Glove breach occurrence during surgical procedures: the benefits of double/indicator system gloves

Background: The use of gloves during surgery aims at preventing surgical site infections (SSIs) and to protect both staff and patients from cross-contamination. 

Aim: To assess the rate of surgical glove breaches, whether these pose an increased risk of infection, and, if so, how might this be overcome (using double/indicator system glove techniques). 

Methods: A scoping review was undertaken to address the primary research questions identified in the objectives. The search strategy was as follows: ‘surgical AND gloves AND perforations’ with a search date from January 1^st, 1970 to July 31^st, 2024 using the PubMed database. The articles were screened independently by two separate reviewers using the PRISMA-Scr checklist methodology. 

Findings: The initial search identified 343 articles that were then screened to provide 129 articles for full review. The results showed that surgical glove perforations are frequently reported to various levels in a variety of different surgical procedures, but that importantly a high proportion of glove breaches go undetected. The incidence of these perforations varies, but analysis of the data indicates that orthopaedic, oral/maxillofacial and obstetrics/gynaecology were pertaining the highest levels, probably due to the use of mechanical procedures that can easily damage the gloves. Increased levels of bacterial transmission and SSIs are associated with increased frequency of surgical glove perforations. The use of indicator system gloves demonstrated significant benefits in terms of identification of surgical glove breaches. 

Conclusion: In high-risk surgical procedures the use of an indicator system provides both surgeon and patient added protection with the perforation/breach detection helping prevent bacterial transmission and cross-infection.