Surgical gloves are specialized barrier protection devices used to prevent the transfer of microorganisms between a patient and a healthcare provider during invasive procedures. The process of putting on these gloves requires a specific method known as sterile donning, which is distinct from simply pulling on standard examination gloves. This meticulous technique ensures the glove’s outer surface remains entirely free of non-sterile contaminants. The goal is to maintain a sterile field, thereby significantly reducing the patient’s risk of developing a surgical site infection from environmental or skin-borne bacteria.
Essential Preparations
The success of sterile gloving depends heavily on thorough preparation. Proper surgical hand antisepsis, whether a traditional scrub or an alcohol-based hand rub, must be performed first to reduce resident bacteria on the hands and forearms. This antiseptic process inhibits the rapid growth of microbes that can occur in the warm, moist environment inside the gloves during a procedure. Following hand antisepsis, ensure the skin is completely dry, as moisture can compromise the sterile packaging and promote bacterial growth.
Next, select the correct glove size; a glove that is too tight can tear, and one that is too loose can impair dexterity and create folds where contamination might harbor. The sterile glove package must be opened carefully on a clean, dry, and flat work surface, ideally at waist level or higher. Peel open the outer wrapper, but drop the inner paper packet containing the gloves onto the surface without touching the inner contents. Unfold the inner packet by only grasping the folded edges, creating a small, temporary sterile field upon which the gloves rest.
Step-by-Step Sterile Donning
The most common self-application method is the Open Gloving Technique, which begins with the glove for the dominant hand. Use the non-dominant hand to pinch the cuff of the first glove, touching only the inside surface. Lift the glove clear of the wrapper, keeping it away from non-sterile surfaces, and carefully slide the dominant hand into the glove. The cuff is left turned down because the non-dominant hand is still un-gloved and considered contaminated.
To glove the second, non-dominant hand, the now-gloved dominant hand is used to pick up the second glove. Place the sterile, gloved fingers under the remaining glove’s cuff, touching only the outer, sterile surface. This ensures sterile-to-sterile contact, protecting the integrity of the first glove. Insert the non-dominant hand into the second glove, pulling it on while maintaining distance from the un-gloved wrist. Once both hands are fully gloved, the cuffs can be unrolled and adjusted by only touching the sterile outer glove surfaces.
Maintaining Integrity and Safe Doffing
Once the gloves are on, the hands are considered part of the sterile field, and maintaining this integrity requires constant awareness. Hands must be kept above the waist and in front of the body, as any surface below waist level or behind the back is instantly considered contaminated. Accidentally touching any non-sterile surface, such as the face, hair, or equipment outside the sterile area, requires immediate glove removal and replacement. Even small tears or punctures require immediate change because they breach the protective barrier against skin flora.
When the procedure is complete, the gloves must be removed using the “glove-in-glove” technique to avoid exposing the bare skin to the contaminated exterior. Pinch the outside of one glove near the wrist with the other gloved hand and peel it off, turning it inside out. Hold the removed, contaminated glove in the palm of the remaining gloved hand.
Next, slide the fingers of the bare hand under the cuff of the second glove, taking care to touch only the clean inside surface. Peel the second glove off inside out, trapping the first glove within it, creating a sealed package of waste. The final step after doffing is performing hand hygiene to remove any residual microorganisms that may have contacted the skin.