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Cochrane reviews on double-gloving

The efficacy of double-gloving to reduce the risk of an inner-glove perforation and increase the detection of perforations when they occurred has been evaluated in two different Cochrane systematic reviews  .

Surgeon using Biogel gloves with puncture indication
Detection of glove perforation through Biogel


The two Cochrane reviews assessed different aspects of double-gloving and aimed to:

• Assess whether additional glove protection reduces the number of underglove perforations 
• Determine whether there is a clinically significant difference in using extra gloves for preventing needlestick injuries during surgery as well as to evaluate whether double gloving has a negative impact on the healthcare professional's hand skills (dexterity) 


  • Tanner et al, 2006, compared single-gloving, double-gloving and coloured puncture-indicating systems and included 31 randomised controlled trials measuring glove perforations 
  • The review from 2014, included 34 randomised controlled trials measuring glove perforations. Increasing numbers of glove layers (single, double, triple) were evaluated 
  • This review also included four additional gloving methods (glove liner, cloth overgloves, steel-weave overgloves and triple gloves) 
  • Risk was determined through the measurement of perforations and self-reported needlestick injuries. Dexterity was measured via self-reporting and perforation rate 
Cochrane review result chart Adapted from Tanner et al 2006


10 studies in the Tanner review could be systematically reviewed for perforation rates in single versus double-gloving and demonstrated double-gloving was significantly more efficient in preventing perforations in the inner glove: 11% of single gloves perforated; 3% of undergloves perforated with double-gloving.   
Significantly more punctures were detected with Biogel Puncture Indication System gloves.  

Mischke et al also demonstrated that double-gloving significantly reduced the risk for innerglove perforation.  There was no significant difference in outer glove perforations between single- and double-gloving, indicating that there is no loss of dexterity with double gloves.   

The evidence from these two systematic reviews confirms that double-gloving provides better protection against blood contamination and inner glove perforations.   


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