Surgical Gloves and Surgical Attire

Little commented topic on which there is much to say

The distinguishing factor of this topic concerning recommendations

Illustration of surgical gloves and attire.

When it comes to the topic of gloves and gowns, prices are often a main criteria - but there is more to be considered as they play a critical role in reducing Surgical Site Infections (SSIs).

Though experimental evidence suggests shedding of microorganisms from operating room personnel, more robust clinical studies are needed to establish a conclusive link.1

The absence of specific WHO recommendations emphasizes the need for further exploration.2

Look at what guidelines and we as supplier recommend ...

Guidelines
GuidelineRecommendationCategory (if mentioned)
CDC1

“Wear a surgical mask that fully covers the mouth and nose when entering the operating room if an operation is about to begin or already under way, or if sterile instruments are exposed. Wear the mask throughout the operation.”

“Wear a cap or hood to fully cover hair on the head and face when entering the operating room.”

“Do not wear shoe covers for the prevention of SSI.”

“Wear sterile gloves if a scrubbed surgical team member. Put on gloves after donning a sterile gown.”

“Use surgical gowns and drapes that are effective barriers when wet (i.e., materials that resist liquid penetration).”

“Change scrub suits that are visibly soiled, contaminated, and/or penetrated by blood or other potentially infectious materials.”

Category IB







WHO2,3

“The panel suggests that either sterile, disposable, non-woven or sterile, reusable woven drapes and surgical gowns can be used during surgical operations for the purpose of preventing SSI.”2

“The panel decided not to formulate a recommendation due to the lack of evidence to assess whether double-gloving or changing of gloves during the operation or using specific types of gloves is more effective in reducing the risk of SSI.”2

“The operating team should cover their hair and wear sterile gowns and sterile gloves during the operation.”3

Conditional recommendation, moderate to very low quality of evidence
NICE4

“The operating team should wear sterile gowns in the operating theatre during the operation.”

“Consider wearing 2 pairs of sterile gloves when there is a high risk of glove perforation and the consequences of contamination may be serious.”


KRINKO5

Put on mouth-nose protection and hair protection before entering the operating room.

Hair protection and mouth/nose protection must completely cover all beard and head hair as well as mouth and nose, as well as any additional headgear worn for personal reasons.

Renew the mouth-nose protection before each operation and when visibly soiled or soaked.

The surgical team should put on a sterile surgical gown and then sterile gloves in the operating room after surgical hand disinfection.

Two pairs of gloves are recommended for operations that experience has shown to be associated with increased glove lesions.

Gloves should be changed after manual handling of sharp-edged implants or explant components or removal of cement fragments (e.g., during endoprosthesis replacement), as well as immediately before implantation of a joint endoprosthesis.

Sterile surgical gowns certified as medical devices and made of disposable or reusable material should be used as protective gowns. Liquid-repellent gowns ("low performance") should be used for operations with low liquid incidence and liquid-tight gowns ("high performance") should be used for operations with expected high liquid incidence and known infection of the patient with high personnel risk (e.g. HIV, HCV).

Protective goggles or shields should be worn during operations where aerosols/secret splashes are expected to occur.

If contamination of the surgical gown... or surgical gloves occurs during surgery, change gowns or gloves....

Change surgical gowns or surgical gloves away from the surgical field.

Category IB

Category II

Category II

Category IB

Category II

Category IB

Category II

Category IB

Category II/IV

Category IB

Category IB


Portrait of Denise Leistenschneider, Senior Clinical Consultant
Denise Leistenschneider, Senior Clinical Consultant
"The safety aspect of gloves and surgical attire ranges from the appropriate material to correct use."

Instructions for surgical attire and surgical gloves

General

  • Put on a cap/hood/hair protection to fully cover hair on the head before entering the operating room.1,3,5
  • Wear a surgical mask that fully covers the mouse and nose before entering the operating room.1,5
  • Renew the mask before each operation and when visibly soiled or soaked.5
  • Do not wear shoe covers in the context of SSI prevention.1
  • Wear protective goggles or shields during operations where aerosols/secret splashes are expected to occur.5

Surgical gown

  • The operating team should wear sterile gowns during the operation.1–5 Certified products should be used.5
  • Use liquid-repellent gowns ("low performance") for operations with low liquid incidence and liquid-tight gowns ("high performance") for operations with expected high liquid incidence and known patient infection with high personnel risk (e.g. HIV, HCV).5
  • If gowns need to be changed during surgery: away from the surgical field.5
Illustration of two medical attires
Portrait of Denise Leistenschneider, Senior Clinical Consultant
Denise Leistenschneider, Senior Clinical Consultant
"Consider design of your surgical gown especially when it comes to inner protection field (front and sleeves)."

Surgical Gloves

  • Put on sterile gloves after donning a sterile gown.1
  • Wear two pairs of gloves during operations that have shown to be associated with increased glove lesions.5
  • Change gloves after manual handling of sharp-edged implants or explant components or removal of cement fragments, as well as immediately before implantation of a joint endoprosthesis.
  • If gowns need to be changed during surgery: away from the surgical field.5
Image showing how to put on your gown and keep your hands protected.

1. Put on your gown- keep your hands protected.

Image showing how to take out the gloves carefully.
2. Take out the gloves carefully.
Image showing how to take out both gloves.
3. Take out both gloves.
Image showing how to take the right hand gloves first.
4. Take the right hand gloves first - thumb of gloves on side of thumb of your hand.
Image showing how to insert the fingers into the opening of the glove.
5. Now insert the fingers into the opening of the glove.
Image showing how to fold the cuff over the waistband.
6. Now fold the cuff over the waistband.
Image showing how to pull up the cuff and insert the fingers into the glove.
7. Pull up the cuff and insert the fingers into the glove fingers provided for this purpose.
Image showing the same procedure described for the other hand.
8. The same procedure for the other hand.
Image showing how to insert the fingers into the opening of the glove.
9. Now insert the fingers into the opening of the glove.
Image showing how to pull up the cuff and insert the fingers into the glove.
10. Pull up the cuff and insert the fingers into the glove fingers provided for this purpose.
Image showing how to cover the waistband completely.
11. Note: Cover the waistband completely! Fit your gloves.
Image showing how to close your gown with ties.
12. Now you can proceed with closing your gown with ties.
Image showing how to close your gown with ties.
13. Now you can proceed with closing your gown with ties.
Image showing the doctor ready to start the operation.
14. Ready to start!
Teaser to contact a Hartmann representative

Safety concerns: take care of your patient and yourself

Surgical Glove perforation

Warning icon
  • The rate of perforations in surgical gloves increases with increasing wearing time.6
  • They occur
    • most frequently (58%) on the non-dominant hand - on the thumb and index finger.7
    • due to: Bone splinters, sharp surgical instruments, needle sticks, use of steel wire (chest).

Perforations after wearing time6

Diagram showing perforations after wearing time

Not all sterile gloves are the same

Illustration of two medical gloves

For reasons of occupational safety surgical gloves should be5

  • skin-friendly
  • non-powdered
  • low in allergens

The requirement for sterile protective clothing depends on various factors

Fulfilment of EN Standard is just one criteria – important, but there is more:
Icon of a clock
the duration of the operation
Icon of a drop
the amount of fluid involved
Icon with four blue arrows pointing to the center, forming a white medical cross
the mechanical stress

Do you still use powdered surgical gloves?

5 Convincing arguments for switching to powder-free medical gloves

  1. Powdered latex gloves can cause type I latex allergy.
  2. Frequent hand washing to remove powder residues can cause skin complications and reduces the efficacy of alcohol-based disinfectants.
  3. Powder is not essential for an easy donning.
  4. Powder can cause postoperative complications, delayed wound healing and additional surgeries for patients.
  5. Removal of glove powder from hands of wearer needs time and causes costs.

Double gloving: a HARTMANN’s hint

If a puncture in the overglove occurs, in contact with fluids (like blood in the operating room), a green dark colour alerts us that the overglove is damaged and we have to remove and replace it.

Double gloving: a HARTMANN’s hint

Double gloving before puncture

Close-up of a sterile medical glove before puncture

Double gloving after puncture

Close-up of a sterile medical glove after puncture
References:
  1. CDC (1999) Guideline for Prevention of Surgical Site Infection. Infect Control Hosp Epidemiol. 20(4): 247–278.
  2. WHO (2016) Global guidelines for the prevention of surgical site infection. World Health Organization 2016.
  3. WHO (2009) WHO Guidelines for Safe Surgery 2009.
  4. NICE (2019) Surgical site infections: prevention and treatment. NICE guidelines. Published 11 April 2019. www.nice.org.uk/guidance/ng125.
  5. KRINKO (2018) PräventionpostoperativerWundinfektionen. Empfehlungen der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsbl 61: 448–473.
  6. Partecke LI, et al. (2009) Incidence of microperforation for surgical gloves depends on duration of wear. Infect Control Hosp Epidemiol 30(5): 409–414.
  7. Kralj N, et al. (1999) ChirurgischeHandschuhe – wie gut schützensievorInfektionen? Gesundheitswesen 61(8-9): 398–403.

In focus

Hand disinfection or gloves?

What are the standard procedures for the two measures and in which situations can they contribute to infection prevention together?

Learn more...

Elements of standard precautions

Hand hygiene is the key measure of Elements of standard precautions. In addition to alcohol-based hand disinfection, the main infection protection measure, it comprises skin care, skin protection and skin cleansing.

Learn more…

Related & interesting

How we keep Healthcare Professionals safe with PPE

HARTMANN provides Insights into Do’sand Don’ts of Personal Protective Equipment.

Learn more...

Patient underlayer

How to support the change-over process between patients treated in sequential interventions?

Look here for an answer…