Consultant Breast Surgeon Nathan Coombs outlines where double gloving should be considered and the peace of mind it can bring to staff in the operating theatre.  

The pandemic has placed the safety of healthcare workers at the top of the news agenda like never before. Ensuring that healthcare professionals and their support teams are not only provided with the most effective personal protective equipment (PPE) , but also given the best guidance on how to operate safely to minimise the risk of infection, has never been of greater importance. Since the start of the pandemic, many UK hospitals have put in place guidance recommending double gloving to minimise the risk to staff of infection.

Well-established as good practice in surgical safety, double-gloving can protect surgical staff from exposure to blood-borne pathogens and other risks.

The impact of Covid on the hospital

As with virtually every other aspect of life, my work as a breast surgeon has been greatly affected by the pandemic, with our hospital referral patterns undergoing a dramatic shift. Covid-19 placed considerable fear amongst the public of attending both primary and secondary care settings, significantly reducing referral numbers in the process. To help meet the change in demand we altered the stratification of who we were operating on, prioritising people with significant high-risk diseases and deferring routine operations only where it was safe to do so.

Thankfully, we are starting to see a rebound in the number of referrals. People who have put off discussing their symptoms are now coming to their GP to speak about them, and we have also been attending to patients whose surgery was unfortunately deferred earlier in the crisis. This is reflected in our growing workload.

Cancer pathways have undergone rapid changes across the NHS, and this has been no different at Great Western. Cancer patients are of course deemed at high risk of contracting the coronavirus, so we have modified our pathways to mitigate this risk. For example, adapting our radiotherapy techniques in order to reduce hospital footfall. Unfortunately, it will be a number of years before we can know what the full impact of Covid has been on cancer outcomes, but as a hospital trust we have been doing everything we can to ensure that patients get the treatment they need as quickly and as safely as possible. 

Ensuring Surgical Safety through best practice

Early on in the pandemic Great Western took the welcome step of training surgical staff in the donning and doffing of PPE and explaining where double gloving should be used for surgical care teams working in the operating theatres. The importance of double gloving as a best practice surgical safety technique has been well known for a long time, but introducing it more widely was raised by colleagues as a vital step in ensuring that the personal risk of our staff was minimised. It’s vital to ensure that our staff can undertake their work without the additional worry of putting their loved ones at risk. Double gloving gives you an added sense of security and that you are doing everything you possibly can to minimise the spread of Covid-19.    

I have long advocated double gloving and it has been welcome to see colleagues adopt it as a technique for maximising surgical safety. So much surgical technique is habit based, and Covid-19 has forced us to evaluate even the smaller details of how we go about doing our work. To encourage reform, our theatre managers have taken in part in Covid-19 training and now two pairs of surgical gloves are available for every member of staff. Simply having them there has prompted much greater usage – if you have them, it is only right to consider using them.

A particular benefit in terms of ensuring the minimisation of risk from Hospital Acquired Infections (HAIs) is when applying dressings at the end of an operative procedure. If you have two pairs of gloves on, you can remove the outer layer, and apply the dressing using the clean pair of gloves you’re still wearing, protecting both you and the patient. You don’t have to reach for a second pair of gloves – saving time and minimising the risk of infection. 

Making the change

A frequent concern of surgeons when they switch to double gloving is around the loss of sensitivity. Surgeons rely on their precision, and I shared the worry that by doubling the amount of material on my skin, my abilities would be compromised. In truth I didn’t notice any difference, as long as the quality of the glove is there. I get the tactile feedback I need – whether this is in breast surgery or a laparoscopic procedure, which I also practice – the feeling and sensitivity are the same and the risk is reduced.

Even before Covid-19, we would always double glove for high risk patients. But now double gloving has become a widespread practice in my team, as we now know that any patient could be deemed high risk. As we train the next generation of surgeons in the post-Covid environment I’m confident that we will continue to ensure that double gloving remains a sensible surgical practice, prioritising the safety of us, our teams and our patients. 

Mr Nathan Coombs is a consultant breast surgeon with over twenty years’ experience in breast surgery, endocrine surgery and general surgery. He is one of only six UK specialists trained to offer Intra-Operative Radiotherapy for breast cancer patients, and is an advisor to the All-Party Parliamentary Group on Cancer. Nathan also serves as a specialist commentator for technology appraisal with the National Institute of Health and Clinical Excellence. Mölnlycke is a proud supporter of Mr Coombs’ work with non-governmental charitable organisation, Mercy Ships, where Nathan teaches a two-day essential surgical skills course in West African countries.