Double Down on Double-Gloving Compliance

A little more than six years ago, Beki Kazanofski, MSN, RN, CNOR, NE-BC, was in the OR when a needle caught the very tip of her glove. “Thank god I was double-gloved, and I had that extra layer of protection, because the needle didn’t end up going through and puncturing my skin,” says Ms. Kazanofski. She’s currently an associate nursing officer at Vanderbilt Medical Center in Nashville, Tenn., but was working in orthopedics when she was nearly punctured.

Had she not been double-gloved, that needle could’ve very well pierced her skin and, even in a best-case scenario, Ms. Kazanofski would’ve faced a long and anxiety-inducing experience. For starters, she would’ve needed labs drawn for herself and her patient. Then, she’d need to spend hours worrying about the results of those labs and whether she’d been exposed to infectious fluids. Back when Ms. Kazanofski had her near-miss, the post-needlestick process was an intense one. “First you’d need to draw the patient’s blood to screen for HIV and hepatitis B and C, and then you’d need to write an order so that patient doesn’t get charged,” she says.

After that, says Ms. Kazanofski, the staff member would need to go to occupational health during regular hours, or the ER for after-hours sticks, and have their own labs drawn and be counseled on next steps, such as preemptive medication cocktails. “You’d be asked if you wanted to get started on a cocktail of meds in the event the patient has HIV because there’s only a window of time to stop the virus from entering and replicating in your body,” she says.

Obviously, it doesn’t take much to convince someone like Ms. Kazanofski that double-gloving should always be a priority. And thankfully, her facility has had a strong double-gloving policy in place for years based upon research and recommended guidelines. In fact, double-gloving is required for any surgical procedure in which providers make an incision and enter a body cavity. Scope cases, such as endoscopy and bronchoscopy procedures, don’t require staff to double-glove.

But for every staff member like Ms. Kazanofski, there’s a surgeon worried about losing crucial tactile feel and dexterity, or a facility administrator who can’t see how they could possibly manage the added cost of additional supplies of gloves. How do you convince these individuals that double-gloving should be a priority?

Kaylan Anderson, RN, BSN, administrator at Cedar Orthopaedic Surgery Center in Cedar City, Utah, believes the pros of double-gloving far outweigh the cons. “When it comes down to it, the negatives are time, cost and some loss of dexterity in the fingers,” he says. “Contrast those negatives to an injury to the caregiver, or patients and caregivers suffering infections, and there’s no comparison.”

While personal stories of near misses or serious needlestick injuries certainly work wonders when it comes to bolstering compliance and reducing complacency, Mr. Anderson says facilities should review all the current research and do everything in their power to avoid getting to that point in the first place. “Learn from others’ mistakes,” he says. “There are plenty of stories and guidelines that talk about near misses, so if you’re waiting until something like that happens to you, it’s too late.”

To prevent getting to the point where staff are experiencing sticks or cuts, Cedar Orthopaedic Surgery Center requires double-gloving for nearly all cases, and even triple gloving for its total joint cases. “We drape the patient, and then pull off the first set of gloves and still have two pairs on,” says Mr. Anderson.

The center’s staff members wear two sets of gloves that are not only different colors, but also different brands. “If the outer glove gets pierced, the color of the under-glove shows through, providing an indication to the wearer that it is time to swap out their gloves for a new set,” says Mr. Anderson.

If you’re looking to improve compliance and reduce pushback, Mr. Anderson stresses the importance of reaching a consensus about the type of products you use to double-glove. “Survey your staff and allow them to try on different gloves so they can share their opinion on which one they’d prefer,” he says, adding that the best way to get buy-in from staff is to provide them with sets of gloves that are easy to put on, aren’t too thick and don’t stick together when they’re taken off.

Ms. Kazanofski seconds this advice on getting staff involved in the trialing of double-gloving systems. She points out that change is often difficult and getting your nurses and other team members involved in helping to select the product they will use minimizes their discomfort with the process. “Sometimes people don’t like change, and they view it as just another thing they have to learn how to do,” she says. “But like everything else, once you get used to double-gloving and a few months go by, it becomes just like something you’ve always done.”

Another key component of double-gloving compliance is having a written policy in place. This is something that can help smooth out ambiguities or confusion about what’s expected of staff when it comes to when they’re expected to don two pairs of gloves. Mr. Anderson’s facility, for instance, is privately owned and operated, and policies, procedures and guidelines are put in place by the physician-owner, something that helps greatly with mandatory compliance. “We have a newer surgeon on staff, and having an established policy made it easy for them to get onboard with double-gloving,” he says.

Get the message across that double-gloving isn’t something you’re requiring to make their jobs more difficult. Remind staff that sticks do occur, and two gloves can protect them.
— Beki Kazanofski, MSN, RN, CNOR, NE-BC

Ms. Kazanofski stresses the importance of getting the message out about double-gloving clearly and in multiple formats, and cites confusion as a factor in pushback or non-compliance. For instance, when her facility first introduced its double-gloving policy, there was the faulty assumption that it would apply to each procedure. “I think initially the message got misinterpreted and staff were like, ‘Wait, I have to double-glove for everything?’” she says. “We then had to explain, ‘No, you only need to double-glove for these types of procedures.’”

To prevent miscommunication, your surgical leaders need to round, check on staff and make sure they understand why double-gloving is so important. “Get the message across that it’s not just something you’re doing to make their jobs more difficult,” says Ms. Kazanofski. “Remind staff that sticks do occur, and two gloves can protect them.” As she knows from firsthand experience, double-gloving can save staff from needing to undergo lab testing, and waiting and worrying over the results.