double gloving technique in major and minor oral surgical procedures: A prospective study

1 Votes
traumaRUs said:
From the WHO:

Double gloving in countries with a high prevalence of HBV,

HCV and HIV for long surgical procedures (>30 minutes), for

procedures with contact with large amounts of blood or body

fluids, for some high-risk orthopaedic procedures, is considered

an appropriate practice.

I don't think that anyone here has been arguing that double gloving for surgical procedures isn't recommended by various organizations. I think we all agree that it is. I just found the OP a bit vague on exactly when it's recommended to double glove. I would also like to see references for the stats presented by OP.

Here's a Cochrane Systematic Review from 2006.

Double gloving to reduce surgical cross-infection - Tanner - 26 - The Cochrane Library - Wiley Online Library

Authors' conclusions:

Quote
There is no direct evidence that additional glove protection worn by the surgical team reduces surgical site infections in patients, however the review has insufficient power for this outcome.

The addition of a second pair of surgical gloves significantly reduces perforations to innermost gloves. Triple gloving, knitted outer gloves and glove liners also significantly reduce perforations to the innermost glove.

Perforation indicator systems results in significantly more innermost glove perforations being detected during surgery.

Ansell said:
It's a fact: studies indicate that double gloving reduces the risk of inner glove perforations by 71 percent over only single gloving.

Hi OP. This is a prime example of something you'd need to support with evidence if you want to make a claim like this to a bunch of nurses. We're not trained to just accept any claim, quite the opposite really. We would appreciate seeing the supporting evidence. That way we can evaluate the study design and any weaknesses it might have. It is absolutely possible that your figures are accurate, but I still need to see the research that you base your claim on.

Also, the logical next question is the one that hhern brought up. I want to know what benefit a 71% reduction of inner glove perforations has for me and/or my patients. So I need to know, how often do inner gloves perforate? That way I can assess if the 71% reduction is meaningful. If the inner glove perforates once in a blue moon, then the benefit is obviously less, as opposed to if inner glove perforation happens once in every five surgeries.

I also want to know what the risk is to me and/or my patients on the occasions that the inner glove does perforate. Does an inner glove perforation mean that pathogens are indeed transferred between healthcare professionals and patients and if it is, how often does it happen. Is it 1:4 or 1:852 or 1:30,000? Do we know?

Only when we know how often inner gloves perforate and how often that perforation actually leads to transmission of blood/bodily fluids, is it possible to fully evaluate the risks to patients and healthcare professionals and the benefit of the 71% reduction.

Yes, I am somewhat giving you a hard time here. The fact is that my feathers do get a bit ruffled when I'm expected to just accept a statement at face value.

Ansell said:
And what if the outer and inner gloves come in different colors - say, a semi-transparent outer glove and a green inner glove? That would allow any tears to the outer glove to be readily visible.

I'm not in the U.S., but during my eleven years of nursing we've always used dark green or dark blue gloves as an inner glove and a semi-transparent outer glove. I'm sure that some people might find your product helpful as it removes the need to don the second glove, but personally I think having the ability to choose sizes on the inner and outer gloves respectively, is a good thing. I work in anesthesia so I don't normally double glove, but I have noticed that the surgeons and OR nurses I work with combine their inner and outer gloves differently sizewise.

1 Votes
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