Healthcare providers must maintain their own safety when caring for a patient with a communicable disease to reduce the risk of transmitting disease to oneself or there patients. Therefore, practices that protect a healthcare provider from disease are in turn in the best interest of all of their current and future patients. All medical personnel are at risk of exposure to patient’s bodily fluids and likewise carry a risk of being exposed to pathogens. Preoperative personnel, though, are at an increased risk for exposure to blood borne pathogens.
Wearing gloves is standard in preoperative care, but increased safety precautions are always sought after. This study aims to examine whether double gloving procedure (GAP) provides superior protection when impaired to the current practice of SSP procedure (SSP). The question we will examine throughout the study is if there is a difference in rate of blood borne pathogen exposure between GAP and SSP. Specifically, this study examines if GAP would decrease risk for transmission Of blood borne pathogens for preoperative person Nell when compared to SSP.
In recent years, GAP as a practice has been examined as an enhanced precautionary measure to protect any health professional from exposure to pathogens. The majority of focus has been on surgical procedures to reduce glove perforation and increase protection of the health professional. Studies have indicated that if GAP was adopted as a standard precaution, then the risk of contracting blood-borne diseases decreases for nurses. Likewise, there is also a correlation indicating that there is greater protection provided for the healthcare provider with GAP than single gloving alone.
GAP as a practice is mostly examined for surgical procedures due to this being where healthcare personnel are most exposed to blood borne pathogens. Accordingly, GAP as opposed to SSP has been adopted for many surgical procedures that involve a possibility of contamination. Typically, the outer loves are removed after an action that causes contamination so the individual does not have to stop the procedure to re-glove. This is most commonly practiced in surgical procedures for obstetrics and genealogy but has not been fully examined for other surgical specialties (Mart, 2003).
The studies chosen contained commonalities in that they all observed how GAP could help to reduce risk of exposure for surgical personnel. Throughout the studies, preoperative personnel were used as the subject populations. Half of the studies focused on perforation rates of the outer pair of gloves versus the inner pair of gloves. One of these studies did not compare the location of the perforations between the outer and inner layer of gloves while the other two involving this examination did document common perforation sites. The other half of the studies examined overall exposure to fluids by the preoperative personnel’s hands.
Not all of the studies specifically focused on nurses, but instead anybody who had higher risks of exposure. These people were typically the surgeon, the first assistant, and the scrub nurse. Thus in most studies involving GAP, all surgical personnel with high exposure to fluids were included. When all surgical personnel were examined, only one third Of the results involved nurses as subjects. The prominent consistency between all of the studies was that GAP was recommended for greater protection for nurses in a preoperative setting.
Within the studies by Guy (2003) and Mart (2012), the GAP perforations were zero when compared to 8. 9% and 9. 8% respectively. In other studies, reductions of contamination were shown to be as significant as a thirteen fold reduction and as slight as a 19. 4% reduction (Phillips, 201 1; Thomas 2001). All studies did correlate to show a reduced rate of exposure with GAP as opposed to SSP and recommend GAP being adopted as general practice. Three of the studies showed an intriguing consistency in the type and length of surgical procedures with glove perforation.
The correlation showed that the longer the surgical procedure was, the higher the chance of glove perforation. For one Of these studies, the length Of surgical procedure was divided by the time of 40 minutes with procedures under 40 minutes (7. 6% gloves perforated) showing a significantly lower perforation rate than surgeries over 40 minutes (18. 6% gloves perforated) (Malory, 2004). Along with having that division on lengths of surgeries, this study had an indication that emergency surgeries had a slightly higher glove perforation rate (16. %) than non-emergency procedures (10. 8%) (Malory, 2004). The American Journal of Surgery published study measured the average time into surgery being 69. 8 minutes for the perforation. This shows some limitation to accuracies because it would not be possible to determine the exact time of the perforation unless it was very apparent. (Guy, 2012) As far as inconsistencies are concerned, the studies varied greatly on how hey tested the gloves for perforations and the types of surgical procedures involved. GAP has seemingly become a standard precaution for high risk procedures.
There were two studies that were specific to a genealogical surgical setting while the remaining studies were inclusive of a variety of surgeries. Almost all genealogical procedures are considered high risk surgeries. It was indicated that GAP is common practice during many genealogical procedures to reduce the risk of cross contamination of the patient’s normal genealogical flora to the patient’s bloodstream. Therefore, these studies would show limited results because SSP is considered at the surgeon’s digression while other personnel would almost always be using GAP.
Some surgeons believe that GAP will affect their dexterity and impair their bill¶y’ to perform surgery properly. As a result, these studies (Malory 2004; Mart 2003) showed very low rate of inner glove perforation with GAP with results being 4. 6% and 0% respectively. All but one of the studies was focused on preoperative personnel but not necessarily nurses. Many of them extrapolated their results to be inclusive of urges in the preoperative setting but did not specifically focus on nurses or even mention them as an inclusive group explicitly.
This could limit the findings due to the different roles and tasks performed in a surgical setting by nurses as oppose to surgeons or other personnel present. Methods used within these studies all followed established guidelines for surgical practice and, thus, maintained an ethical approach. The studies all used consistent, valid, and reliable tools to measure leakage. The tools for measurement included air inflation and a water leak method (hydro- installation). With these methods, leakage was noted by observing or feeling a substance leaking through the glove.
The approach for design was quasi- experimental within all of our selected studies. The studies lacked randomization because they used all of the surgeries performed in a certain setting. A lack of randomization could have affected results if the preoperative personnel were aware of the studies or a change from the normal in their gloving procedures. Our studies contained levels Of evidence that varied from very strong to weak. Our strongest studies contained minimal bias, large sample sizes, good applications to evidence based practices, and consistency in results.
The main limiting factors for our weaker studies included small sample sizes and a lack of content. Mortality could be a factor in any of our studies if gloves were damaged to a certain extent that the personnel discarded them without submitting them to the study. The recruitment and data collection procedures compared SSP to GAP and contained quantitative data across all studies. From this data, percentages were derived to signify the increased protection GAP provides. Internal validity was only threatened by one major factor for our purposes.
The main inconsistency between the studies was within the testing methods. The use of water to determine leakage could put increased pressure on the gloves themselves, but at the same time, water leakage can be measured much easier than air leakage. Likewise, with water there could be more catastrophic damage inflicted upon the glove than from the initial perforation. On the other hand, air leakage would be more difficult to detect than water leakage, yet it wouldn’t be as easily measurable. Accordingly, air leakage could indicate fewer gloves reported as damaged than were actually damaged.
External validity may have caused preoperative personnel to be more or less cautious than usual when using a different gloving procedure then to which they are accustomed. Along with this, their caution could have caused a lower rate of perforations. The interaction of treatment with selection of subjects was at risk for some bias. The preoperative personnel have varying hand sizes, degrees of dexterity, and different tasks to perform in the theatre setting. Hand size could affect comfort when wearing two pairs of gloves or how gloves fit the individual.
Tasks performed and dexterity could be important if the person’s dexterity is impaired by GAP. Some preoperative personnel require less finesse from dexterity due to their role in the operating room. Also, an extra layer Of gloves could impair dexterity until the individual adapts to the procedure. For future practice it is recommended that GAP should be utilized as opposed to SSP for almost all situations in a preoperative setting. The reduction of needle sticks is universally reduced along with perforation rates of both inner and outer gloves.
The risk reduction is significant enough to justify adopted GAP as a standard precaution. It is suggested that a system where the first glove layer and the second glove layer are different colors would increase detection of perforations. Finally, the indicator finger of the non-dominant was consistently a major risk for perforation and needle sticks. Making surgical personnel aware of the highest risk areas for perforations may be beneficial for increased protection. Future studies could be useful to show the preferences of GAP or SSP along with the dexterity resulting from both procedures.
Different environments should probably be utilized with the limitations to preoperative being Mathew exclusive for the studies examined. A select testing method of either air or water pressure could be used to establish greater consistency among studies’ results. The studies also would benefit from greater randomization. References Parish, C. (2006). Double gloving recommended for low-risk surgical procedures. Nursing Standard,21(6), 11. Phillips, S. (201 1). The comparison of double gloving to single gloving in the theatre environment. Journal Of Preoperative Practice, 21(1), 10-15.
Malory, M. , Sahara, J. , Wad, L. , , R. (2004). Prospective study of love perforation in obstetrical and genealogical operations: are We safe enough?. The Journal Of Obstetrics And Campanology Research, 30(4), 319-322. Guy, Y. , Wong, P. , Lie, Y. , & Or, P. (2012). Is double-gloving really protective? A comparison between the glove perforation rate among preoperative nurses with single and double gloves during surgery. American Journal of Surgery, 204(2), 210-215. DOI:1 0. 101 6/j. Amusers. 201 1. 08. 017 Thomas, S. , Augural, M.. & Meta, G. (2001).
Interpolative glove perforation- single versus double gloving in protection against skin contamination. Postgraduate Medical Journal, 77(909), 458-460. Mart, E. , Silva, C. , & J;noir, O. (2003). Frequency of glove perforation and the protective effect of double gloves in genealogical surgery. Archives of Genealogy And Obstetrics, 268(2), 82-84. Appendix Integrated Review of Literature (RILL) Summary Table for EBPP Papers Group Names: Lee Brutal, Mica Miller, and Matthew Lower Research Question: Does double gloving by medical professionals decrease the risk of contamination when compared to single glove usage?
Author(s) Title Nursing Journal Year Background of Clinical Problem Clinical Problem Question Clinical Practice Setting and Patient Population Findings Based on Evidence Recommendations for Practice Based on Evidence Implications for Practice Based on Evidence imitations to Findings Parish, C. Double gloving recommended for low-risk surgical procedures. 2006 “People do not like to wear two pairs of gloves, but the research shows there is no evidence that wearing two pairs makes you more clumsy” Does double gloving provide better protection for low-risk surgical procedures?
Preoperative nurses and patients – there is an 11 percent chance of a single-layer glove perforating during low- sis operations. – double gloving would reduce the average preoperative nurse from 1 58 perforations a year down to an annual average of 43. Double gloving is recommended for low-risk surgical procedures. If double gloving for low-risk surgical procedures is implemented, the number of perforations will decline, resulting in a lower risk of contamination. Data and results are limited to preoperative nurses in low-risk surgical procedures. High risk procedures already have double gloving as the standard.
Phillips, S. The comparison of double gloving to single gloving in the theatre environment. 201 1 The role of surgical gloving is to minimize the risk of surgical site infection (SSI) and to protect the surgical team from cross infection. However, different practitioners have different views as to when double gloving is appropriate, with many factors like specialist and procedure dictating their use. This review will look at best practice through the evidence available and provide recommendations for practice. ” Does double gloving or single gloving provide better protection in the theatre environment?
Nurses and patients in the theatre environment – Surgical staff who wore a single set of gloves were 13 times more likely to experience perforations and contamination than staff who wore a double set of gloves Double gloving is recommended over single gloving in the theatre environment. If double gloving for the theatre environment is implemented, the number of perforations will decline, resulting in a lower risk of contamination. Data and results are limited to the theatre environment (surgical procedures). Malory, Sahara, J. , Wad, L. And Roar, R. Respective study of glove perforation in obstetrical and genealogical operations: Are we safe enough? Journal of Obstetrics & Campanology Research 2004 “Several erogenous have already been infected with HIVE and hepatitis at work and needle stick HIVE coerciveness has occurred. ” What is the glove perforation rate and what is the efficacy of double gloving vs.. Single gloving. Obstetric and genealogical surgery -13. 8% or outer gloves were perforated -13. 2% of inner gloves were perforated -4. 6% of perforations matched up from the inner and outer gloves -surgeries 40 minutes had 18. % perforation -emergency surgery had a perforation rate Of 16. 6% vs.. 10. 8% for non emergency Double gloving is recommended because it decreases the number of perforations in the inner gloves. Double gloving for BOGGY surgical procedures will result in a decrease in the number poof glove perforations. This will decrease the risk of contamination from diseases such as HIVE, hepatitis B, and Hepatitis C. Study is limited to obstetric and gynecologist surgeons. Although the results were extrapolated to the operating staff as a whole, the specific study was only on obstetric and gynecologist surgeons.
Guy, You Ping; Wong, Pop Mining; Lie, Y; Peggy Pup Alai Is double-gloving really protective? A comparison between the glove perforation rate among preoperative nurses with single and double gloves during surgery The American Journal of Surgery 2012 “double-gloving is not practiced commonly by operating room nurses and there are only limited studies about double-gloving that targets only preoperative nurses” What is the effectiveness of double-gloving in protecting preoperative nurses? ” Water-leakage and air-inflation tests were used to detect glove perforation in single vs.. Double gloved preoperative nurses.
Preoperative nurses; preoperative patient -8. 9% of single gloves were perforated -1 1. 3% of outer gloves were perforated in double glove nurses -0% of inner gloves in double glove nurses were perforated The average occurrence of perforation was 69. 8 minutes into surgery. -most perforation were located on the left middle and ring fingers Preoperative nurses should double glove to prevent exposure to blood borne pathogens. If double gloving was standard procedure for preoperative nurses, the risk of exposure to blood borne pathogens caused by glove perforation could be eliminated. Only examine preoperative nurse population.
It is a relatively small study with slightly over 100 participants in each of the two groups. Kraal, N. , Whitman, A. , Cover, J. , Status, K. , Hofmann, F. Study on Blood Contact in Simulated Surgical Needle Stick Injuries with Single or Double Latex Gloving Injury Prevention 201 0 “The risk of infection following a needle stick injury during surgery, greatly depends on the quantity of pathogenic germs transferred at the point of injury’ Does double gloving, as opposed to single gloving, decreased the amount of blood (and therefore pathogens) transferred during a surgical needle stick injury.
Surgical personnel in contact with surgical needles; Surgical patients – 0. 064 1 blood was transferred in punctures of single glove wearers -0. 11 1 blood was transferred in punctures of double glove wearers – wearing two pairs of gloves, the transferred volume of blood was reduced by a factor Of 5. 8. Surgical personnel in contact with surgical needles should wear double gloves. Wearing double gloves will strongly decrease the exposure to blood pathogens in surgical needle stick injuries Sample size is not given.
Specific to a surgical needle and did not examine other surgical needles generally used S Thomas, M Augural, G Meta Interpolative glove perforation-”single versus double gloving in protection against skin contamination Postcard Medical Journal 2001) “Surgeons have the highest risk of contact with patients’ blood and body fluids, and breaches in gloving material may expose operating room staff to risk of infections” Does double gloving protect the hands of surgical room personnel from transmission of pathogens better than single gloving alone?
Surgical room personal, especially surgeons. Gloving pattern Perforations (No (%) with visible Skin contamination) Single glove 19 8 (42. 1) Double glove 22 5 (22. 7) Double gloving was accepted and adopted by the majority of surgeons, especially with repeated use. This study shows that double gloving Offers significantly better protection than single Gloving. It is recommended that double gloves are used routinely in all surgical procedures in view of the significantly higher protection it provides.