Twice the Protection

Of the safety measures surgeons tend to turn their masks up at, double gloving ranks up there with safety sharps and smoke evacuation. But surgeons have loosened their grip on refusing to don a second pair of gloves. While nearly one-third of the 165 respondents to last month's Outpatient Surgery online poll say their surgeons never (18%) or rarely (13%) double-glove, more than two-thirds of our respondents say their docs double-glove for some (34%), most (15%) or all (20%) cases.

Ramon Berguer, MD, FACS, remembers when needlesticks were considered an accepted occupational hazard in the OR. It's been many years since Dr. Berguer and others in the medical community started preaching the importance of double-gloving. By the early 2000s, the research showed the safety measure offered strong protection for healthcare workers against sharps injuries and the threat of bloodborne diseases like HIV and hepatitis. Still, it's taken a while to catch on.

Fast forward to 2019, and Dr. Berguer says he sees steady progress in the effort to get surgeons to double-glove, estimating that half of surgeons double-glove today.

"That might be slightly optimistic, but it tells me we've made progress." says Dr. Berguer, a general surgeon at Contra Costa Regional Medical Center and John Muir Medical Center, both located in California. Everyone wants to keep their staff protected against sharps injuries and unnecessary contact with patient bodily fluids, and double-gloving is a great place to start. Research indicates surgeons and first assistants suffer nearly 60% of the injuries that happen in the OR. Scrub nurses and scrub technicians are next, accounting for about 19% of OR injuries. Putting on a second pair of gloves is one of the simplest things your OR staff can do to stay safe. If you're not double-gloving, these OR safety experts make the case for you to start.

Janine Jagger, MPH, PhD, traces the movement to double-glove all the way back to the 1980s. A big takeaway from that era still endures: A single needlestick can change a healthcare worker's life forever.

The height of the HIV/AIDS epidemic put healthcare personnel in a perilous position, and that wasn't the only threat they faced. U.S. healthcare workers contracted about 12,000 hepatitis B cases annually at that time, says Dr. Jagger, professor emeritus of medicine at the University of Virginia School of Medicine and founder of the International Healthcare Worker Safety Center. Double-gloving was one of several safety measures that emerged from that period, and it's still protecting healthcare workers to this day, says Dr. Jagger. She says it's easy to lose sight of how far we've come, but the need to protect healthcare workers remains the same.

"Double-gloving was found not only to reduce contact with blood, but also to reduce needlestick injuries," says Dr. Jagger. "The suture needle has to go through 2 layers. It offers 2 layers of protection." The worries over infectious disease transmission in the OR have changed with time. In 2019, hepatitis C poses a big concern for healthcare workers, says Mary J. Ogg, MSN, RN, CNOR, senior perioperative practice specialist at AORN.

Dr. Jagger says there was a "wave of whining" that followed double-gloving and the other healthcare worker safety initiatives of the 1980s. Slowly, the changes started to take hold.

Dr. Berguer has similar memories of the response in the surgical community. "The initial reaction from many surgeons was that they didn't like it, that it changes my tactile sensation." But it's important to look at the big picture, he says.

Dr. Berguer says it can take surgeons a couple weeks to get acclimated to the feeling of wearing 2 gloves on each hand, but they do get used to it over time. Some surgical specialties, such as neurosurgery, may require finer suturing and a more delicate touch. Wearing a single pair of gloves makes sense for those cases.

"Whether you're doing general, orthopedics or plastics or all the other specialties that are out there, I think you can get used to it," says Dr. Berguer. "Just start double-gloving on cases where you don't think there's fine suturing involved. After a while you realize it doesn't really change what you're doing." Surgeons are creatures of habit, prioritizing repetition and consistency in everything they do. Once they get used to wearing 2 pairs of gloves, they usually won't go back, says Dr. Berguer.

"I've been wearing 2 gloves for a long time," he says. "Now there have been a couple of times where I've ended up with one pair of gloves, and I felt completely naked with a single pair of gloves."

Don't wait for a mistake

Most safety measures come with some degree of inconvenience, and that can be a blockade for change. Sometimes it takes an injury or an accident to take a closer look at safety.

Dr. Berguer remembers his initial response to wearing protective eyewear. He says it felt uncomfortable, and he wasn't thrilled about keeping his eyes covered. Then, he got sprayed in the eye with blood during a procedure and realized the merits of protective glasses. When it comes to double-gloving, the same process tends to play out.

"For a lot of people, a close call or a needlestick is what it takes for them to think, "Wow I wish I had double-gloved,'" says Dr. Berguer. "That's unfortunate, but that's the way humans often react to a sudden event."

Find your fit

It's natural for your surgeons and staff to feel uncomfortable when they first try to double-glove. "It does feel a little bit different," says Ms. Ogg. "I encourage people to try different combinations."

Your 2 pairs of gloves need not be the same size. Try out different size combinations, and you'll start to get a better sense of what works best for your team. If your facility changes glove manufacturers, you'll need to go through the process again.

"Give it a fair chance to get that right fit and get used to that fit," says Ms. Ogg.

You add another level of safety when you wear a colored pair of gloves underneath a standard pair of gloves, says Ms. Ogg.

"Wearing a colored glove underneath, as soon as you get even a tiny pin prick in your glove, it's very visible that you have it," says Ms. Ogg. "You know there's a breach in your glove."

A surgical approach

It's good to have policies that encourage double-gloving. But if you want to see a change at your facility, you'll need buy-in from your surgeons, says Dr. Jagger.

"If the surgeon doesn't want to do it, nobody in the operating room gets the benefit," says Dr. Jagger. "The surgeons are, for the most part, in control of all of the safety devices and protocols in the OR. If the surgeon doesn't want to double-glove, the surgeon won't double-glove."

Many times, wearing 2 gloves comes down to a personal choice. The good news is more and more surgeons, particularly younger ones, see double-gloving as an essential part of safety in the OR. As time goes on, Dr. Berguer expects the trend to continue.

"I think there's more acceptance now that we should use these safety measures in every case and not just the high-risk cases," says Dr. Berguer. OSM

Most safety measures come with some degree of inconvenience, and that can be a blockade for change. Sometimes it takes an injury or an accident to take a closer look at safety.

Dr. Berguer remembers his initial response to wearing protective eyewear. He says it felt uncomfortable, and he wasn't thrilled about keeping his eyes covered. Then, he got sprayed in the eye with blood during a procedure and realized the merits of protective glasses. When it comes to double-gloving, the same process tends to play out.

"For a lot of people, a close call or a needlestick is what it takes for them to think, "Wow I wish I had double-gloved,'" says Dr. Berguer. "That's unfortunate, but that's the way humans often react to a sudden event."

It's natural for your surgeons and staff to feel uncomfortable when they first try to double-glove. "It does feel a little bit different," says Ms. Ogg. "I encourage people to try different combinations."

Your 2 pairs of gloves need not be the same size. Try out different size combinations, and you'll start to get a better sense of what works best for your team. If your facility changes glove manufacturers, you'll need to go through the process again.

"Give it a fair chance to get that right fit and get used to that fit," says Ms. Ogg.

You add another level of safety when you wear a colored pair of gloves underneath a standard pair of gloves, says Ms. Ogg.

"Wearing a colored glove underneath, as soon as you get even a tiny pin prick in your glove, it's very visible that you have it," says Ms. Ogg. "You know there's a breach in your glove."