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Surgical Gloving

Surgical gloves protect the operative field and the team's hands. Use sterile, powder-free gloves intended for surgical use, maintain hand antisepsis, and replace a damaged or contaminated barrier promptly. Gloves do not replace surgical hand antisepsis.[1][2]

Selecting Gloves​

Choose the surgical product, fit and allergy profile together. The frequently cited nitrile-versus-latex failure study tested medical examination gloves under simulated use, limiting its relevance to prolonged reconstructive operations.[3]

Selection issuePractical approach
Intended useCheck sterile surgical labeling, package integrity and manufacturer instructions; an examination glove is not a substitute merely because it is nitrile.[1]
Vinyl and copolymerIn the examination-glove study, vinyl and copolymer gloves failed water testing far more often (8.2% each) than nitrile (1.3%) or latex (2.2%). Use a surgical-grade latex, polyisoprene, polychloroprene or nitrile glove for operative work, not vinyl.[3][5]
FitFit every team member before their first scrub. Refit when the manufacturer or product changes, or when comfort or performance suffers, and stock several sizes and styles. Trial the actual glove combination for movement and instrument control. There is no established rule that everyone should wear an inner glove half a size larger (that draft statement failed consensus).[4]
Natural rubber latex allergyUse a suitable synthetic surgical glove and a latex-safe perioperative pathway.[5][6]
Delayed contact dermatitisConsider rubber-accelerator allergy and occupational dermatology assessment. Latex-free does not necessarily mean accelerator-free; select the specific formulation accordingly.[7]

Powdered surgical and examination gloves are banned in the United States; the FDA rule took effect January 18, 2017. Select powder-free products and never wash, disinfect or reuse disposable medical gloves.[1][8]

The ban rests on the harms of cornstarch powder: peritoneal adhesions and granulomatous peritonitis, impaired wound healing and wound infection, and carriage of latex allergen. In rats, starch or glove powder on the peritoneum increased adhesions and intra-abdominal tumor-cell growth. In a separate rat model, powdered and latex gloves each raised adhesion scores and cytokine levels, and powder-free synthetic gloves produced none.[16][17][18]

Donning and Replacing Gloves​

For initial closed gloving, keep the hands within the gown sleeves until the gloves cover the cuffs. Assisted gloving requires a sterile team member to handle the new sterile glove. A circulator can assist with removal of a contaminated glove using appropriate protection, without pulling the gown cuff over the hand; a sterile team member then assists with regloving. If sterility cannot be maintained, change the gown and gloves using the institution's aseptic technique.[2]

The evidence comparing particular donning methods mostly measures simulated contamination. A small randomized simulation found less fluorescent cuff contamination with closed-assisted than open-assisted donning; a separate gloves-first study also used a contamination surrogate. These simulations measured fluorescent contamination, with no SSI outcome; a later gloves-first simulation found more on the assisting scrub person's gloves.[26][9][10]

At a recognized breach, stop the relevant contact and restore an intact sterile barrier. Evaluate both layers when double gloved, and follow the occupational-exposure protocol if a sharp injury or blood exposure occurred. An indicator system does not guarantee that the inner glove or skin is intact.[1][2][11]

Double Gloving and Indicator Systems​

Double gloving reduces inner-barrier perforations and blood contamination of the hands. The 2014 Cochrane review included 34 randomized trials and 6,890 person-operations. Compared with single gloves, double gloves reduced perforations of the protective inner barrier (rate ratio 0.29, 95% CI 0.23–0.37) and blood stains on skin (RR 0.35, 95% CI 0.17–0.70). These are occupational-exposure outcomes; evidence for preventing actual needlestick injuries was imprecise.[11]

Three further Cochrane and later findings shape use. One small trial found triple gloving lowered perforations further (RR 0.03, 95% CI 0.00–0.52), but the evidence is low quality.[11] A 2025 meta-analysis included 18 trials; its 14-trial analysis found fewer inner-glove perforations with double versus single gloving (OR 0.2, 95% CI 0.14–0.31), and its six-trial analysis found less hand contamination (OR 0.28, 95% CI 0.14–0.54).[22] Longer, deeper operations and the primary surgeon carry the highest perforation risk, which is where double gloving matters most.[19][22]

The 2026 Enz consensus says double gloving should be considered for surgery, with recognized exceptions where single gloves are appropriate. When double gloving, it advises that all scrubbed team members wear an indicator inner glove. This is a manufacturer-funded consensus.[4] Direct evidence that double gloving alone reduces patient SSI remains insufficient. The Cochrane review found two trials with no infections in either arm, and the WSES paper assigns its insufficient-data statement GoR 2B in the detailed text but GoR 2C in the summary table.[12][13]

Fit and tactile performance still matter. Outer-glove perforation rates were similar for double and single gloves in the Cochrane review (RR 1.10, 95% CI 0.93–1.31), which the authors read as no loss of dexterity.[11] That is a surrogate; test an appropriate combination rather than dismissing a reported loss of sensation or control.[11][4]

Indicator gloves detect breaches; they do not prevent them. In the Cochrane trials, indicator systems did not reduce the total number of perforations in an operation. A 2025 systematic review found a two- to six-fold higher detection rate than two same-colored gloves (that review had manufacturer funding and author employment). Change gloves as soon as a spot appears and still inspect the inner glove.[11][23]

Perforation Rates​

Perforations are common and often unnoticed. The median control-group rate in the Cochrane trials was 18.5 perforations per 100 person-operations.[11] In a prospective series of 70 open abdominal operations (280 glove pairs), 10.7% of gloves and 54.3% of operations had a perforation, and 78% of the perforations went unnoticed.[19] Most were in the non-dominant hand. Risk was 5.8 times higher for surgeons than for other team members, and 12.8 times higher once operating time reached 61 minutes.[19] A Tunisian water-leak study of 284 gloves found 16.5% perforated and none noticed; 61.7% of the perforated gloves came from urology cases, but the study did not report perforation rates by department, so this is not a comparative risk.[20] A gastrointestinal series of 5,267 gloves found no difference between single (10.2%) and double (10.0%) gloving overall, but the inner glove failed less often than the outer (5.7% versus 11.6%).[21]

When to Change Gloves​

TriggerAction and evidence
Known or suspected perforation, contamination or loss of integrityReplace promptly with sterile technique; do not wait for a scheduled interval.[1][2]
Prolonged wearIncorporate planned changes into the local protocol. Enz 2026 suggests considering a 60–120-minute interval for single or outer gloves, alongside procedural steps. This is not a demonstrated universal SSI-prevention threshold. Observational glove-testing data point the same way: outer-glove perforations rose after 60 minutes of wear (12.6% versus 7.1%) and accumulated fastest up to 90 minutes.[4][21]
Inner glove during a long caseChange for a breach or contamination; an intact inner glove is not guaranteed safe for 240 minutes. One cohort found inner-glove perforations higher beyond 240 minutes (7.2% versus 4.4%), but the optimal routine inner-glove interval is unresolved.[4][21]
Prosthesis handlingPlan a clean handling step with new sterile gloves under the device and institutional protocol. Arthroplasty reviews mainly measure glove contamination/perforation. The arthroplasty reviews and the Enz consensus favor changing after draping, before handling the implant, before closure and at least hourly.[4][14]
Abdominal wound closure after a contaminated intra-abdominal phaseChange the team's gloves and use separate sterile closure instruments as a combined intervention; see ChEETAh below. Enz recommends this change as part of a bundle in general surgery. WHO 2018 made no recommendation on it before ChEETAh, citing lack of evidence.[4][15]

The WSES position paper states that interval changes may protect staff (Grade 2C). Its discussion cites a 90-minute observational recommendation; its formal statement does not mandate that interval for every procedure.[13]

ChEETAh: a major trial relevant to abdominal reconstruction​

ChEETAh randomized 81 hospitals in seven low- and middle-income countries, enrolling 13,301 patients undergoing clean-contaminated, contaminated or dirty abdominal surgery. Before handling wound edges for closure, the scrub team changed gloves (outer gloves if double gloved) and used a separate sterile needle holder, forceps and scissors.[15]

Among patients assessed for the primary outcome, 30-day superficial or deep incisional SSI occurred in 931/5,789 (16.1%) intervention patients versus 1,280/6,768 (18.9%) controls; adjusted RR 0.87 (95% CI 0.79–0.95). The intervention combined glove and instrument changes, so the trial cannot isolate the benefit of either component.[15]

The cohort included 679 urologic operations, but the trial was not specific to urinary diversion or prostheses. Almost all operations were open; clean surgery and cesarean delivery were excluded. Apply the finding most directly to comparable abdominal reconstruction, without assigning the same effect size to clean implant surgery or purely endoscopic procedures.[15]

Latex Allergy Planning​

Confirm the allergy history during preoperative planning and communicate it to the operating room, anesthesia and recovery teams. For confirmed natural rubber latex allergy, use synthetic surgical gloves and check the equipment and devices that will contact the patient.[5][6]

ASCIA's operating-suite guidance recommends first-case scheduling and additional room preparation where powdered latex exposure could leave airborne allergen. It explicitly states that those extra measures are unnecessary in an operating suite that does not use powdered latex gloves. Do not impose first-case scheduling on every latex-allergic patient regardless of the local environment. Latex-safe equipment and communication remain necessary.[6]

Occupational Exposure Protocol​

In a single-institution prospective series, the operating surgeon was exposed to potentially contaminated body fluids in 173 of 594 urologic procedures (29%); exposure occurred in 41% of endoscopic surgical cases.[29] For occupational HIV exposure assessment, blood, tissue, visibly bloody fluids, semen, pre-seminal fluid, vaginal and rectal fluids, breast milk, and cerebrospinal, synovial, pleural, peritoneal, pericardial and amniotic fluids are potentially infectious. Urine is not considered potentially infectious unless visibly bloody.[24] Do not recap used needles, and consider double gloving during high-risk maneuvers (see above).

At a sharps injury or mucocutaneous blood exposure: stop the activity; wash a puncture or cut with soap and water, flush splashes to the skin, nose, or mouth with water, and irrigate an exposed eye with clean water or saline; report immediately to employee health or the emergency department for evaluation without waiting until the end of the case.[28] The 2025 PHS guideline estimates average HIV transmission risk after percutaneous exposure to HIV-infected blood at 0.23% (95% CI 0–0.46%).[24] Deep injury, visible blood on the device and prior placement in a vein or artery were associated with higher risk; laboratory work found greater blood transfer with hollow-bore than solid needles.[24]

When HIV post-exposure prophylaxis (PEP) is indicated for a health care worker, start it as soon as possible and within 72 hours of exposure, without waiting for source test results; seek HIV expert advice for a high-risk exposure presenting after 72 hours. Current US Public Health Service guidance recommends a three-drug regimen for 28 days, with occupational health directing source testing and regimen selection.[24] For possible HCV exposure, occupational health should arrange source and worker testing, with follow-up HCV RNA testing when indicated; HCV PEP is not recommended.[27] After a sharps exposure, occupational health should document hepatitis B vaccination and anti-HBs response and obtain source HBsAg testing when indicated. Susceptible workers may need prompt hepatitis B immune globulin and vaccination; documented responders need no HBV prophylaxis.[25]

See Also​

References​

1. US Food and Drug Administration. Medical Gloves. FDA.

2. Association of Surgical Technologists. Standards of Practice for Gowning and Gloving. Revised 2014. Standards IX–XI. AST.

3. Korniewicz DM, El-Masri M, Broyles JM, Martin CD, O'Connell KP. "Performance of latex and nonlatex medical examination gloves during simulated use." Am J Infect Control. 2002;30(2):133-138. doi:10.1067/mic.2002.119512

4. Enz A, Boermeester MA, Chatterjee A, et al. “Hand Deserve Better: global clinical consensus recommendations on surgical gloving practice.” J Hosp Infect. 2026;172:115–128. doi:10.1016/j.jhin.2026.03.025.

5. Taylor JS, Erkek E. "Latex allergy: diagnosis and management." Dermatol Ther. 2004;17(4):289-301. doi:10.1111/j.1396-0296.2004.04024.x

6. Australasian Society of Clinical Immunology and Allergy. Operating Suite Guidelines for Latex Allergic Patients. March 2010. ASCIA.

7. Crepy MN, Lecuen J, Ratour-Bigot C, Stocks J, Bensefa-Colas L. "Accelerator-free gloves as alternatives in cases of glove allergy in healthcare workers." Contact Dermatitis. 2018;78(1):28-32. doi:10.1111/cod.12860

8. US Food and Drug Administration. Banned Devices; Powdered Surgeon’s Gloves, Powdered Patient Examination Gloves, and Absorbable Powder for Lubricating a Surgeon’s Glove. Final rule, December 19, 2016; effective January 18, 2017. Official rule.

9. Jones C, Brooker B, Genon M. "Comparison of open and closed staff-assisted glove donning on the nature of surgical glove cuff contamination." ANZ J Surg. 2010;80(3):174-177. doi:10.1111/j.1445-2197.2010.05211.x

10. Byrd WA, Kavolus JJ, Penrose CT, Wellman SS. "Donning gloves before surgical gown eliminates sleeve contamination." J Arthroplasty. 2019;34(6):1184-1188. doi:10.1016/j.arth.2019.01.015

11. Mischke C, Verbeek JH, Saarto A, et al. "Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel." Cochrane Database Syst Rev. 2014;(3):CD009573. doi:10.1002/14651858.CD009573.pub2

12. Tanner J, Parkinson H. "Double gloving to reduce surgical cross-infection." Cochrane Database Syst Rev. 2006;(3):CD003087. doi:10.1002/14651858.CD003087.pub2

13. De Simone B, Sartelli M, Coccolini F, et al. "Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines." World J Emerg Surg. 2020;15(1):10. doi:10.1186/s13017-020-0288-4

14. Kim K, Zhu M, Munro JT, Young SW. "Glove change to reduce the risk of surgical site infection or prosthetic joint infection in arthroplasty surgeries: a systematic review." ANZ J Surg. 2019;89(9):1009-1015. doi:10.1111/ans.14936

15. NIHR Global Research Health Unit on Global Surgery. "Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh): a pragmatic, cluster-randomised trial in seven low-income and middle-income countries." Lancet. 2022;400(10365):1767-1776. doi:10.1016/S0140-6736(22)01884-0

16. Edlich RF, Long WB 3rd, Gubler DK, et al. "Dangers of cornstarch powder on medical gloves: seeking a solution." Ann Plast Surg. 2009;63(1):111-115. doi:10.1097/SAP.0b013e3181ab43ae

17. van den Tol MP, Haverlag R, van Rossen ME, et al. "Glove powder promotes adhesion formation and facilitates tumour cell adhesion and growth." Br J Surg. 2001;88(9):1258-1263. doi:10.1046/j.0007-1323.2001.01846.x

18. Dwivedi AJ, Kuwajerwala NK, Silva YJ, Tennenberg SD. "Effects of surgical gloves on postoperative peritoneal adhesions and cytokine expression in a rat model." Am J Surg. 2004;188(5):491-494. doi:10.1016/j.amjsurg.2004.07.019

19. Sayın S, Yılmaz E, Baydur H. "Rate of glove perforation in open abdominal surgery and the associated risk factors." Surg Infect (Larchmt). 2019;20(4):286-291. doi:10.1089/sur.2018.229

20. Tlili MA, Belgacem A, Sridi H, et al. "Evaluation of surgical glove integrity and factors associated with glove defect." Am J Infect Control. 2018;46(1):30-33. doi:10.1016/j.ajic.2017.07.016

21. Kobayashi M, Tsujimoto H, Takahata R, et al. "Association between the frequency of glove change and the risk of blood and body fluid exposure in gastrointestinal surgery." World J Surg. 2020;44(11):3695-3701. doi:10.1007/s00268-020-05681-1

22. Singh KV, Walia K, Farooque K, Mathur P. "Double gloving for self-protection in high-risk surgeries: a systematic review and meta-analysis." Syst Rev. 2025;14(1):57. doi:10.1186/s13643-025-02760-z

23. Wharton KR, Sawyer RG, Enz A, Bah-Rösman J, Brindle CT. "Hands Deserve Better: a systematic review of surgical glove indicator systems and identification of glove perforation." J Clin Med. 2025;14(22):7977. doi:10.3390/jcm14227977

24. Kofman AD, Struble KA, Heneine W, et al. "2025 US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Post-exposure Prophylaxis in Healthcare Settings." Infect Control Hosp Epidemiol. 2025;46(9):863-873. doi:10.1017/ice.2025.10254

25. Centers for Disease Control and Prevention. "Table 1: Treatment for HBV Exposures in Health Care Settings." May 13, 2024. CDC.

26. Sundet A, Nelms NJ, Michelson JD. "Donning Gloves Before Surgical Gown Cross-contaminates the Assistant." Arthroplast Today. 2022;17:142-144. doi:10.1016/j.artd.2022.08.009

27. Moorman AC, de Perio MA, Goldschmidt R, et al. "Testing and Clinical Management of Health Care Personnel Potentially Exposed to Hepatitis C Virus—CDC Guidance, United States, 2020." MMWR Recomm Rep. 2020;69(6):1-8. doi:10.15585/mmwr.rr6906a1

28. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. "Bloodborne Infectious Disease Risk Factors." CDC. 2025. CDC/NIOSH.

29. Kapoor DA, Smiley DG, Reddy PK. "The risk of exposure to potentially contaminated body fluids in urological surgery." J Urol. 1993;149(5):1058-1060. doi:10.1016/S0022-5347(17)36295-X