Every year, 40-50 million surgeries are performed in the United States, according to the International Journal of Surgery; an estimated 310 million are performed globally. Each procedure involves a coordinated team of healthcare professionals working to provide the best possible outcome, and, for the members of the scrubbed surgical team, sterile surgical gloves support that goal, serving as the primary barrier of protection against infection and other complications, helping increase hand health and enabling the surgeon’s manual dexterity.
Our surgical glove manufacturing heritage spans more than 60 years. About 30 years ago, when recognizing that a glove with an effective barrier can be enhanced to support clinicians’ skin health and ergonomics, we began making Cardinal Health™ Protexis™ Surgical Gloves in our own glove facility in Rayong, Thailand. Today, these gloves are worn by healthcare providers around the world, protecting clinician and patient safety and helping mitigate clinicians’ hand fatigue and hypersensitivity even through long procedures.
"Most patients never think about the surgical gloves used during their procedure, and that's how it should be,” said Bridget Stovall, MSN, RN, Global Medical Advisor, Cardinal Health. “But for the clinicians who rely on them every day, gloves are essential tools that support safety, precision and performance. High-quality surgical gloves allow clinicians to focus on delivering the best possible care."
Safety in the operating room
“Surgical gloves are key to maintaining sterility for clinicians and patients,” said Keith Berend, M.D., of JIS Orthopedics in New Albany, Ohio. “They represent the baseline safety protocol for protecting the operating room staff from needlesticks and contamination from body fluids in surgery.”
A glove can be torn or punctured during surgery without the wearer immediately realizing it; some glove damage is so small that it may not be immediately visible to the wearer. Justin Martinez, MSN, RN, CNOR, CCRN, part of the cardiac surgical team at NewYork-Presbyterian Weill Cornell Medical Center and a member of Cardinal Health’s peri-operative advisory board, said he often is the first to notice when a surgeon’s glove has been compromised. Cardiac and vascular surgeons wear surgical loupes to perform intricate procedures, he explained, and are unlikely to notice much outside of the surgical site and the surgeon’s peripheral vision.
Today, multiple organizations, including the Centers for Disease Control and Prevention (CDC), the Occupational Safety and Health Administration (OSHA), the American College of Surgeons, the American Academy of Orthopaedic Surgeons, and the Association of peri-Operative Registered Nurses (AORN), recommend that members of the surgical team wear two pairs of gloves at a time. This practice is called double gloving. If the outer glove gets pierced or stuck with a needle, the inner layer acts as backup, reducing the risk of bloodborne viruses like hepatitis and HIV from reaching the skin. According to a study published in the Cochrane Review 2014, double-gloving reduces the risk of blood contamination by 65% and reduces the risk of an inner-glove perforation by 71%, compared to single gloves.
For Martinez, double gloving has become more appealing with improvements in glove technology. “When I first started nursing about 20 years ago, I used a single glove, because I was handling finer sutures, and wanted as little bulk on my hands as possible.” But today, the materials used to make gloves are much thinner and more flexible. “Now, I always double glove and don’t believe I am sacrificing the feel and control surgery requires,” Martinez said.
Dr. Berend added, “There’s no loss of tactile senses with the use of double gloves, particularly with high-quality gloves. Certainly, in most general orthopedics and large joint replacement surgeries, the benefit of double gloving outweighs any perceived benefit of single gloving.”
Making glove damage easier to see
To help minimize surgical glove stress and avoid breakage, AORN recommends that surgical teams change their gloves every 60-150 minutes. But even when healthcare professionals wear two gloves and change them frequently, they need to know right away when the outer glove has been compromised. That's why some double-gloving systems use a “surgical glove perforation indicator system,” making inner gloves one color and outer gloves another; if the outer glove develops a tear or puncture, the contrasting color of the glove underneath becomes obvious, and lets the wearer know the outer glove needs to be changed, before the tear or puncture becomes a larger concern.
This puncture indication system can be demonstrated with the Cardinal Health™ Protexis™ PI Blue Surgical Gloves with Neu-Thera™ Coating, which can be worn as the foundational, under glove layer when double gloving. The blue color alerts wearers to breaches in the outer glove.
Research shows that gloves with puncture indication systems are effective; colored undergloves provide a breach detection rate of up to 68% compared to 29% without colored undergloves, according to one study published in Clinical Orthopaedics and Related Research.
Protecting hand health, dexterity and comfort
The right gloves can impact a clinician’s performance: Comfort, the prevention of latex hypersensitivity or allergic reactions, and manual dexterity are all critical in the operating room. Designed to meet all these needs, products in the Cardinal Health™ Protexis™ Surgical Glove portfolio feature interlocking beaded cuffs to prevent the gloves from rolling down and have specialized thickness profiles for enhanced dexterity. With a comprehensive range of sizes, textures and materials, Protexis™ gloves help meet both complex procedural needs and individual clinician preferences.
Frequent hand scrubbing and regular glove use can take a toll on a clinician’s skin. Some gloves feature moisturizing coatings to combat dryness and irritation. For example, the Protexis™ PI Blue Surgical Gloves with Neu-Thera™ Coating contain glycerin, gluconolactone and provitamin B5, which promotes skin hydration. Research has shown that clinicians using moisturized gloves reported more hydrated and smoother skin. In a study by AORN of perioperative nurses and other healthcare workers, it was reported that 65% of those who had worn a moisturized surgical glove found it left their skin feeling more hydrated, and 58% found that it left their skin feeling smoother and more supple.
Other research, published in the peer-reviewed journal MEDSURGE Nursing, has found that healthcare workers who used moisturized surgical gloves reported less dry skin than those who wore gloves without moisturizing properties. For Martinez, the difference is tangible. “The gloves I choose to wear are moisturized; when I take them off, I don’t feel like I’ve been wearing them all day.”
Beyond skin well-being, the physical design of a glove is crucial for dexterity and reducing hand fatigue, especially when double-gloving. Cardinal Health’s Protexis™ gloves use a proprietary hand mold that mimics the hand's natural, resting shape rather than laying flat. Because the mold shapes the thumb independently, the glove allows for natural, unrestricted movement and is designed to help reduce material pull and support comfort during long procedures.
Finally, the material of the glove itself is a key factor in both safety and comfort. On average, 10 out of 100 healthcare workers may have a latex allergy, according to research in the Journal of Occupational Health; a study conducted at Alta Bates Medical Center in Berkeley, California, found that an estimated cost of a single latex allergy event in an operating room is just over $15,000.
Many healthcare facilities have adopted synthetic alternatives like polyisoprene as an alternative to latex, which offer the flexibility and tactile sensitivity clinicians require without the natural rubber latex proteins associated with latex allergies. These alternatives help hospitals reduce the potential for disruptions associated with latex allergy management and support a healthcare environment focused on staff and patient safety.
For healthcare organizations, the surgical glove is not a basic commodity; it is a strategic investment in safety, performance and risk management. Our Cardinal Health™ Protexis™ Surgical Gloves Portfolio offers synthetic polyisoprene options with a combination of diverse features designed to provide the fit, comfort and tactile sensitivity clinicians seek.
"Latex sensitivities can affect both patients and healthcare workers and often require significant precautions to manage,” Stovall said. “By adopting synthetic polyisoprene gloves, healthcare facilities can help promote a safe and more streamlined care environment without compromising the fit, feel and performance clinicians need during surgery. Ultimately, it's about giving care teams one less thing to worry about so they can focus entirely on the patient in front of them."