Surgical Glove Perforations and Double Gloving

In an operating theatre, surgeons, operative assistants and scrub nurses are at risk of exposure to bloodborne pathogens from surgical glove perforations. Research shows that the average time for a perforation to occur in operating theatres is 69.8 minutes (Guo et al. 2012), with the rate increasing substantially for surgeries greater than two hours (Makama et al. 2016).

To ensure the highest level of protection for the operating team, double gloving practices are recommended for all surgical procedures. Makama et al. (2016) showed that wearing both an under glove and outer glove provides 98.83% of protection. When it comes to infection control, single gloving does not provide the same level of protection against bloodborne pathogens as double gloving, regardless if you are wearing latex or nitrile gloves. Based on a study by Greco et al. (1995), the risk for operating room staff decreased by 70% when double gloving compared to single gloving. Educating staff on the importance of double gloving and its undeniable benefits, will assist healthcare facilities in promoting a safer work environment for both workers and patients.

Detecting surgical glove perforations is just as important as the practice of double gloving. In a study that focused on the glove perforation rates among perioperative nurses, a surprising 95.5% of surgical glove perforations were overlooked and discovered post-surgery (Guo et al. 2012). According to Thomas-Copeland (2009), the most common sites of perforation include the index finger, thumb, middle finger, and dorsal aspect of the palm of the non-dominant hand. Furthermore, Partecke et al. (2009) reinforced the significant difference between microperforations on the hands of glove wearers in a surgical setting, illustrating that the non-dominant hand presents more than double the rate of punctures (66.7%) compared to the dominant hand (33.3%) (see figure 1).

The location of surgical glove perforations is connected to the glove wearer’s role on the operating team. For example, surgeons using a needle-holder in their primary hand are more prone to accidentally puncturing the index finger and thumb on their opposing hand (Guo et al. 2012).

Figure 1. Breakdown of surgical glove perforations in the non-dominant hand and dominant hand

Double Gloving with an Indicator System

An indicator system is the best approach for surgical staff to identify breaches in their outer glove and prevent contact with bloodborne pathogens to their innermost glove. Wearing a distinctive coloured under glove combined with a white outer glove promotes immediate puncture detection (Thomas-Copeland 2009).

An indicator system effectively warns surgical staff of breaches to their outer glove during surgical procedures, and allows them to act promptly to replace their perforated glove. This technique reduces the probability of perforating both layers of surgical gloves and becoming exposed to infectious contaminates (Tanner et al. 2009).

Double gloving with an indicator system is now being recognised as best practice by leading healthcare organisations. With a greater focus on practical application of an under and outer glove in a surgical setting, perceived barriers for double gloving can change (Korniewicz et al. 2012).

Participants’ views of potential barriers for Double Gloving (Korniewicz et al. 2012)

See no need27.4%72.6%
Causes numbness / tingling31.8%68.2%
Decreases hand sensation39.5%60.5%
Impedes handling efficiency25.3%74.7%
N=471 respondents


  1. Greco, RJ, Garza, JR 1995, ‘Use of double gloves to protect the surgeon from blood contact during aesthetic procedures’, Aesthetic Plastic Surgery, vol. 19, no. 3, pp. 265-267
  2. Guo, YP, Wong, PM, Li, Y, Or, PPL 2012, ‘Is double-gloving really protective? A comparison between the glove perforation rate among perioperative nurses with single and double gloves during surgery’, The American Journal of Surgery, vol. 204, no. 2, pp. 210-215
  3. Korniewicz, D, El-Masri, M 2012, ‘Exploring the Benefits of Double Gloving During Surgery’, AORN Journal, vol. 95, no. 3, pp. 328-336
  4. Makama, JG, Okeme, IM, Makama, EJ, Ameh, EA 2016, ‘Glove Perforation Rate in Surgery: A Randomized, Controlled Study To Evaluate the Efficacy of Double Gloving’, Surgical Infections, vol. 17, no. 4, pp. 436-442
  5. Partecke, L, Goerdt, AM, Langner, I, Jaeger, B, Assadian, O, Heidecke, CD, Kramer, A, Huebner, NO 2009, ‘Incidence of Microperforation for Surgical Gloves Depends on Duration of Wear’, Infection Control and Hospital Epidemiology, 30, no. 5, pp. 409-414
  6. Tanner, J, Parkinson, T 2006, ‘Double gloving to reduce surgical cross-infection’, Cochrane Database of Systematic Reviews, no. 3 Art. No. CD003087
  7. Thomas‐Copeland, J 2009, ‘Do Surgical Personnel Really Need to Double‐Glove?’, AORN Journal, vol. 89, no. 2, pp. 322-332