Double gloving: double protection or double trouble?

Aug. 1, 2007
Question: Several co-workers in my office want to double glove.

Question: Several co-workers in my office want to double glove. What do you think?

Answer: Appropriately used medical gloves, when paired with effective handwashing, can provide protection against bloodborne pathogens and other infectious diseases. Still, gloves do not guarantee two-way protection against infection. Glove integrity can decrease through extended use, the rigors of dental procedures, and sharps accidents (punctures).

The U.S. Food and Drug Administration considers the gloves used during dental treatment to be medical devices. Thus, the FDA regulates their quality. In 2006, the FDA issued a final ruling to improve the barrier quality of medical gloves marketed in the U.S. The ruling reduced the current acceptable quality levels for leaks and visual defects noted during testing. The rule becomes effective Dec. 19, 2008.

FDA medical glove testing includes visual observation for defects and a water leak test. Elastic straps affix test gloves to standard-sized plastic pipes. This step is followed by the addition of 1,000 mL of room temperature water. Observation of the gloves continues for two minutes. The FDA considers 1.5 defects to be the minimum level of quality for sterile surgical gloves and 2.5 defects the minimum quality level for patient examination gloves.

So, does wearing two pairs of gloves (double gloving) protect against exposure to bloodborne pathogens? More than 40 studies report lower frequency of inner glove perforation and visible blood on practitioner hands with double gloving.

One study indicated that double gloving reduced the risk of exposure to blood by as much as 87 percent. Another study reported that the volume of blood on a solid suture needle decreases as much as 95 percent when passing through two glove layers. The American College of Surgeons Committee on Operating Room Environment stated in 1998 that double gloving does help reduce, by a factor of 10, the number of potential exposures. Less frequent skin exposure to blood and microorganisms should translate into lower rates of occupationally acquired infections.

Glove perforations are common, varying from 11 to 51 percent with single gloving. Unfortunately, practitioners often are not aware that a perforation has occurred (one study reported this rate to be as high as 83 percent for surgeons). One study stated perforation rates for outer gloves were almost 6 percent, while detection of matched outer and inner perforations occurred in only 0.3 percent of the 1,316 glove sets tested.

Acceptance, however, has not been universal. One issue is cost. Two gloves are more expensive than one. Double gloving usually requires two sizes of gloves, ideally manufactured in half-sizes. This increases costs. But, if safety improves, then the use of two gloves actually is cost efficient. There are other key issues - tactile sensitivity, dexterity, and comfort. Studies support the position that double gloving does not substantially reduce either tactile sensation or manual dexterity.

The size of gloves worn for double gloving may have an effect on comfort. Often the underglove is the size normally used while the outer glove is a half-size larger. A study involving surgeons indicated that wearing a smaller glove on the outside was considered more comfortable than the opposite approach.

Question: Is there a way to test to see if a double glove is needed?

Answer: There is a way to test for glove defects while treating patients. A company called Molnlycke Health Care (www.molnlycke.com) manufactures the Biogel line of surgical gloves. One type of Biogel glove is the double gloving puncture indicator system. The system provides the wearer with an immediate, easily recognizable visual indication of glove puncture in the presence of a fluid. The early warning system includes an indicator underglove and a close-fitting outer glove. The manufacturer claims only limited loss of sensitivity and dexterity. When the outer glove is punctured, fluid can move through the defect and a dark green patch develops around the site. Molnlycke indicates the effect is purely visual and that there is no leaching of the dye. One study reported that the system had an 84 percent accuracy rate in identifying punctures when both gloves were latex.

The Organization for Safety and Asepsis Procedures is a global dental organization dedicated to promoting infection control and safety policies and practices supported by science and research. Additional information about the selection and use of gloves is available on the OSAP Web site at www.osap.org.

Dr. Charles John Palenik is the director of Infection Control Research and Services at the Indiana University School of Dentistry. Dr. Palenik is the co-author of the popular “Infection Control and Management of Hazardous Materials for the Dental Team.” In 2003, he was chairman of the Executive Board of OSAP, dentistry’s resource for infection control and safety. Questions about this article or any infection control issue may be directed to [email protected].