Double gloving is the practice of wearing two layers of surgical or examination gloves simultaneously to enhance protection for both the wearer and the patient. This technique is recommended in high-risk settings where the potential for exposure to hazardous materials or infectious agents is high. While single gloving provides a basic barrier, adding a second layer offers a significant increase in safety against breaches, contamination, and the transmission of pathogens. This practice is standard when procedures involve sharps, significant bodily fluids, or prolonged exposure.
The Rationale for Enhanced Barrier Protection
The primary reason for double gloving is to mechanically reduce the rate of barrier failure, which is the breakthrough of contaminants to the skin. Surgical gloves, despite being manufactured to strict quality standards, are susceptible to micro-perforations and tears, especially during lengthy or complex procedures. Studies show that a single glove layer can have a failure rate leading to skin contamination as high as 51% in some surgical settings, often going unnoticed by the wearer during the procedure.
Wearing two gloves dramatically lowers this risk because the inner glove acts as a secondary, uncontaminated shield. If the outer glove is punctured or torn, the inner layer is contaminated significantly less often, reducing the risk of exposure to blood and other potentially infectious materials by up to 87%. This mechanism also reduces the inoculation volume that passes through a puncture from a sharp object like a needle. The presence of the second glove can reduce the volume of blood on a suture needle by as much as 95%.
The outer glove absorbs the immediate impact and contamination, while the inner glove remains intact to protect the wearer’s hand. This two-layer system also allows for the wearer to quickly remove the soiled outer glove if a breach is detected, maintaining a sterile or clean barrier underneath until a new pair can be donned. This layered approach provides continuous protection that a single glove cannot offer when integrity is compromised.
Specific Contexts Where Double Gloving is Standard
Double gloving is standard practice where the risk of glove failure or exposure is elevated. Major surgical procedures are the most common settings, especially those involving bone work, trauma, or long operating times, where the mechanical stress on the gloves is high. For instance, orthopedic and trauma procedures, which involve sharp instruments and bone fragments, have a particularly high rate of glove damage.
Infections involving high volumes of blood or bodily fluids, such as those in obstetrics or certain gastrointestinal surgeries, also warrant the two-layer approach. Double gloving is recommended by organizations like the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA) for invasive surgeries. This practice is also extended to situations involving patients with known blood-borne pathogens, such as HIV or Hepatitis.
The practice is not limited to patient care; it is also standard when handling highly hazardous materials, such as cytotoxic drugs used in chemotherapy. In contrast, routine, non-surgical patient care like a standard examination, administering injections, or drawing blood does not typically require the double-gloving technique. The recommendation is reserved for scenarios where the consequence of a barrier breach is severe for the patient, the provider, or both.
Maintaining Performance: Addressing Dexterity and Technique
A frequent concern with wearing two layers of gloves is the potential for reduced tactile sensitivity and dexterity, which could affect the performance of delicate tasks. Modern glove technology addresses this issue by manufacturing thinner inner layers or combining different materials, like a thin nitrile inner glove under a heavier outer glove, to better maintain sensory feedback. While functionality is generally satisfactory, some users may still notice a slight loss of tactile sensation compared to wearing a single glove.
The proper technique for double gloving often involves using a color-coded indicator system, where a darker inner glove is worn beneath a lighter-colored outer glove. If the outer glove is punctured, the contrasting color of the inner glove becomes visible through the tear, immediately alerting the wearer to the breach. This visual cue significantly increases the detection rate of perforations and allows for timely replacement, which is often not possible with a single glove.
For correct application, the individual may wear two gloves of the same size or sometimes a slightly larger outer glove for easier removal. When a breach is detected or the procedure is complete, the proper removal, or doffing, of the outer layer is necessary to avoid contaminating the inner glove and the hands. If the inner glove is also removed, the process must ensure that the contaminated outer surfaces do not touch the skin or clothing.