With appropriate hand hygiene (HH) compliance extremely challenging during anesthesiology practice in the OR, some are considering double gloving or disinfecting gloves while still wearing them as has been done in Ebola outbreaks.

The Society for Healthcare Epidemiology of America (SHEA) recently issued guidance¹ on infection control during anesthesiology procedures in the operating room that raised the possibility of using the unorthodox practices.

“Double gloving may be an option to a least reduce some of the risk, which for example would mean that as soon as the laryngoscopy is complete, the outer set of contaminated gloves is removed, and contamination of other areas is dramatically reduced,” said co-author of the guidelines David J. Birnbach, MD, of the American Society of Anesthesiologists.

The SHEA guidance recommends, “To reduce risk of contamination in the OR, providers should consider wearing double gloves during airway management and should remove the outer gloves immediately after airway manipulation. As soon as possible, providers should remove the inner gloves and perform HH.”

The primary rationale for this practice is that the upper-airway patient secretions contaminate the gloved hands during airway access and endotracheal intubation. If hand hygiene cannot be immediately performed, the contaminated gloves can contaminate the OR environment. Thus, the outer glove acts as a sheath that can be removed until a full glove change with hand hygiene.

“A small fraction of anesthesiologists believe very strongly, as I do, that using alcohol rubs on gloved hands also has a place,” Birnbach said. “At this point, there is really inadequate evidence to go one way or the other on whether that should be done routinely during these very task-intense periods in the operating room.”

The SHEA recommendations reflect this sentiment, stating, “changing gloves with HH between doffing and donning is the preferred method of disinfection. Current data are inadequate for the authors to either support or discourage the procedure of using [alcohol-based hand rub] on gloved hands or to determine whether application of foam or gel affects glove integrity. However, application of [alcohol-based hand rub] to gloved hands might be better than to not perform any HH when doffing and donning are not feasible.”

REFERENCE

1. Munoz-Price LS, Bowdle A, Johnston BL, et al. Infection prevention in the operating room anesthesia work area. Infect Control Hosp Epidem 2019;40(1):1-17 doi:10.1017/ice.2018.303.