The practice of double gloving involves wearing two layers of surgical or examination gloves, one over the other. This technique is widely recommended and often mandated in clinical settings, especially during invasive procedures. The primary purpose of this layered approach is to provide enhanced protection for both the patient and the healthcare professional. This added barrier significantly reduces the risk of exposure to bloodborne pathogens and guards against sharps injuries that occur when handling instruments.
How Double Gloving Enhances Safety
The mechanism of protection is based on the principle of an increased physical barrier against perforation. Surgical gloves, while resilient, can develop micro-perforations or tears during a procedure without the wearer noticing. Studies show that a single layer of glove can be compromised in up to 45% of surgeries, particularly those lasting longer than two hours.
When the outer glove is punctured, the inner layer acts as a backup, preventing the transfer of fluids to the skin. Research indicates that double gloving reduces the risk of blood exposure to the hand by 65% to 70% compared to using a single glove. The rate of a “through-and-through” puncture—one that breaches both layers—is exceptionally low, offering a high level of protection.
A further enhancement involves the use of indicator gloves, where the inner glove is a different color, often green or blue. If the outer glove is torn, the contrasting color is immediately visible to the surgical team. This visibility allows the team member to promptly replace the compromised outer glove, maintaining a sterile field and reducing the time the skin is vulnerable to contamination.
When Double Gloving is Required
Double gloving transitions from a strong recommendation to a standard practice in several high-risk clinical contexts. Procedures involving sharp instrumentation, prolonged manipulation of tissues, or high volumes of blood and bodily fluids carry the highest risk of barrier failure. The Association of periOperative Registered Nurses (AORN) recommends that healthcare practitioners double-glove during all invasive procedures.
Specific surgical disciplines, such as orthopedic and trauma surgery, mandate double gloving due to the frequent use of wires, bone fragments, and heavy instruments. Procedures lasting longer than two hours are also considered higher risk, as the integrity of a single glove decreases significantly with prolonged wear. Furthermore, procedures involving patients with known bloodborne pathogens, such as Hepatitis or HIV, require this added protection.
Double gloving is also required for any procedure where the surgical team makes an incision and enters a body cavity, ensuring maximum protection when exposure to internal fluids is certain. Major health organizations, including the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA), support this practice to mitigate the risk of accidental exposure incidents.
Balancing Dexterity and Protection
The primary concern regarding double gloving is the potential for decreased tactile sensitivity and manual dexterity. The ability to feel fine textures and perform intricate movements is a necessary surgical skill, and a second layer of material can dampen this sensation. However, studies have found that double gloving does not substantially impact manual dexterity or the ability to discriminate touch compared to single gloving.
To mitigate any perceived loss of feel, specialized gloves are available, including thinner inner gloves or those made from materials optimized for sensitivity. Proper sizing is also important; some surgeons wear a half-size larger glove as the outer layer for better comfort and fit. Proper technique allows for quickly and aseptically changing the outer glove if a breach is detected, letting the procedure continue safely with the inner glove intact. While minor logistical considerations exist, such as increased cost and waste, these are outweighed by the substantial reduction in the risk of infection and injury to the surgical team.