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Background: Needlestick injuries are always associated with a risk of infection, because these types of punctures may expose healthcare workers to a patient's blood and/or body fluids., Objective: To compare the efficacy of 4 different types of surgical gloves for preventing exposure to blood as a result of needlestick injury., Methods: For simulation of needlestick injury, a circular sample of pork skin was tightened onto a bracket, and a single finger from a medical glove was stretched over the sample. First, a powder-free surgical glove with a gel coating was used to test blood contact. Second, a glove with a patented puncture indication system was used to test blood contact with a double-gloved hand. Third, 2 powder-free latex medical gloves of the same size and hand were combined for double gloving, again to test blood contact. Finally, we tested a glove with an integrated disinfectant on the inside. The punctures were carried out using diverse sharp surgical devices that were contaminated with (99)Tc-marked blood. The amount of blood contact was determined from the transmitted radioactivity., Results: For the powder-free surgical glove with a gel coating, a mean volume of 0.048 microL of blood (standard error of the mean [SEM], 0.077 microL) was transferred in punctures with an automated lancet at a depth of 2.4 mm through 1 layer of latex. For the glove with an integrated disinfectant on the inside, the mean volume of blood transferred was 0.030 microL (SEM, 0.0056 microL) with a single glove and was 0.024 microL (SEM, 0.003 microL) with 2 gloves. For the glove with the patented puncture indication system, a mean volume of 0.024 microL (SEM, 0.003 microL) of blood was transferred., Conclusions: Double gloving or the use of a glove with disinfectant can result in a decrease in the volume of blood transferred. Therefore, the use of either of these gloving systems could help to minimize the risk of bloodborne infections for medical staff.

In 2007, AORN's Recommended Practices Task Force revised the "Recommended practices on prevention of transmissible infections in the perioperative practice setting" to recommend that health care practitioners double-glove during invasive procedures. Previously, AORN had suggested that wearing two pairs of gloves might be indicated for some procedures. Research on the protective effects of double gloving provides compelling evidence that surgical personnel should double-glove during all surgical procedures. Statistics on unreported injuries and conversion rates of HIV and hepatitis B indicate that change is difficult; however, research also suggests that objections to double-gloving can be overcome and a practice change implemented to ensure the safety of health care workers and patients alike.

Objective: Needlestick injuries are the most common injuries that occur among operation room personnel in the health care service. The risk of infection after a needlestick injury during surgery greatly depends on the quantity of pathogenic germs transferred at the point of injury. The aim of this study was to measure the quantity of blood transferred at the point of a percutaneous injury by using radioactively labeled blood., Design: This study was conducted to evaluate the risk of infection through blood contact by simulating surgical needlestick injuries ex vivo. The tests were conducted by puncturing single and double latex gloves with diverse sharp devices and objects that were contaminated with Technetium solution-labeled blood., Results: A mean volume of 0.064 microL of blood was transferred in punctures with the an automatic lancet at a depth of 2.4 mm through 1 layer of latex. When the double-gloving indicator technique was used, a mean volume of only 0.011 microL of blood was transferred (median, 0.007 microL); thus, by wearing 2 pairs of gloves, the transferred volume of blood was reduced by a factor of 5.8., Conclusions: The results revealed that double gloving leads to a significant reduction in the quantity of blood transferred during needlestick injury.

Background: Acquiring a blood-borne disease is a risk of performing operations. Most data about seroconversion are based on hollow-bore needlesticks. Some studies have examined the inoculation volumes of pure blood delivered by suture needles. There is a lack of data about the effect of double-gloving on contaminant transmission in less viscous fluids that are not prone to coagulation., Study Design: We used enzymatic colorimetry to quantify the volume of inoculation delivered by a suture needle that was coated with an aqueous contaminant. Substrate color change was measured using a microplate reader. Both cutting and tapered suture needles were tested against five different glove types and differing numbers of glove layers (from zero to three)., Results: One glove layer removed 97% of contaminant from tapered needles and 65% from cutting needles, compared with the no-glove control data. Additional glove layers did not significantly improve contaminant removal from tapered needles (p > 0.05). For the cutting needle, 2 glove layers removed 91% of contaminant, which was significantly better than a single glove (p = 0.002). Three glove layers did not afford statistically significant additional protection (p = 0.122). There were no statistically significant differences between glove types (p = 0.41)., Conclusions: With an aqueous needle contaminant, a single glove layer removes contaminant from tapered needles as effectively as multiple glove layers. For cutting needles, double-glove layering offers superior protection. There is no advantage to triple-glove layering. A surgeon should double-glove for maximum safety. Additionally, a surgeon should take advantage of other risk-reduction strategies, such as sharps safety, risk management, and use of sharpless instrumentation when possible.

Background: Incidental needlestick injury with exposure of blood pathogens has a high incidence among health care workers. Because plastic surgeons make up an important risk group for this type of accident, this study sought to evaluate the incidence of glove perforation during minor and major plastic surgery procedures., Methods: Evidence of glove perforation was evaluated for 390 gloves after 100 consecutive minor surgical procedures and for 710 gloves after 100 consecutive major surgeries using Maffuli's test. An index based on the number of first assistant's glove perforation and the surgical time was created to compare these accidents associated with both types of procedures., Results: Glove perforations were found in four gloves (1.02%) after minor surgery and 76 gloves (21.40%) after major surgery. During minor surgeries, the assistant was more likely to have exposure than the surgeon. During major surgery, the surgeon experienced more glove perforations (59.21%) than the assistant (40.79%). The most common location of perforations was the palmar face of the left hand in both groups. The surgeons did not notice these perforations at any time. The duration of the minor procedures varied from 10 to 30 min (average, 17.55 min), whereas the time of major procedures ranged from 1 to 6 h (average, 186 min). There was no statistical significant difference in the perforation's index between minor and major procedures., Conclusions: The risk of perforation to the surgeon's glove during minor surgery is minimal. The frequency of perforation to the first assistant's glove is similar between minor and major plastic surgery procedures.

Double-gloving has been shown to reduce conclusively the risk of operating room personnel's exposure to blood. Limiting risk of exposure to blood by double-gloving provides protection against the transmission of bloodborne diseases. Realizing the importance of double-gloving, a double-glove hole puncture indication system exists that accurately detects the presence of glove hole puncture in the presence of fluid. Once a glove puncture is recognized by this double-glove hole puncture indication system, it provides a warning to the surgeon to remove the punctured gloves, wash hands, and don a new, sterile double-glove hole puncture indication system. While accurately identifying the presence of glove hole puncture in the presence of fluid, this double-glove hole puncture indication system also has resistance to needle puncture superior to that of single gloves. It is the purpose of this study to document the resistance to needle puncture of latex and non-latex double-glove hole puncture indication systems using a reproducible experimental model. The resistance to needle puncture of the double-glove systems was significantly greater than that of the undergloves or outer gloves alone. The resistance to glove puncture of the non-latex and latex single and double-glove systems was significantly greater than those encountered by the latex single and double-glove systems, respectively. On the basis of their accuracy in detecting glove hole puncture, combined with their demonstrated superior resistance to surgical needle puncture as compared to single gloves, these latex and non-latex double-glove hole puncture indication systems are recommended for all surgical procedures.

During operative procedures, operating room personnel wear sterile surgical gloves designed to protect them and their patients against transmissible infections. The Food and Drug Administration (FDA) has set compliance policy guides for manufacturers of gloves. The FDA allows surgeons' gloves whose leakage defect rates do not exceed 1.5 acceptable quality level (AQL) to be used in operating rooms. The implications of this policy are potentially enormous to operating room personnel and patients. This unacceptable risk to the personnel and patient could be significantly reduced by the use of sterile double surgical gloves. Because double-gloves are also susceptible to needle puncture, a double-glove hole indication system is urgently needed to immediately detect surgical needle glove punctures. This warning would allow surgeons to remove the double-gloves, wash their hands, and then don a sterile set of double-gloves with an indication system. During the last decade, Regent Medical has devised non-latex and latex double-glove hole puncture indication systems. The purpose of this comprehensive study is to detect the accuracy of the non-latex and latex double-glove hole puncture indication systems using five commonly used sterile surgical needles: the taper point surgical needle, tapercut surgical needle, reverse cutting edge surgical needle, taper cardiopoint surgical needle, and spatula surgical needle. After subjecting both the non-latex and latex double-glove hole puncture indication systems to surgical needle puncture in each glove fingertip, these double-glove systems were immersed in a sterile basin of saline, after which the double-gloved hands manipulated surgical instruments. Within two minutes, both the non-latex and latex hole puncture indication systems accurately detected needle punctures in all of the surgical gloves, regardless of the dimensions of the surgical needles. In addition, the size of the color change visualized through the translucent outer glove did not correlate with needle diameter. On the basis of this extensive experimental evaluation, both the non-latex and latex double-glove hole puncture indication systems should be used in all operative procedures by all operating room personnel.

The National Fire Protection Association has developed standards for glove puncture resistance using a metal puncture probe. Biomechanical performance studies have demonstrated that glove puncture resistance to the probe is significantly greater than that of the hypodermic needle, suggesting that these standards have no clinical relevance. These standards give a false sense of security to health care personnel and sanction the production and use of gloves that give inadequate protection. The result is potentially harmful for medical personnel.

An electronic glove tester complying with safety regulations for electric current flow is described. In our laboratory, it was able to detect 100 percent of glove punctures caused by 4-0 and 6-0 surgical needles. When used regularly in the surgical suite, this device may help to minimize the surgeon's exposure to patients' blood and body fluids.

A prospective study was undertaken to determine the perforation rate of surgical gloves when double-gloving techniques were employed in 120 hip fracture operations. One or more perforations occurred in 30 operations (25%). In 10 operations (8.3%), perforations of both the outer and inner gloves occurred at corresponding sites. The surgeons were able to recognize the perforations during the surgery on five occasions only. Of the 64 perforations identified, 41 (64%) occurred in the left (nondominant) hands, and 42 (65.6%) occurred at the tips of thumbs and index fingers. Nearly half of the perforations (46.9%) occurred at the thumb and index finger of left (nondominant) hands. To reduce the perforation rate, further protection of the thumb and index finger of the nondominant hand of surgeons is therefore required.