Double gloving for self-protection in high-risk surgeries: a systematic review and meta-analysis.

Background: Double gloving is recommended for protecting surgical personnel from infections, but it is not a universal practice, especially in low- and middle-income countries where risk is very high. Evidence for double gloving is still only moderate, and for indicator double gloves, it is even rare. This systematic review and meta-analysis includes recent trials to analyse outcomes like glove perforations (inner/outer/matched/intraoperatively detected) and hand contamination rates for single versus double including indicator double-gloved conditions and identify factors to be considered for deciding double gloving.

Method: Six databases PubMed, EBESCO, Embase, CINAHL, Scopus, Web of Science, and CENTRAL were searched up to May 2024. The quality of included trials was assessed using Cochrane risk-of-bias tool (version 5.1.0). Heterogeneity among trials was estimated using the chi-squared (I) test. RevMan 5.3 was used for meta-analysis and subgroup analysis. Odds ratio at 95% confidence interval was used as statistical measure to compare outcomes and calculate effect size. Publication bias was assessed through a funnel plot.

Result: A review of these total of 18 randomized controlled trials showed that deep/major/emergent surgeries, primary surgeons, and longer surgical duration are prone to have higher glove perforations. Impaired dexterity is not a constraint for double gloving and has no impact on glove perforations. Meta-analysis of outcomes suggests that double gloving (standard or indicator) provides significant protection against infections compared to single gloves in terms of reduced inner (OR = 0.2, 95% CI 0.14-0.31) and matched glove perforations (OR = 0.1, 95% Cl 0.07-0.13) and lower incidences of hand contamination (OR = 0.28, 95% Cl 0.14-0.54). Standard double gloves were more effective in reducing matched glove perforations than indicator double gloves. But for detecting glove perforations intraoperatively, only the indicator double glove (OR = 8.64, 95% Cl 4.78-15.61) was effective.

Conclusion: Double gloving is recommended over single gloving for better safety of surgical personnel and indicator gloves for better detection of perforations during surgery so that it can be changed timely, but it does not provide any additional protection. In the future, there should be high-quality trials for specific surgeries, surgical personnel, and different surgical durations taking into consideration the cost-effectiveness of indicator gloving over standard double gloving so that specific recommendations can be made.