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Double gloving to reduce infection

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VOL: 99, ISSUE: 07, PAGE NO: 58

The invasive nature of surgery, with its increased exposure to blood, means that during surgery there is a high risk of a transfer of pathogens. Pathogens can be transferred through contact between surgical patients and the surgical team, resulting in postoperative or blood-borne infections in patients or blood-borne infections in the surgical team. Wearing two pairs of surgical gloves, as opposed to one pair, is considered to provide a barrier and reduce the risk of contamination.

The invasive nature of surgery, with its increased exposure to blood, means that during surgery there is a high risk of a transfer of pathogens. Pathogens can be transferred through contact between surgical patients and the surgical team, resulting in postoperative or blood-borne infections in patients or blood-borne infections in the surgical team. Wearing two pairs of surgical gloves, as opposed to one pair, is considered to provide a barrier and reduce the risk of contamination.

Objectives: The primary objective of this review was to determine if double gloving rather than single gloving, reduces the number of postoperative or blood-borne infections in patients or the surgical team. The secondary objective was to determine if double gloving, rather than single gloving, reduces the number of perforations to the innermost pair of surgical gloves - the last barrier between the patient and the surgical team.

Search strategy: The reviewers searched the Cochrane Wounds Group Specialised Trials Register, MEDLINE, CINAHL, EMBASE and the Cochrane Controlled Trials Register. Glove manufacturing companies and professional organisations were also contacted. The selection criteria included randomised controlled trials involving: single gloving, double gloving, glove liners or coloured puncture indicator systems.

Main results: Two trials were found which addressed the primary outcome. A total of 18 randomised controlled trials which measured glove perforations were identified and included in the review.

Double gloving: Nine trials compared single latex gloves versus double latex gloves. No difference was found in the number of perforations between the single latex gloves and the outermost pair of the double latex gloves, but the number of perforations to the double latex innermost glove was significantly reduced when two pairs of latex gloves were worn.

Orthopaedic gloves: One trial compared single latex orthopaedic gloves - which are thicker than standard latex gloves - with double latex gloves. This showed there was no difference in the number of perforations to the innermost gloves when wearing double latex gloves compared with a single pair of latex orthopaedic gloves.

Indicator gloves: Three trials compared double latex gloves versus double latex indicator gloves (coloured latex gloves worn underneath latex gloves). These trials showed similar numbers of perforations to both the innermost and outermost gloves for both glove groups. Perforations to the outer gloves were detected more easily when double latex indicator gloves were worn. Wearing double latex indicator gloves did not increase the detection of perforations to the innermost gloves.

Glove liners: Two trials compared double latex gloves with double latex gloves with liners (an insert worn between two pairs of latex gloves). These trials showed a significant reduction in the number of perforations to the innermost glove when a glove liner was worn between two pairs of latex gloves.

Cloth gloves: Two trials compared double latex gloves with latex inner plus cloth outer gloves. The trials showed that wearing a cloth outer glove significantly reduced the number of perforations to the innermost latex glove.

Steel weave gloves: One trial compared double latex gloves with latex inner with steel weave outer gloves. This trial showed no reduction in the number of perforations to the innermost glove when wearing a steel weave outer glove.

Reviewers' conclusions: Wearing two pairs of latex gloves significantly reduces the number of perforations to the innermost glove. This evidence comes from trials undertaken in 'low-risk' surgical specialties, that is specialties which did not include orthopaedic joint surgery. Wearing two pairs of latex gloves does not cause the glove wearer to sustain more perforations to their outermost glove. Wearing double latex indicator gloves enables the glove wearer to detect perforations to the outermost glove more easily than when wearing double latex gloves.

In joint replacement surgery, wearing a glove liner between two pairs of latex gloves significantly reduces the number of perforations to the innermost glove compared with wearing double latex gloves only. Wearing cloth outer gloves significantly reduces the number of perforations to the innermost glove compared with wearing double latex gloves. Wearing steel weave outer gloves does not reduce the number of perforations to innermost gloves compared with double latex gloves.

Cochrane Reviews are regularly updated as new information becomes available and in response to comments and criticisms. The reader should consult The Cochrane Library for the latest version of a Cochrane Review. Information on The Cochrane Library can be found at www.update-software.com.

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