Double gloving to reduce surgical cross-infection

Do Gloves Provide Adequate Protection Against Infection?

In the early 1800s gloves were a foreign concept to surgeons, as a result, patient care suffered, and mortality was high due to poor sanitary conditions in the operating room. This all changed in 1889, where the introduction of the surgical glove completely revolutionized surgical aseptic ideals. Through the work of William Halsted and his desire to help his nurse, Caroline Hampton, who was from suffering contact dermatitis, the first pair of rubber gloves were created. Since this invention, there have been significant advancements in glove technology including the use of latex and non-latex gloves. However, significant problems remain including, perioperative contamination in longer procedures, a false sense of sterility, and no consensus in optimal glove donning procedures. Additional measures including patient preparation, limited handling of tissue specimens, minimal coagulation, and in particular a no-touch strategy need to be continued and optimized to minimize iatrogenic infection and sequelae. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

[Prevention of Surgical Site Infections]

The burden of surgical site infections (SSIs) is increasing. The number of surgical procedures continues to rise, and surgical patients present increasingly complex comorbidities. Half of SSIs are deemed preventable using evidence-based strategies. It is recommended for patients to bathe or shower prior to surgery. Hair should be removed only with a clipper. Shaving is strongly discouraged at all times. Antimicrobial prophylaxis should be administered only when indicated, based on guidelines, and timed correctly in order to achieve a bactericidal concentration in the tissues when the incision is made. Prophylaxis must not be continued beyond surgery. For skin preparation in the operating room an alcohol-based agent plus chlorhexidine or octenidine is recommended. During surgery, glycemic control and goal-directed fluid therapy should be implemented. Normothermia should be targeted in all patients. The perioperative use of an increased fraction of inspired oxygen may reduce the risk of SSI. Using a surgical safety checklist during a team time-out immediately before surgery reduces the incidence of SSI.

Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines

BACKGROUND

Surgical site infections (SSI) represent a considerable burden for healthcare systems. They are largely preventable and multiple interventions have been proposed over past years in an attempt to prevent SSI. We aim to provide a position paper on Operative Room (OR) prevention of SSI in patients presenting with intra-abdominal infection to be considered a future addendum to the well-known World Society of Emergency Surgery (WSES) Guidelines on the management of intra-abdominal infections.

METHODS

The literature was searched for focused publications on SSI until March 2019. Critical analysis and grading of the literature has been performed by a working group of experts; the literature review and the statements were evaluated by a Steering Committee of the WSES.

RESULTS

Wound protectors and antibacterial sutures seem to have effective roles to prevent SSI in intra-abdominal infections. The application of negative-pressure wound therapy in preventing SSI can be useful in reducing postoperative wound complications. It is important to pursue normothermia with the available resources in the intraoperative period to decrease SSI rate. The optimal knowledge of the pharmacokinetic/pharmacodynamic characteristics of antibiotics helps to decide when additional intraoperative antibiotic doses should be administered in patients with intra-abdominal infections undergoing emergency surgery to prevent SSI.

CONCLUSIONS

The current position paper offers an extensive overview of the available evidence regarding surgical site infection control and prevention in patients having intra-abdominal infections.

Occupational hazard for Dental staff exposed to the SARS-CoV-2 virus during Dental procedures

Introduction: The dental profession is a high-risk profession, considering the aspect of a possible 100% infection from patients who are carriers of bacterial, viral and fungal diseases during dental interventions. Aim: To perform the analysis of all data that explain the possibility of a SARS-CoV-2 virus infection in dental practice. Material and Methods: The literature data on the presence of SARS-CoV-2 virus, and its characteristics and behavior in the external environment and in living tissues was analyzed. Databases from the Medline, Cochrane Library, Science-Direct, EMBASE, and Google scholar libraries were used, as well as other sources of literature information about this virus. Results: SARS-CoV-2 is an RNA virus, which has a submicron size and the ability to survive in various environments. The retention of SARS-CoV-2 virus in air / aerosol lasts an average of 3 hours, while the half-life of this virus is 5 to 6 hours on stainless steel and 6 to 8 hours on plastic. Infected patients with SARS-CoV-2 virus develop COVID-19 disease, which manifests itself through presymptomatic, symptomatic and post-symptomatic periods of the disease. Conclusion: The SARS-CoV-2 virus can be found in aerosols generated by dental equipment, which uses compressed air for its work. Protection of dentists and staff from infection with the virus is possible by wearing an N95 respiratory mask with protection levels 2 and 3, which has a filtration efficiency, i.e. retention of submicron particles with an efficiency of ≥ 98%. Waterproof goggles with a protective visor or a special industrially designed facial visor in the form of a full face mask, which has its own motor for the supply of filtered air to the mask, and which prevents the contamination of the mucous membranes of the eyes, nose and mouth from liquid or solid aerosol in the air, need to be used. Other disposable protective equipment also must be waterproof. Korona virus izaziva prehladu kod ljudi, koja ima uobičajne simptome prehlade gornjih respiratornih puteva; zahvata nosnu šupljinu,a ponekad se širi i na ždrelo, larinks i sinuse 5,6,7 . Sa druge strane, SARS-CoV-2 virus, koji je izazivač masovne/globalne virusne infekcije, ima sličnosti sa druga dva korona virusa -beta korona virusom (SARS-CoV-1) i virusom srednjeistočnog respiratonog sindroma (MERS-CoV).

Preventing transmission of bloodborne viruses from infected healthcare workers to patients: Summary of a new Canadian Guideline

Background

Although it is well documented that bloodborne viruses (BBVs), including human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV) have been transmitted from patients to healthcare workers (HCWs), there has also been reported transmission from HCWs to patients during the provision of health care. With remarkable progress in infection prevention, diagnosis tools, treatment regimens and major improvements in guideline development methodology, there was a need to develop an evidence-based guideline to replace the 1998 Canadian consensus document for managing HCWs infected with BBVs.

Purpose

This article summarizes the Canadian Guideline on the Prevention of Transmission of Bloodborne Viruses from Infected Healthcare Workers in Healthcare Settings.

Methods

A Guideline Development Task Group was established and key questions developed to inform the guideline content. Systematic reviews were conducted to evaluate the risk of HCW-to-patient transmission of HIV, HCV and HBV. Environmental scans were used to provide information on Expert Review Panels, disclosure of a HCW's serologic status and lookback investigations. Federal, provincial and territorial partners and key stakeholder organizations were consulted on the Guideline.

Results

The risk of HCW-to-patient BBV transmission was found to be negligible, except during exposure-prone procedures, where there is a risk that injury to the HCW may result in exposure of a patient's open tissues to the HCW's blood. Risk of ensuing transmission and the rate of transmission varied by BBV, and were lowest with HIV and highest with HBV. The Guideline provides key content, including recommendations regarding criteria to determine if a procedure is an exposure-prone procedure, management of HCWs infected with a BBV, including considerations for the HCW's fitness for practice, Expert Review Panels, HCW disclosure obligations and right to privacy and lookback investigations.

Conclusion

This new Guideline provides a pan-Canadian approach for managing HCWs infected with a BBV, with recommendations related to preventing HCW-to-patient transmission of BBVs during the provision of care.

[Infections after reconstructive spinal interventions : How do I deal with them?]

BASICS

Postoperative surgical site infections of the spine have been described in up to 20% of patients and can result in serious consequences for the patient and substantial treatment costs. Typical bacteria often arise from skin or fecal flora. Various risk factors for infection have been described, including obesity, diabetes, high ASA scores, as well as intraoperative factors such as heavy blood loss, dural tears, or several revision procedures. Consequently, the prophylaxis with pre- and postoperative risk minimization is of particular importance.

TREATMENT

When an infection has developed, it is important to carry out early operative revision involving tissue debridement, lavage and acquiring microbiological samples for culture. If the infection presents early, the instrumentation can often be retained. Adjuvant measures such as negative pressure wound treatment may improve the outcome. In late-onset infections, due to the biofilm production on the instrument surface or in cases of implant loosening, one should attempt to remove the instrumentation, and in cases of instability replace it. This article deals with the current literature on the subject and provides an overview of the data with regard to peri- and postoperative infections.

Prevention and detection of prosthetic temporomandibular joint infections-update

Prosthetic joint infections are not only distressing complications for patients and surgeons, but also have an enormous financial impact on healthcare systems. The reported incidence of prosthetic joint infection is likely underestimated due to difficulties in their diagnosis. This unfortunate complication has challenged joint replacement surgeons for years, despite all the advances made in this surgical discipline. Since eradication of these infections can be very difficult, prevention remains the primary objective. Identifying recipient risk factors, adopting a proper surgical technique, appropriate wound care, optimizing the operating room environment, and appropriate postoperative care have become some of the core elements that can help to minimize the overall incidence of this complication. The purpose of this article is to provide the temporomandibular joint replacement surgeon with an update on the prevention and detection of prosthetic joint infections based on a review of the most recent information published in the orthopedic and surgical literature.

Preventing infection in shoulder surgery

Although rare, infection after shoulder surgery can represent a devastating complication. Infection can negatively affect clinical outcomes, and eradication often requires a protracted treatment course. Staphylococcus aureus, Staphylococcus epidermidis, and Cutibacterium acnes are among the most frequently isolated pathogens. Perioperative measures can be implemented to reduce infection risk. Here we review various perioperative practices and their efficacy at reducing infection after shoulder surgery.

The Benefits of a Wound Protector in Preventing Incisional Surgical Site Infection in Elective Open Digestive Surgery: A Large-Scale Cohort Study

BACKGROUND

The objective of this study was to evaluate the benefits of wound protectors (WPs) in preventing incisional surgical site infection (I-SSI) in open elective digestive surgery using data from a large-scale, multi-institutional cohort study.

METHODS

Patients who had elective digestive surgery for malignant neoplasms between November 2009 and February 2011 were included. The protective value of WPs against I-SSI was evaluated.

RESULTS

A total of 3201 patients were analyzed. A WP was used in 1022 patients (32%). The incident rate of I-SSI (not including organ/space SSI) was 9%. In the univariate and the multivariate analyses for perioperative risk factors for I-SSI, the use of WP was an independent favorable factor that reduced the incidence of I-SSI (odds ratio 0.73, 95% confidence interval 0.55-0.98. P = 0.038). The subgroup forest plot analyses revealed that WP reduced the risk of I-SSI only in patients aged 74 years or younger, males, non-obese patients (body mass index <25 kg/m²), patients with an American Society of Anesthesiologists score of 1/2, patients with a previous history of laparotomy, non-smokers, and patients who underwent colon and rectum operations. In patients who underwent colorectal surgery, the postoperative hospital stay was significantly shorter in patients with WP than those without WP (median 13 vs. 15 days, P = 0.040). In terms of the depth of SSI, WP only prevented superficial I-SSI and did not reduce the incidence of deep I-SSI.

CONCLUSIONS

WP is a useful device for preventing superficial I-SSI in open elective digestive surgery.

TRIAL REGISTRATION NUMBER

UMIN000004723.

Risk of surgical glove perforation in oral and maxillofacial surgery

Oral and maxillofacial surgery, which involves several sharp instruments and fixation materials, is consistently at a high risk for cross-contamination due to perforated gloves, but it is unclear how often such perforations occur. This study aimed to address this issue. The frequency of the perforation of surgical gloves (n=1436) in 150 oral and maxillofacial surgeries including orthognathic surgery (n=45) was assessed by the hydroinsufflation technique. Orthognathic surgery had the highest perforation rate in at least 1 glove in 1 operation (91.1%), followed by cleft lip and palate surgery (55.0%), excision of oral soft tumour (54.5%) and dental implantation (50.0%). The perforation rate in scrub nurses was 63.4%, followed by 44.4% in surgeons and first assistants, and 16.3% in second assistants. The odds ratio for the perforation rate in orthognathic surgery versus other surgeries was 16.0 (95% confidence interval: 5.3-48.0). The protection rate offered by double gloving in orthognathic surgery was 95.2%. These results suggest that, regardless of the surgical duration and blood loss in all fields of surgery, orthognathic surgery must be categorized in the highest risk group for glove perforation, following gynaecological and open lung surgery, due to the involvement of sharp objects.

Surgeons' and residents' double-gloving practices at 2 teaching hospitals in Ontario

BACKGROUND

Surgeons and residents are at increased risk of exposure to blood-borne pathogens owing to percutaneous injury (PI) and contamination. One method known to reduce risk is double-gloving (DG) during surgery.

METHODS

All surgeons and residents affiliated with the University of Western Ontario (UWO) and McMaster University in 2005 were asked to participate in a Web-based survey. The survey asked respondents their specialty, the number of operations they participated in per week, their age and sex, the proportion of surgeries in which they double-gloved (DG in ≥75% surgeries was considered to be routine), and the average number of PIs they sustained per year and whether or not they reported them to an employee health service.

RESULTS

In total, 155 of 331 (47%) eligible surgeons and residents responded; response rates for UWO and McMaster surgeons were 50% and 39%, respectively, and for UWO and McMaster residents, they were 52% and 47%, respectively. A total of 43% of surgeons and residents reported routine DG; 50% from McMaster and 36% from UWO. Using logistic regression to simultaneously adjust for participant characteristics, we confirmed that DG was more frequent at McMaster than at UWO, with an odds ratio of 3.32 (95% confidence interval 1.35-8.17). Surgeons and residents reported an average of 3.3 surgical PIs per year (2.2 among McMaster participants and 4.5 among UWO participants). Of the 77% who reported at least 1 injury/year, 67% stated that they had not reported it to an employee health service.

CONCLUSION

Percutaneous injuries occur frequently during surgery, yet routine DG, an effective means of reducing risk, was carried out by less than half of the surgeons and residents participating in this study. This highlights the need for a more concerted and broad-based approach to increase the use of a measure that is effective, inexpensive and easily carried out.

Glove perforation in hip and knee arthroplasty

BACKGROUND

The transmission of blood-borne pathogens during surgery is a major concern. Surgical gloves are the primary barrier between the surgeon and the patient. Surgical procedures that need manual handling of bony surfaces or sharp instruments have the highest risk of glove perforations. The frequencies and the sites of surgical glove perforations in arthroplasty procedures were assessed.

METHODS

We assessed the surgical glove perforations in total hip and knee arthroplasty procedures. Double standard latex gloves were used. A total of 983 outer and 511 inner gloves were tested. The gloves of all the surgical team members were tested for perforations during the first and second hours of surgery.

RESULTS

There were 18.4% outer and 8.4% inner glove perforations. The most frequent site of perforation was the second digit of the nondominant hand (25.5%). We found that hip and knee arthroplasty had significantly more glove perforation risk for the surgeon in the first half of the operation rather than the second half, and 57.8% of the perforations were at the index finger and the thumb.

CONCLUSIONS

Arthroplasty procedures still have high glove perforation rates despite the use of double gloving with frequent changes. Extra augmentation of the gloves in selected areas of the hand, in addition to double gloving, may be safer and more cost-effective than double gloving alone.

Hands-free technique in the operating room: reduction in body fluid exposure and the value of a training video

OBJECTIVES

This study sought to determine if (1) using a hands-free technique (HFT)--whereby no two surgical team members touch the same sharp item simultaneously--> or = 75% of the time reduced the rate of percutaneous injury, glove tear, and contamination (incidents); and (2) if a video-based intervention increased HFT use to > or = 75%, immediately and over time.

METHODS

During three and four periods, in three intervention and three control hospitals, respectively, nurses recorded incidents, percentage of HFT use, and other information in 10,596 surgeries. The video was shown in intervention hospitals between Periods 1 and 2, and in control hospitals between Periods 3 and 4. HFT, considered used when > or = 75% passes were done hands-free, was practiced in 35% of all surgeries. We applied logistic regression to (1) estimate the rate reduction for incidents in surgeries when the HFT was used and not used, while adjusting for potential risk factors, and (2) estimate HFT use of about 75% and 100%, in intervention compared with control hospitals, in Period 2 compared with Period 1, and Period 3 compared with Period 2.

RESULTS

A total of 202 incidents (49 injuries, 125 glove tears, and 28 contaminations) were reported. Adjusted for differences in surgical type, length, emergency status, blood loss, time of day, and number of personnel present for > or = 75% of the surgery, the HFT-associated reduction in rate was 35%. An increase in use of HFT of > or = 75% was significantly greater in intervention hospitals, during the first post-intervention period, and was sustained five months later.

CONCLUSION

The use of HFT and the HFT video were both found to be effective.

The "six sigma approach" to the operating room environment and infection

The patient's external environment plays a significant, and in some cases dominant, role in his or her infection risk. The use of ultraclean air for certain procedures, as well as avoidance of hypothermia have been proven to reduce the risk of infection. There is no data to support the routine use of surgical masks (by surgeons or staff), ventilating helmets, or routine cleaning of all environmental surfaces in between cases. More research needs to be done in order to determine whether OR design changes, in addition to increasing OR efficiency and thus reducing case times, can also reduce infection rates. Further research is also needed to determine whether or not double gloves and/or the use of antiseptic scrubbing in addition to painting are efficacious.

The impact of human immunodeficiency virus (HIV) on outcome and practice in trauma: past, present and future

Since the initial description of a concentrated outbreak of pneumocystis carnii pneumonia in 1981, the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) pandemic has accounted for nearly 25 million deaths worldwide. This review focuses on estimations of prevalence by geographic region and identification of high-risk populations within each region, outcome for trauma patients with HIV and AIDS and risk management for health care workers who sustain occupational exposures. Trauma surgeons are more likely to encounter patients infected with HIV in geographic areas where HIV prevalence is high or in areas where intravenous drug use, high-risk sexual behaviours and penetrating trauma are more common. Patients with HIV may be expected to have higher rates of infectious and respiratory complications if they have active AIDS and/or liver disease caused by one of the hepatitis viruses. Certain aspects of therapy may change in this group of patients. Clinicians should be aware that highly active anti-retroviral therapy (HAART) might produce complications. Occupational exposure among healthcare workers is uncommon. Cases of infection in healthcare workers from needlesticks are rare. Certain precautions regarding body fluid and needlestick exposures have been widely adopted over the past decade. When percutaneous injury results in known exposure to HIV, post-exposure prophylaxis (PEP) should be used and can be expected to be effective in preventing infection in the large majority of cases.

Double gloving to reduce surgical cross-infection

BACKGROUND

The invasive nature of surgery, with its increased exposure to blood, means that during surgery there is a high risk of transfer of pathogens. Pathogens can be transferred through contact between surgical patients and the surgical team, resulting in post-operative or blood borne infections in patients or blood borne infections in the surgical team. Both patients and the surgical team need to be protected from this risk. This risk can be reduced by implementing protective barriers such as wearing surgical gloves. Wearing two pairs of surgical gloves, triple gloves, glove liners or cloth outer gloves, as opposed to one pair, is considered to provide an additional barrier and further reduce the risk of contamination.

OBJECTIVES

The primary objective of this review was to determine if additional glove protection reduces the number of surgical site or blood borne infections in patients or the surgical team. The secondary objective was to determine if additional glove protection reduces the number of perforations to the innermost pair of surgical gloves. The innermost gloves (next to skin) compared with the outermost gloves are considered to be the last barrier between the patient and the surgical team.

SEARCH STRATEGY

We searched the Cochrane Wounds Group Specialised Register (January 2006), and the Cochrane Central Register of Controlled Trials (CENTRAL)(The Cochrane Library Issue 4, 2005). We also contacted glove manufacturing companies and professional organisations.

SELECTION CRITERIA

Randomised controlled trials involving: single gloving, double gloving, triple gloving, glove liners, knitted outer gloves, steel weave outer gloves and perforation indicator systems.

DATA COLLECTION AND ANALYSIS

Both authors independently assessed the relevance and quality of each trial. Data was extracted by one author and cross checked for accuracy by the second author.

MAIN RESULTS

Two trials were found which addressed the primary outcome, namely, surgical site infections in patients. Both trials reported no infections. Thirty one randomised controlled trials measuring glove perforations were identified and included in the review. Fourteen trials of double gloving (wearing two pairs of surgical latex gloves) were pooled and showed that there were significantly more perforations to the single glove than the innermost of the double gloves (OR 4.10, 95% CI 3.30 to 5.09). Eight trials of indicator gloves (coloured latex gloves worn underneath latex gloves to more rapidly alert the team to perforations) showed that significantly fewer perforations were detected with single gloves compared with indicator gloves (OR 0.10, 95% CI 0.06 to 0.16) or with standard double glove compared with indicator gloves (OR 0.08, 95% CI 0.04 to 0.17). Two trials of glove liners (a glove knitted with cloth or polymers worn between two pairs of latex gloves)(OR 26.36, 95% CI 7.91 to 87.82), three trials of knitted gloves (knitted glove worn on top of latex surgical gloves)(OR 5.76, 95% CI 3.25 to 10.20) and one trial of triple gloving (three pairs of latex surgical gloves)(OR 69.41, 95% CI 3.89 to 1239.18) all compared with standard double gloves, showed there were significantly more perforations to the innermost glove of a standard double glove in all comparisons.

AUTHORS' CONCLUSIONS

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.

Anticipated detection of imminent surgeon-patient barrier breaches. A prospective randomized controlled trial using an indicator underglove system

The double gloving indicator underglove system (IUS) is based on a colored detection of the outer glove perforation. Our objective was to determine the IUS efficiency to detect outer glove perforations and to reduce the risks of blood and body fluids exposure, warning the surgeon before the breach of the surgeon-patient barrier (SPB). A series of 100 visceral surgical procedures were randomly assigned to either double (IUS) or single gloving. The noticed glove perforations (using the water test method) and the IUS efficiency were analyzed in 99 procedures. In 49 single-gloving procedures, 19 perforations were noticed: one was immediately perceived (perceived accidental exposure, PAE); 3 were discovered as the gloves were being removed, and 15 were undetected before the water test (unperceived prolonged contact, UPC). In 50 double-gloving procedures (IUS), 16 perforations were noticed, all of them involving only the outer glove: the IUS allowed immediate detection of 3 perforations without any blood exposure; 13 other perforations went undetected but without any UPC. In conjunction with the protective quality of double gloving, the IUS allows detection of significant breaches of the outer glove before the breach of the SPB.

Antibiotic prophylaxis in orthopedic prosthetic surgery

The problem of prophylaxis in orthopedic implant surgery will become increasingly important and complex as the population ages and requires more arthroplasty procedures, and the prevalence of antimicrobial-resistant bacteria meanwhile also continues to rise. Energy spent preventing prosthetic joint infection is more effective than that expended in treating the infection of a prosthetic joint, once established. Preventive measures encompass a wide array of variables related to host response, wound environment, and microorganisms. Prophylaxis should address these areas in the preoperative, intraoperative, and postoperative periods. Antimicrobial prophylaxis remains the single most effective method of reducing the prevalence of infection after total joint arthroplasty. In the postoperative period, prophylaxis aims to protect the prosthetic joint against hematogenous seeding from oral, urologic, skin, or gastrointestinal sources. Currently, dental and urologic advisory statements provide recommendations for antimicrobial prophylaxis for high-risk patients with total joint arthroplasty undergoing high-risk procedures. Close collaboration between the orthopedic surgeon, urologist, or dentist and the infectious disease specialist is crucial for providing recommendations regarding prophylaxis in special circumstances. In these particular circumstances, individual decisions should be made based on clinical judgment.

Double gloving: a risk reduction strategy

BACKGROUND

The use of sterile surgical gloves has become the international standard of care in the perioperative environment. Yet the potential for barrier failure exists, with the subsequent potential for the transfer of pathogens to both the patient and the surgical team. The practice of double gloving (wearing two pairs of sterile surgical gloves) is often considered a mechanism for managing the potential risk of exposure during surgery.

LITERATURE ON DOUBLE GLOVING

In the 2002 Cochrane review of double gloving, findings were summarized from 18 studies. The review, which covers a variety of surgical environments and addresses several double gloving options, indicates that double gloving significantly reduced perforations to the innermost glove. Other studies report a risk reduction of 70%-78% attributed to double gloving.

OVERCOMING PRACTITIONER OBJECTIONS

Practitioners, in voicing objections to double gloving, cite poor fit, loss of tactile sensitivity, and increased costs. An important issue is how the two gloves work together, especially when they are powder free. Several studies have reported good acceptance of double gloving without loss of tactile sensitivity, two-point discrimination, or loss of dexterity. Although double gloving increases the glove cost per practitioner, the reduction of bloodborne pathogen exposure and possible seroconversion of practitioners represents a significant savings. Strategies that may help to facilitate the process include sharing the data on double gloving to build justification for the implementation, enlisting the support of the champions of the change at hand, and providing a glove-fitting station.

SUMMARY

The stresses placed on a surgical glove today--the length of cases, heavy and/or sharp instrumentation, and chemicals used in the surgical field--make it imperative that barrier protection be ensured.

The appropriate use of gloves to reduce allergies and infection

Twenty years ago, the wearing of gloves for non-sterile procedures was viewed as insulting to the patient as it made him/her feel 'unclean'. Today, gloves are worn for all procedures and are often wastefully used. There must be a fine balance between inappropriate and appropriate use of gloves and between the use of latex gloves for comfort and fine movements vs the potential for latex allergies. This article will review the use of synthetic and latex gloves and examine some of the related issues.