The effect of double gloving on frequency of glove perforations

The purposes of this prospective investigation were to determine the frequency of glove perforation during obstetric and gynecologic procedures and to assess the value of double gloving in preventing damage to the inner glove.

During a 2-month period, surgeons in the Department of Obstetrics and Gynecology were asked to double glove during all operative procedures. At the conclusion of surgery, the gloves were collected and the surgeons noted the type of procedure and their role as primary surgeon or first assistant. They also indicated whether a perforation was recognized intraoperatively. The gloves were tested for damage by first filling them with air and immersing them in water and then by directly filling them with water.

Four hundred forty-one sets of double gloves were evaluated. Of these, 61 sets (14%, 95% confidence interval 10.8-17.2%) had holes in at least one of the four gloves and six sets had more than one perforation, for a total of 67 holes. Fifty-two holes (78%) penetrated only the outer glove and nine (13%) were only in the inner glove. Penetration of both gloves at identical sites occurred in only six of the total glove sets (1.4%, 95% confidence interval 0.3-2.5%). The two most common sites of perforation were the thumb and index finger of the nondominant hand. Glove perforation occurred in 15% of cesarean deliveries and 11% of vaginal deliveries, a nonsignificant difference. In contrast, penetration occurred in 28% of major gynecologic procedures (P less than .05 compared with cesarean or vaginal delivery). Chief and third-year residents were significantly more likely to sustain perforation than were attending physicians or junior residents (P less than .01). Perforation to the gloves of chief residents typically occurred while they were serving as assistants for first- and second-year residents. Third-year residents usually sustained perforations while functioning as primary surgeons.

Glove perforations occur with relatively high frequency during pelvic surgery, particularly abdominal procedures. Double gloving offers a measure of protection against damage to the inner glove and may prevent subsequent exposure of the surgeon to blood and other body fluids.