Double gloving refers to the process of placing another pair of gloves, sterile or non-sterile, over the initial pair of gloves a provider has donned. Double gloving is performed commonly during surgery or the prehospital childbirth situation. The choice between sterile and non-sterile gloves is dependent on scenario and patient needs. In the prehospital scenario, non-sterile gloves are often the only readily available option.
Although double gloving is only explicitly needed in prehospital childbirth, there are a large amount of scenarios where it would be beneficial to both the provider and the patient. These include times where there are significant contaminants, times where many pairs of gloves may be used in quick succession, or even when the provider's sweat may prevent easy re-gloving if necessary. Let's look at a scenario:
Mike is an EMT called to the residence of a 58 year old male who has been experiencing bleeding from his recently created dialysis fistula. Mike enters the patient's house after performing his PENMAN assessment and notes significant trip/slip hazards in the form of piles of magazines and several walkers and wheelchairs. Mike's patient is in the back bedroom with poor access initially, so Mike and his partner clear a path after assessing his patient and determining that no lifesaving interventions are needed and that the patient is stable and not currently bleeding. Mike and his partner then sit-pick the patient to their gurney and load him into the ambulance. During Mike's second assessment, the patient's fistula is found to be bleeding profusely, possibly from trauma associated with his method of movement to the gurney.
In this case, there are several issues that are evident such as the method of extrication and potential need for additional resources. These will not be discussed during this module.
Let us think about why double gloving may have been useful for Mike.
- Although Mike performed a PENMAN assessment, he did not call for assistance that may have made patient extrication easier. Both he and his partner likely exerted themselves enough to sweat and make re-gloving difficult.
- From a cleanliness standpoint, Mike and his partner were protecting themselves from the environment as they cleared a path through the patient's house. After doing so, the environment remains on the outside of their gloves and will be transferred to the patient quite easily if interventions like hemorrhage control require direct pressure with a gloved hand.
- The patient had a known history of bleeding from an arterial source. There existed a significant chance that Mike and his partner would need to deal with significant amounts of blood. That blood would get on their gloves and contaminate anything they touched (such as the trauma cabinet and supplies when looking for bleeding control supplies). Using bloody gloves in an ambulance leads to longer times at a hospital spent cleaning and potential contamination of further patients.
In this scenario, double gloving would have let Mike and his partner change gloves to prevent patient and ambulance contamination much more easily than single gloving would.
Double gloving can be useful in dealing with: blood, pus, feces, urine, sweat, or significant environmental contaminants. The utility of double gloving must be weighed against the increased waste production and supply usage as well as the reduction in mobility and tactile sensation (this specifically is more of an issue for paramedics, especially when palpating for veins).