Understanding the Issues of Double Gloving

HEALTHCARE WORKER RISK AND INJURY

So if the research is so impressive, why isn’t everyone double gloving? One thing about the research is that no one has added the extra benefit of informing healthcare workers of the consequences of blood and body fluid contamination in the form of post-exposure seroconversion. It is essential for wearers to understand their true risk of exposure and the probability of post-exposure seroconversion. Many studies show that a large number, and perhaps a majority of OR injuries go unreported. One survey of over 14,000 surgeons and nurses reported in 2004 found that 73% of surgeons failed to report sharps injuries they suffered, and other healthcare workers did not report 52% of their injuries.¹⁸

Every year, an estimated 100–200 injured workers die from hepatitis B. Hundreds of others contract hepatitis C, which can be fatal, as well. The CDC also documented nearly 200 cases of HIV in healthcare workers as of June 2001, classifying them as either confirmed or possible occupational-related transmissions. The risk of acquiring a virus from one percutaneous needle stick is 0.3% to 0.4% for HIV, 6% to 30% for hepatitis B (HBV), and 2.7% to 10% for hepatitis C (HCV).¹² Surgeons incorrectly estimate these seroconversion rates at 66% for HIV, 88% for HBV and 84% for HCV. One study found that a cardiac surgeon with chronic hepatitis B (HBV) transmitted HBV to five of his patients during open-heart surgery.¹⁹

This surgeon reported a rate of approximately 20 percutaneous injuries per 100 procedures, which were directly related to wire closure of the sternum. He also reported 2 percutaneous injuries per 100 cases, which were associated with sharps. The surgeon acknowledged that cases of HBV and HIV transmission from infected health care workers to patients had been documented.19 Another study reported an outbreak of HBV infection in 19 patients from an HBV-infected thoracic surgery resident. The resident complained of pain on the index fingers after suturing.

The resident, who did not double glove, reported glove failure as evidenced by blood on his hands at the end of his cases. During a one-hour suture-tying simulation, the resident got “paper-cut-like lesions” on his fingers, and the HBV surface antigens and DNA were obtained from washings of his hands.¹⁹ Although double gloving increases the glove budget for a hospital, the reduction of bloodborne pathogen exposure and possible seroconversion of healthcare workers represents a significant savings to the hospital. “Occupationally acquired HBV infection is common among surgeons; it has been identified as having occurred in 25-30% of operating surgeons who have been in practice of surgery for more than 10 years.”¹³ Double gloving reduces risk of exposure to patient blood by as much as 87% when the outer glove is punctured.⁷

“Volume of blood on a solid suture needle is reduced as much as 95% when passing through two glove layers, thereby reducing viral load in the event of a contaminated percutaneous injury.”⁷

Because of the occult nature of intraoperative glove failures, double gloving may prevent occult hand contact with patient blood. Using electronic detection of glove barrier failure, one study estimates that surgeons wearing a single pair of gloves would have contact with patient blood for 42 hours for every 100 hours of operating time.⁷ Costs of post exposure treatment of an occupationally acquired bloodborne pathogen such as HIV are significant to a hospital. Direct costs include initial evaluation of the healthcare worker, counseling, evaluation of the source patient, post exposure prophylactics, baseline and follow up pathology tests, clinical monitoring and follow up.

In addition, there are indirect costs, which include filing workers’ compensation and Occupational Health and Safety reports and other administrative paperwork, potential increase in liability premiums and legal fees. How do you put a cost to these statistics, and the cost of these infections to the future of healthcare? These statistics can be changed with double gloving.

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