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Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel

  1. Christina Mischke1,
  2. Jos H Verbeek2,*,
  3. Annika Saarto3,
  4. Marie-Claude Lavoie4,
  5. Manisha Pahwa5,
  6. Sharea Ijaz2

Editorial Group: Cochrane Work Group

Published Online: 7 MAR 2014

Assessed as up-to-date: 26 JUN 2013

DOI: 10.1002/14651858.CD009573.pub2


How to Cite

Mischke C, Verbeek JH, Saarto A, Lavoie MC, Pahwa M, Ijaz S. Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD009573. DOI: 10.1002/14651858.CD009573.pub2.

Author Information

  1. 1

    Cochrane Occupational Safety and Health Review Group, Kuopio, Finland

  2. 2

    Finnish Institute of Occupational Health, Cochrane Occupational Safety and Health Review Group, Kuopio, Finland

  3. 3

    Finnish Institute of Occupational Health, Turku, Finland

  4. 4

    University of Maryland Baltimore, Baltimore, Maryland, USA

  5. 5

    University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada

*Jos H Verbeek, Cochrane Occupational Safety and Health Review Group, Finnish Institute of Occupational Health, PO Box 310, Kuopio, 70101, Finland. jos.verbeek@ttl.fi.

Publication History

  1. Publication Status: New
  2. Published Online: 7 MAR 2014

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Characteristics of included studies [ordered by study ID]
Aarnio 2001

MethodsStudy design: randomised controlled trial
Object of randomisation: patient


ParticipantsFinland; September to October 1999

Surgeon and sometimes assistant surgeon

All vascular surgical operations during 2-month trial period (n = 73)


InterventionsIntervention: double gloving with indicator glove (Biogel Indicator, Regent Medical, Malaysia)
Control group: single gloving (Gammex or Nutex, Ansell Medical, Malaysia)


OutcomesIncluded in the review: number of perforations in inner gloves per gloves used

Additional: number of perforations detected during surgery


NotesMissing information per gloving type: number of operations, number of persons per operation; no response to emails


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationHigh riskAccording to year of birth of patient

Allocation concealmentHigh riskYear of birth unlikely concealed

Blinding of study subjectsLow riskSubjects not blinded, low risk of influencing outcome

Blinding of outcome assessorUnclear riskUnknown

Incomplete outcome data (attrition bias)Low riskNo information about excluded data (gloves nor patients); author stated 73 operations were performed and reported data for all of them; more glove pairs than operations which means likely all gloves included in analysis

Selective outcome reporting (reporting bias)Low riskNumber of inner and outer glove perforations per number of gloves used reported

Outcome measure (combined air and water test used?)High riskStandardised water filling test method (EN 455-1), air test missing

Avery 1999a

MethodsStudy design: randomised controlled trial
Object of randomisation: workers


ParticipantsUK

Two senior dental surgeons and three qualified dental hygienists performing routine dental treatments on HIV-positive patients

Number of operations: 67 with double gloves, 71 with single gloves; approximated two persons per operation on average


InterventionsIntervention: two gloves (two surgical gloves or Regent 'reveal' glove system)

Control: one glove (Biogel D, Regent or Surgical glove)


OutcomesOutcome: number of glove perforations
The total number of gloves in each group not reported
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water
Secondary outcomes: subjective opinions of the ease of glove donning, comfort and sensitivity


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information provided

Allocation concealmentUnclear riskNo information provided

Blinding of study subjectsLow risk

Blinding of outcome assessorUnclear riskNo information provided

Incomplete outcome data (attrition bias)Low risk4 out of 138 patients were excluded

Selective outcome reporting (reporting bias)Low riskPerforations

Outcome measure (combined air and water test used?)High riskWater test only (water inflation technique, visual detection for contamination with blood)

Avery 1999b

MethodsStudy design: randomised controlled trial
Object of randomisation: workers


ParticipantsUK
Two principal surgeons and their assistants performing maxillofacial surgery
Number studied: 1061 gloves (113 patients)
Intervention group n = 453 (113 patients); control group n = 608 (113 patients)


InterventionsThe workers used one of two methods of double gloving: standard Regent surgical gloves or the Reveal perforation identification system. Inner glove perforations were used as control


OutcomesOutcome: number of outer glove perforations per total number of gloves
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water
Secondary outcome: glove comfort and sensibility


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskRandomly allocated, no information provided on how

Allocation concealmentUnclear riskNo information

Blinding of study subjectsLow risk

Blinding of outcome assessorUnclear riskNo information

Incomplete outcome data (attrition bias)Low riskAll randomised cases analysed; probably all gloves included

Selective outcome reporting (reporting bias)High riskOnly number of unnoticed outer glove perforations per type of glove reported; number of inner glove perforations missing

Outcome measure (combined air and water test used?)High riskInflating with water only

Berridge 1998

MethodsStudy design: randomised controlled trial
Object of randomisation: not reported


ParticipantsUK
Surgeons, assistants and scrub nurses performing elective and emergency peripheral vascular surgical operations
Number studied: 88 operations
Intervention group n = 43; control group n = 45
Number of gloves not reported


InterventionsDouble gloving
The control group wore single gloves


OutcomesOutcome: proportion of participants with blood-contaminated hand or digit detected by macroscopic evidence; proportion of participants with glove perforation(s)
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNot described

Allocation concealmentUnclear riskNot reported

Blinding of study subjectsLow risk

Blinding of outcome assessorUnclear riskNot reported

Incomplete outcome data (attrition bias)Unclear riskUnclear if all gloves used were collected

Selective outcome reporting (reporting bias)Low riskPerforations in single and double gloves and contamination reported

Outcome measure (combined air and water test used?)High riskWater test only; not reported whether both inner and outer gloves were tested

Carter 1996

MethodsStudy design: randomised controlled trial
Object of randomisation: the order of gloves used


ParticipantsUK
One surgeon performing most common anorectal procedures
Number studied: 280 operations (690 gloves)
Intervention group n = 140 (351 gloves); control group n = 140 (339 gloves)


InterventionsUse of Biogel Super-Sensitive gloves which are thinner but theoretically as strong as standard Biogel gloves. Standard Biogel gloves were used as control


OutcomesOutcome: number of perforated gloves per total number of gloves
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information

Allocation concealmentUnclear riskNot reported; likely decided by surgeon

Blinding of study subjectsLow riskNot possible; knowledge about the gloving method judged as low risk of changing the outcome

Blinding of outcome assessorUnclear riskNo information

Incomplete outcome data (attrition bias)Low riskAll gloves used reported as analysed

Selective outcome reporting (reporting bias)Low riskNumber of gloves with punctures reported

Outcome measure (combined air and water test used?)High riskWater test only

Chua 1996

MethodsStudy design: randomised controlled trial
Object of randomisation: the order of gloves used


ParticipantsUK
Two consultants, two senior registrars and two postgraduate students performing orthodontic procedures
Number studied: 60 patients (716 gloves)
Group 1: n = 238 gloves; Group 2: n = 238 gloves; Group 3: n = 240 gloves


InterventionsIntervention: single gloving with latex glove designed for heavy duty (Biogel D, Regent hospital product)
Control group either single gloving with latex standard (lightweight micro-touch glove, Johnson & Johnson) or single latex-free (N-Dex, Best Manufacturing Europe N.V.)


OutcomesOutcome: number of perforations per total number of gloves
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water. Permanent black ink was added to the water to improve the detection
Secondary outcome: user satisfaction


NotesIntervention: Biogel D
Control: micro-touch


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskOrder of use based on randomisation code

Allocation concealmentLow riskNot concealed until OP; OP were similar; each surgeon used both types of gloves

Blinding of study subjectsLow riskNot possible; knowledge of gloving type judged as low risk of changing the outcome

Blinding of outcome assessorHigh riskNot blinded; 1 investigator assessed all gloves; investigator was one of the surgeons

Incomplete outcome data (attrition bias)Low riskOnly 4 of 720 gloves excluded

Selective outcome reporting (reporting bias)Low riskPerforations reported

Outcome measure (combined air and water test used?)High riskOnly water test

Doyle 1992

MethodsStudy design: randomised controlled trial
Object of randomisation: per operation; two operators were individually randomised to use either one or two standard gloves


ParticipantsUK
Surgeons and their assistants performing operative obstetric and gynaecological procedures involving use of sharp instruments
Number randomised: 150 glove sets (number followed 147)
Intervention group n = 79 (glove sets); control group n = 68 (pairs of gloves)

Total number of operations: 75 (not separately reported for control and intervention)


InterventionsDouble gloves worn by surgeons and/or their assistants in the intervention group
The control group wore single gloves


OutcomesOutcome: the number of perforations per total number of (inner) glove pairs; needlestick injuries; presence of blood on the skin
Measurement: not reported for presence of blood on the skin. Perforation detection: the gloves were filled with water and perforations were noted as a jet of water
Secondary outcome: subjective views on impairment of dexterity when double gloved


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskRandom number tables

Allocation concealmentUnclear riskAt the time of operation

Blinding of study subjectsLow risk

Blinding of outcome assessorUnclear riskGloves were placed in a bag together with a questionnaire (type and other information); unclear if assessor saw the questionnaire

Incomplete outcome data (attrition bias)Low risk

Selective outcome reporting (reporting bias)Low riskthree of four outcomes reported: perforations, needlestick injuries, subjective impairment of dexterity

Not reported: presence of blood

Outcome measure (combined air and water test used?)High riskWater test only; each glove was filled with approximally 500 ml of water and tested for leaks

Duron 1996

MethodsStudy design: randomised controlled trial
Object of randomisation: patient


ParticipantsFrance
One surgeon and two theatre nurses performing operations which comprised central venous cannulation and insertion of implantable catheters with ports
Number studied: 100 operations (216 double glove sets)
Intervention group n = 216 inner gloves; control group n = 216 outer gloves


InterventionsDouble gloving
All participants double gloved and outer gloves were used as controls


OutcomesOutcome: number of (matching) perforations per total number of gloves
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNot described

Allocation concealmentUnclear riskNot described

Blinding of study subjectsLow riskNot possible; knowledge about the gloving method judged as low risk of changing the outcome

Blinding of outcome assessorUnclear riskNot described

Incomplete outcome data (attrition bias)Unclear riskNo information about excluded gloves

Selective outcome reporting (reporting bias)Low riskAll outcomes reported (perforations recognised during OP and with test)

Outcome measure (combined air and water test used?)High riskWater test only

Gani 1990

MethodsStudy design: cluster-randomised controlled trial
Object of randomisation: patients (corresponding to operating teams)


ParticipantsAustralia
Surgeons, assistants and scrub nurses performing other than microsurgical operations
Number studied: 218 operations (1761 gloves)
Intervention group n = 846 gloves; control group n = 915 gloves


InterventionsDouble gloving
The control group was single gloved


OutcomesOutcome: number of perforated gloves. Only matching outer-inner glove perforations were included in the intervention group. Perforation detection: the gloves were filled with water and perforations were noted as a jet of water


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationHigh riskHospital record numbers (odd versus even numbers)

Allocation concealmentUnclear riskNo information provided

Blinding of study subjectsLow riskNot possible

Blinding of outcome assessorHigh riskEach member of the operating team was trained and responsible for testing all the gloves worn by him/her during the case

Incomplete outcome data (attrition bias)Low risk15 out of 233 cases excluded

Selective outcome reporting (reporting bias)Low riskAll outcomes reported

Outcome measure (combined air and water test used?)High riskWater-filling and individual digital distension (no air test)

Hester 1992 o-c

MethodsStudy design: randomised controlled trial
Object of randomisation: patients


ParticipantsUSA
Surgeons and their assistants in consecutive orthopaedic surgeries
Number randomised: 75
Intervention group 1: n = 25; intervention group 2: n = 25; control group: 25


InterventionsIntervention group 1: double gloving with one thicker glove and one cotton glove (outer cotton Protek, inner orthopaedic glove)
Control group was double gloving with one thicker glove (latex inner, orthopaedic glove outer layer)


OutcomesOutcome: the number of inner glove perforations per total number of glove sets
Perforation detection: water leak test


NotesHester 1992 o-c: double latex versus latex-cotton. Hester 1992 o-c-l: double latex versus latex-cotton-latex


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationHigh riskBased on hospital admission day

Allocation concealmentHigh riskNot possible to conceal

Blinding of study subjectsLow riskNot possible; knowledge about the gloving method judged as low risk of changing the outcome

Blinding of outcome assessorUnclear riskNot reported

Incomplete outcome data (attrition bias)Unclear riskNo information

Selective outcome reporting (reporting bias)Low riskPerforation and needlestick, skin contamination

Outcome measure (combined air and water test used?)High riskWater test only

Hester 1992 o-c-o

MethodsSame as Hester 1992 o-c


ParticipantsSame as Hester 1992 o-c


InterventionsIntervention group 2: double gloving plus one cotton glove (outer standard latex, middle Protek cotton, inner orthopaedic glove)
Control group was double gloving including one thicker glove (latex inner, orthopaedic glove outer layer)


OutcomesSame as Hester 1992 o-c


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationHigh riskSame as Hester 1992 o-c

Allocation concealmentHigh risk

Blinding of study subjectsLow risk

Blinding of outcome assessorUnclear risk

Incomplete outcome data (attrition bias)Unclear risk

Selective outcome reporting (reporting bias)Low risk

Outcome measure (combined air and water test used?)High risk

Jensen 1997

MethodsStudy design: randomised controlled trial
Object of randomisation: two participants per OP, each individually randomised to type of glove


ParticipantsDenmark
Principal surgeons and first assistants in consecutive intra-abdominal operations in a county hospital
Number randomised: 400 glove sets
Intervention group n = 200 (glove sets); control group n = 200 (pairs of gloves)


InterventionsDouble gloves worn by surgeons and/or first assistants in the intervention group
The control group wore single gloves


OutcomesOutcome: the number of perforations per total number of (inner) glove pairs
Measurement: double glove barrier was recorded as perforated only if both the inner and the outer glove had one or more leaks
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water
Secondary outcome: participants' opinions about the use of double gloves


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information

Allocation concealmentLow riskEnvelope was opened just before the beginning of the operation

Blinding of study subjectsLow riskKnowledge about the gloving method judged as low risk of changing the outcome

Blinding of outcome assessorUnclear riskNo information

Incomplete outcome data (attrition bias)Unclear riskOnly gloves from the beginning were included; unknown how many gloves were changed and not included

Selective outcome reporting (reporting bias)Low riskPerforated glove barriers reported

Outcome measure (combined air and water test used?)High riskWater test only (filling glove with water and manipulating each digit)

Kovavisarach 1998

MethodsStudy design: randomised controlled trial
Object of randomisation: worker


ParticipantsThailand
Surgeons performing perineorrhaphies
Number studied: 1400 gloves (700 patients)
Intervention group n = 658 gloves; control group n = 742 gloves


InterventionsDouble gloving
Control group was single gloved


OutcomesOutcome: number of (matching) perforations per total number of gloves
Perforation detection: the gloves were filled with air, immersed in water and perforations were noted as air bubbles Secondary outcome: user satisfaction


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskRandomly selected 1 out of 2 envelopes

Allocation concealmentUnclear riskNo information provided

Blinding of study subjectsLow riskKnowledge about the gloving method judged as low risk of changing the outcome

Blinding of outcome assessorHigh riskBags with gloves were labelled with method and other information

Incomplete outcome data (attrition bias)Unclear riskNot reported how many operations or gloves were excluded or missing

Selective outcome reporting (reporting bias)Low riskPerforation rates

Outcome measure (combined air and water test used?)High riskAir test only; filling with air and immersing in water

Kovavisarach 1999

MethodsStudy design: randomised controlled trial
Object of randomisation: patients


ParticipantsThailand
Primary surgeons in 300 caesarean sections in an antenatal clinic
Number randomised: 300
Intervention group n = 150; control group n = 150


InterventionsDouble gloves worn by surgeons in the intervention group (150 glove sets)
The control group wore single gloves (150 glove pairs)


OutcomesOutcome: the number of perforations per total number of glove pairs
Measurement: both matching inner-outer perforations and double-inner perforations were recorded in the intervention group
Perforation detection: the gloves were filled with air and then immersed in water and perforations were noted as air bubbles


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskSealed envelopes, 1 out of 2

Allocation concealmentLow riskRandomisation at the time of operation

Blinding of study subjectsLow riskKnowledge about the gloving method judged as low risk of changing the outcome

Blinding of outcome assessorHigh riskBags with gloves were labelled with method and other information

Incomplete outcome data (attrition bias)Unclear riskNot reported

Selective outcome reporting (reporting bias)Low riskGlove perforation rates

Outcome measure (combined air and water test used?)High riskAir test only, filling with air and immersing in water

Kovavisarach 2002

MethodsStudy design: randomised controlled trial
Object of randomisation: workers


ParticipantsThailand
Primary surgeons and specialist assistants performing total abdominal hysterectomy
Number studied: 544 gloves (170 operations)
Intervention group n = 368 gloves; control group n = 176


InterventionsDouble gloving
Control group was single gloved


OutcomesOutcome: number of (matching) perforations per total number of gloves
Perforation detection: the gloves were filled with air and then immersed in water and perforations were noted as air bubbles


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNot described; comment: probably done as earlier study from the same investigator clearly describes use of random sequences (Kovavisarach 1999)

Allocation concealmentUnclear riskNo information; comment: earlier studies showed low risk (Kovavisarach 1999)

Blinding of study subjectsLow riskKnowledge about the gloving method judged as having a low risk of changing the outcome

Blinding of outcome assessorLow riskAfter OP each glove in separate bag; information coded via number on bag and recorded in separate book; authors were unaware of the kind of gloving method during testing

Incomplete outcome data (attrition bias)Unclear riskVisible perforated gloves were changed during OP and only original gloves were used for the study (missing data); insufficient reporting of the number of exclusions

Selective outcome reporting (reporting bias)Low riskGlove perforation in single and double gloving methods

Outcome measure (combined air and water test used?)High riskAir test only (filling with air and immersing in water)

Laine 2001

MethodsStudy design: randomised controlled trial
Object of randomisation: patients


ParticipantsFinland
Surgeons and assistants performing different types of surgeries
Number studied: 2462 gloves (885 operations)
Intervention group n = 1442; control group n = 1020


Interventions1) Double gloving with an indication system: control group 1 was single gloved, control group 2 was double gloved with two standard gloves

2) Double gloving with two standard gloves; control group was single gloved


OutcomesOutcome: number of (matching) perforations per total number of (inner) gloves
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water


NotesLength of surgery: glove perforations significantly higher in surgeries longer than two hours compared to those less than two hours.

The number of double inner gloves was the sum of indicator system and combination glove inner gloves. The number of double outer gloves was not used, only single gloves


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationHigh riskAccording to year of birth of patient (even or uneven)

Allocation concealmentUnclear riskNo information

Blinding of study subjectsLow riskKnowledge of gloving type judged as low risk

Blinding of outcome assessorUnclear riskGloves were labelled with identification labels; unknown what they were

Incomplete outcome data (attrition bias)Unclear riskOnly first gloves collected; unknown how many excluded

Selective outcome reporting (reporting bias)Low riskGlove perforations

Outcome measure (combined air and water test used?)High riskWater test only (EN455-1)

Laine 2004a

MethodsStudy design: randomised controlled trial
Object of randomisation: workers


ParticipantsFinland
Surgeons and assistant surgeons performing conventional and laparoscopic abdominal operations
Number studied: 806 gloves (271 procedures)
Intervention group n = 358; control group n = 448


InterventionsDouble gloving
Control group was single gloved


OutcomesOutcome: number of perforated gloves per total number of gloves. Only matching outer-inner glove perforations were included in the intervention group
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskProcedure not reported

Allocation concealmentUnclear riskNot reported

Blinding of study subjectsLow riskKnowledge of gloving type judged as low risk

Blinding of outcome assessorUnclear riskNot reported

Incomplete outcome data (attrition bias)Unclear riskNot reported how many operations or gloves were excluded or missing

Selective outcome reporting (reporting bias)Low riskPerforations of gloves

Outcome measure (combined air and water test used?)High riskWater test only: water-leak test (EN 455-1)

Laine 2004b 2R

MethodsStudy design: randomised controlled trial
Object of randomisation: workers


ParticipantsFinland
Principal and assistant surgeons performing orthopaedic and trauma operations
Number studied: 1769 gloves (349 operations)
Intervention group n = 1516; control group n = 224


InterventionsDouble gloving
Control group was single gloved


OutcomesOutcome: number of perforated gloves per total number of gloves. Only matching outer-inner glove perforations were included in the intervention group
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water


NotesIn RevMan analyses we have divided the control group evenly over the 2 study arms with 7/112 each


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information

Allocation concealmentUnclear riskNo information

Blinding of study subjectsLow riskKnowledge of gloving type judged as low risk

Blinding of outcome assessorUnclear riskNo information

Incomplete outcome data (attrition bias)Unclear riskTotal does not include gloves changed during surgery; unknown how many excluded

Selective outcome reporting (reporting bias)Low riskPerforations

Outcome measure (combined air and water test used?)High riskWater test only (EN455-1)

Laine 2004b DI

MethodsStudy design: randomised controlled trial
Object of randomisation: workers


ParticipantsFinland
Principal and assistant surgeons performing orthopaedic and trauma operations
Number studied: 1769 gloves (349 operations)
Intervention group n = 1516; control group n = 224


InterventionsDouble gloving with an indicator glove
Control group 1 was single gloved
Control group 2 was double gloved with two standard gloves


OutcomesOutcome: number of perforated gloves per total number of gloves. Only matching outer-inner glove perforations were included in the intervention group
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskSame as Laine 2004b 2R

Allocation concealmentUnclear risk

Blinding of study subjectsLow risk

Blinding of outcome assessorUnclear risk

Incomplete outcome data (attrition bias)Unclear risk

Selective outcome reporting (reporting bias)Low risk

Outcome measure (combined air and water test used?)High risk

Liew 1995 Double

MethodsStudy design: cluster-randomised controlled trial
Object of randomisation: patients


ParticipantsAustralia
Surgeons, assistants and scrub nurses performing elective orthopaedic operations
Number studied: 579 gloves (107 patients)
Intervention group n = 392; control group n = 187


InterventionsDouble gloving including thicker latex glove (Triflex, Baxter)
Control group: double gloving including thinner latex glove (Gammex, Ansell)


OutcomesOutcome: number of perforated gloves per total number of gloves. Only matching outer-inner glove perforations were included in the intervention group
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water


NotesWe have used the thicker Baxter glove as the comparison glove. Comparison is perforations in inner gloves only


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationHigh riskAccording to unit record number

Allocation concealmentHigh riskNot concealed

Blinding of study subjectsLow riskNot possible; knowledge about the gloving method judged as having a low risk of changing the outcome

Blinding of outcome assessorUnclear riskNot reported

Incomplete outcome data (attrition bias)Unclear riskNot reported

Selective outcome reporting (reporting bias)Low riskPerforations

Outcome measure (combined air and water test used?)High riskWater test only

Liew 1995 Single

MethodsStudy design: cluster-randomised controlled trial
Object of randomisation: patients


ParticipantsAustralia
Surgeons, assistants and scrub nurses performing elective orthopaedic operations
Number studied: 579 gloves (107 patients)
Intervention group n = 392; control group n = 187


InterventionsSingle gloving with thicker latex glove (Triflex, Baxter)
Control group was single gloved with thinner latex glove (Gammex, Ansell)


OutcomesOutcome: number of perforated gloves per total number of gloves. Only matching outer-inner glove perforations were included in the intervention group
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationHigh riskSame as Liew 1995 Double

Allocation concealmentHigh risk

Blinding of study subjectsLow risk

Blinding of outcome assessorUnclear risk

Incomplete outcome data (attrition bias)Unclear risk

Selective outcome reporting (reporting bias)Low risk

Outcome measure (combined air and water test used?)High risk

Louis 1998

MethodsStudy design: randomised controlled trial
Object of randomisation: patients


ParticipantsUS
Surgeons and assistants performing orthopaedic procedures
Number studied: 223 inner gloves (50 operations)
Intervention group n = 106; control group n = 117


InterventionsDouble gloving with polyester/stainless steel wire weave gloves as outer gloves and latex gloves as inner gloves
The control group was double latex gloved


OutcomesOutcome: number of perforated gloves per total number of gloves
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskCards indicating glove type in shuffled envelopes, numbered from 1 to 50

Allocation concealmentLow riskSealed envelopes, opened at time of operation

Blinding of study subjectsLow riskNot possible; knowledge about the gloving method judged as having a low risk of changing the outcome

Blinding of outcome assessorUnclear riskNo information provided

Incomplete outcome data (attrition bias)Unclear riskNot enough data provided

Selective outcome reporting (reporting bias)Low riskGlove perforations

Outcome measure (combined air and water test used?)High riskWater test only

Marín Bertolin 1997

MethodsStudy design: randomised controlled trial
Object of randomisation: not reported


ParticipantsSpain
Surgeons and scrub nurses performing plastic and reconstructive surgery
Number studied: 666 gloves (107 operations)
Intervention group n = 338; control group n = 328


InterventionsDouble gloving
Control group was single gloved


OutcomesOutcome: number of (matching) perforations per total number of (inner) gloves
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water
Secondary outcome: peroperatively detected needlestick injuries


NotesLength of surgery: in surgeries lasting more than two hours, there were many more perforations than in those lasting less than two hours


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskProcedure not reported

Allocation concealmentUnclear riskNo information

Blinding of study subjectsLow risk

Blinding of outcome assessorHigh riskBags were labelled with name and method; unlikely that bags got relabeled before testing, e.g. into numbers from another person then the tester

Incomplete outcome data (attrition bias)Low risk12 out 1092 gloves excluded

Selective outcome reporting (reporting bias)Low riskPerforation rates for single, double-outer and double-inner gloves

Outcome measure (combined air and water test used?)High riskWater test only; 500 ml water and gently squeezed

Naver 2000

MethodsStudy design: cluster-randomised controlled trial
Object of randomisation: patient (operation)


ParticipantsDenmark
Surgeons, assistants and scrub nurses performing elective gastrointestinal surgery
Number studied: 566 glove pairs
Intervention group n = 260; control group n = 306


InterventionsDouble gloving with indicator system
Control group was single gloved


OutcomesOutcome: number of perforations per total number of gloves
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water
Secondary outcomes: incidence of blood contamination of the hands, self detection of glove perforations during surgery


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskProcedure not described

Allocation concealmentUnclear riskNo information

Blinding of study subjectsLow riskNot possible; knowledge about the gloving method judged as having a low risk of changing the outcome

Blinding of outcome assessorUnclear riskNo information

Incomplete outcome data (attrition bias)Unclear riskSome people used more than one pair of gloves but only the first pair was included in analysis; number of excluded cases not reported

Selective outcome reporting (reporting bias)Low riskPunctures in inner and outer gloves

Outcome measure (combined air and water test used?)High riskWater test only, filled with water (EN 455-1)

Nicolai 1997

MethodsStudy design: cluster-randomised controlled trial
Object of randomisation: patients


ParticipantsEngland
Surgeons, first assistants and scrub nurses performing total hip or knee arthroplasty
Number studied: 362 gloves (22 operations)
Intervention group n = 209; control group n = 153


InterventionsDouble gloving with indicator system
Control group used standard double gloves


OutcomesOutcome: number of glove perforations per total number of gloves
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water
Secondary outcome: self detection of glove perforations


NotesExact numbers of inner gloves in both groups are not reported


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNo information

Allocation concealmentLow riskSealed envelopes

Blinding of study subjectsLow riskNot possible; knowledge about the gloving method judged as having a low risk of changing the outcome

Blinding of outcome assessorUnclear riskInformation on labels not described

Incomplete outcome data (attrition bias)Unclear riskNo information

Selective outcome reporting (reporting bias)Low riskGlove perforations reported

Outcome measure (combined air and water test used?)High riskWater test

Pieper 1995 l-k-k

MethodsStudy design: randomised controlled trial
Object of randomisation: workers


ParticipantsUS
Oral and maxillofacial surgery residents and staff performing application of Erich arch bars
Number studied: 270 gloves (30 procedures)
Group 1: n = 60, Group 2: n = 90, Group 3: n = 60, Group 4: n = 60


InterventionsGroup 1: double latex gloving
Group 2: triple gloving including Kevlar glove
Group 3: triple gloving including stainless steel glove
Group 4: triple layer latex gloving


OutcomesOutcome: number of inner glove perforations per total number of gloves
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskProcedure not described

Allocation concealmentUnclear riskNot reported

Blinding of study subjectsLow riskNot possible; knowledge about the gloving method judged as having a low risk of changing the outcome

Blinding of outcome assessorHigh riskAll gloves used for testing purposes were placed in separate bags marked outer glove, inner glove, middle triple, inner triple, inner Kevlar, inner stainless steel

Incomplete outcome data (attrition bias)Unclear riskNot reported

Selective outcome reporting (reporting bias)Low riskGlove perforations

Outcome measure (combined air and water test used?)High riskWater test only

Pieper 1995 l-l-l

MethodsSame as Pieper 1995 l-k-k


Participants


Interventions


Outcomes


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskSame as Pieper 1995 l-k-k

Allocation concealmentUnclear risk

Blinding of study subjectsLow risk

Blinding of outcome assessorHigh risk

Incomplete outcome data (attrition bias)Unclear risk

Selective outcome reporting (reporting bias)Low risk

Outcome measure (combined air and water test used?)High risk

Pieper 1995 l-s-s

MethodsSame as Pieper 1995 l-k-k


Participants


Interventions


Outcomes


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskSame as Pieper 1995 l-k-k

Allocation concealmentUnclear risk

Blinding of study subjectsLow risk

Blinding of outcome assessorHigh risk

Incomplete outcome data (attrition bias)Unclear risk

Selective outcome reporting (reporting bias)Low risk

Outcome measure (combined air and water test used?)High risk

Punyatanasakchai 2004

MethodsStudy design: randomised controlled trial
Object of randomisation: workers


ParticipantsThailand
Surgeons performing episiotomy repairs after vaginal delivery during a 7-month period
Number studied: 900 gloves
Intervention group n = 600; control group n = 300


InterventionsDouble gloving
Control group was single gloved


OutcomesOutcome: number of perforated glove pairs per total number of glove pairs (also in RevMan analyses)
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskProcedure not described

Allocation concealmentUnclear riskNo information provided

Blinding of study subjectsLow riskNot possible; knowledge about the gloving method judged as having a low risk of changing the outcome

Blinding of outcome assessorHigh riskGloves in bags were labelled; re-labelling before testing unlikely

Incomplete outcome data (attrition bias)Unclear riskGloves got changed if visibly perforated and only original gloves were used for study; number of excluded gloves unknown

Selective outcome reporting (reporting bias)Low riskGlove perforation rates

Outcome measure (combined air and water test used?)High riskWater test only

Quebbeman 1992

MethodsStudy design: randomised controlled trial
Object of randomisation: workers


ParticipantsUS
Surgeons and first assistants performing operations which were predicted to last more than 2 hours and to include blood loss of more than 100 ml
Number studied: 284 exposures (involvement of individual surgical team member) (143 procedures)
Intervention group n = 130; control group n = 154


InterventionsDouble gloving
Control group was single gloved


OutcomesOutcome: 1. Number of glove failures per total number of exposures; 2. number of glove cuts per total number of exposures; 3. number of needlestick injuries per total number of exposures
Secondary outcome: ease of use
Measurement: visual detection


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskRandomisation chart

Allocation concealmentHigh riskParticipants could refuse randomisation and wear desired glove type

Blinding of study subjectsLow riskNot possible; knowledge about the gloving method judged as having a low risk of changing the outcome

Blinding of outcome assessorHigh riskNurse inspected finger of surgeons, knowing type of gloves used

Incomplete outcome data (attrition bias)Low riskAll cases analysed

Selective outcome reporting (reporting bias)Low riskBlood contamination of the finger, compliance

Outcome measure (combined air and water test used?)High riskVisual inspection

Rudiman 1999

MethodsStudy design: randomised controlled trial
Object of randomisation: patients


ParticipantsIndonesia
Surgeons and first assistants performing laparotomies
Number studied: 180 gloves (60 operations)
Intervention group n = 60 (27 operations); control group n = 120 (33 operations)


InterventionsDouble gloving
Control group was single gloved


OutcomesOutcome measure: 1. Number of glove pairs with 1 or more inner glove perforations; 2. incidence of blood contamination
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water
Secondary outcome: self detection of glove perforations


NotesOperations that were 2 hours or longer were significantly associated with a higher incidence of glove perforation


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationHigh riskBased on hospital record numbers (odd versus even)

Allocation concealmentUnclear riskNo information

Blinding of study subjectsLow riskNot possible; knowledge about the gloving method judged as having a low risk of changing the outcome

Blinding of outcome assessorHigh riskSelf evaluation by the user of the glove

Incomplete outcome data (attrition bias)High risk12 out of 72 excluded

Selective outcome reporting (reporting bias)Low riskGlove perforation rates for double and single glove method

Outcome measure (combined air and water test used?)High riskWater test only (glove was filled with water to the wrist and each finger was individually pressured)

Sanders 1990

MethodsStudy design: randomised controlled trial
Object of randomisation: workers


ParticipantsUS
Surgeons performing bone manipulation and/or application of implants
Number studied: 110 inner gloves (50 operations)
Intervention group n = 52; control group n = 58


InterventionsDouble gloving with cotton cloth outer gloves and latex inner gloves
Control group used double latex gloves


OutcomesOutcome: number of inner glove perforations per total number of inner gloves
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water
Secondary outcome: self reported glove perforations


NotesIn the control group, the number of punctures increased with the duration of the operation. A puncture was found in all operations longer than 3 hours


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskCards indicating glove type in shuffled envelopes, numbered from 1 to 50

Allocation concealmentLow riskSealed envelopes, opened at time of operation

Blinding of study subjectsLow riskNot possible; knowledge about the gloving method judged as having a low risk of changing the outcome

Blinding of outcome assessorUnclear riskNot reported

Incomplete outcome data (attrition bias)Unclear riskNot reported

Selective outcome reporting (reporting bias)Low riskNumber of inner glove perforations

Outcome measure (combined air and water test used?)High riskWater test only

Sebold 1993

MethodsStudy design: randomised controlled trial
Object of randomisation: operations


ParticipantsUS
Surgeons performing major joint arthroplasty
Number studied: 284 gloves inner or outer gloves (71 operations)
Intervention 1: n = 100; Intervention 2: n = 96; control group: n = 88


Interventions1) Double gloving with thicker glove (orthopaedic outer gloves and latex inner gloves)
Control group was double latex gloves

2) Triple gloving with latex outer gloves, cloth middle gloves and latex inner gloves
Control group 1 was double latex gloved; control group 2 was double gloving with thicker glove


OutcomesOutcome: number of inner glove perforations per total number of inner gloves
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water
Secondary outcome: self detection of glove perforations


NotesDouble versus double: Sebold 1993; triple versus double Sebold 1993


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskCards indicating glove type in envelopes, sealed and shuffled, numbered from 1 to 75

Allocation concealmentLow riskEnvelopes sealed until beginning of OP

Blinding of study subjectsLow riskNot possible; knowledge about the gloving method judged as having a low risk of changing the outcome

Blinding of outcome assessorUnclear riskNot reported

Incomplete outcome data (attrition bias)Low risk3 out of 25 cases in control excluded; 1 out of 25 in cloth glove group excluded

Selective outcome reporting (reporting bias)Low riskPerforations reported for inner, outer, changed gloves

Outcome measure (combined air and water test used?)High riskWater test only

Sutton 1998

MethodsStudy design: randomised controlled trial
Object of randomisation: patients


ParticipantsUK
One surgeon performing hip and knee arthroplasty
Number studied: 118 procedures
Intervention group n = 56; control group n = 62


InterventionsUse of spectra polyethylene fibre gloves (Paraderm) between two layers of latex gloves (Ansell Nutex as inner, Regent Biogel as outer)
Control group used two pairs of latex gloves (Ansell Nutex as inner, Regent Biogel as outer gloves)


OutcomesOutcome: number of inner and outer glove perforations per total number of procedures
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskProcedure not described: "randomised (using sealed envelopes) into two groups"

Allocation concealmentLow riskSealed envelopes

Blinding of study subjectsLow riskNot possible; knowledge about the gloving method judged as having a low risk of changing the outcome

Blinding of outcome assessorLow riskInvestigator testing for punctures was blind to which group the gloves belonged

Incomplete outcome data (attrition bias)Unclear riskAll used gloves were tested; unknown if cases (OPs) were excluded

Selective outcome reporting (reporting bias)Low riskPerforations

Outcome measure (combined air and water test used?)High riskWater test only

Tanner 2006

MethodsStudy design: randomised controlled trial
Object of randomisation: operating teams


ParticipantsUK
Consultants, specialist registrars, senior house officers and scrub nurses performing hip or knee arthroplasty during a 4-month period
Number studied: 406 gloves
Intervention group n = 220; control group n = 186


InterventionsDouble gloving with knitted outer gloves and latex inner gloves
Control group was double latex gloved


OutcomesOutcome: number of inner glove perforations per total number of inner gloves
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water
Secondary outcome: self detection of glove perforations


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskRandom number tables

Allocation concealmentLow riskSealed envelopes until time of OP

Blinding of study subjectsLow riskNot possible; knowledge about the gloving method judged as having a low risk of changing the outcome

Blinding of outcome assessorLow riskTesters checking were blind to which group the gloves belonged

Incomplete outcome data (attrition bias)Unclear riskNot enough information provided

Selective outcome reporting (reporting bias)Low riskInner glove perforations

Outcome measure (combined air and water test used?)High riskWater test only

Thomas 2001

MethodsStudy design: randomised controlled trial
Object of randomisation: workers


ParticipantsIndia
Surgeons and first assistants performing surgical procedures which lasted more than 1 hour
Number studied: 66 procedures (396 gloves)
Intervention group n = 33; control group n = 33


InterventionsDouble gloving
Control group was single gloved


OutcomesOutcome: 1. Number of (matching inner) glove perforations per total number of procedures; 2. number of visible blood contamination cases of the participant's hands per total number of procedures
Perforation detection: firstly, the gloves were filled with air, immersed in water and perforations were noted as air bubbles. Secondly, the gloves were filled with water and perforations were noted as a jet of water


NotesMatching outer-inner glove perforations used in RevMan analyses. Total numbers of inner and outer gloves are not reported. We have therefore presumed that the number of double inner gloves is 1/3 of the total number of gloves and that the number of single gloves is 1/3 of the total number of gloves


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskProcedure not described

Allocation concealmentLow riskSealed envelopes until start of OP

Blinding of study subjectsLow riskNot possible; knowledge about the gloving method judged as having a low risk of changing the outcome

Blinding of outcome assessorUnclear riskNot reported (author contacted, awaiting answer)

Incomplete outcome data (attrition bias)Unclear riskNot reported (author contacted, awaiting answer)

Selective outcome reporting (reporting bias)Low riskOuter and inner glove perforations per gloving type; matched holes for double gloving

Outcome measure (combined air and water test used?)Low riskAir and water test used

Turnquest 1996

MethodsStudy design: randomised controlled trial
Object of randomisation: workers


ParticipantsUS
Primary surgeons, first and second assistants, and surgical technicians performing obstetrical procedures during a 6-month period

Number of glove pairs: intervention group: 169 double glove pairs; control group: 172 single glove pairs


InterventionsDouble gloving
Control group was single gloved


OutcomesOutcome: number of (matching) perforations per total number of gloves
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water
Secondary outcome: recognition of punctures during the procedures


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskComputer-generated set of random numbers

Allocation concealmentLow riskSealed envelopes, opened at the beginning of OP

Blinding of study subjectsLow riskNot possible; knowledge about the gloving method judged as having a low risk of changing the outcome

Blinding of outcome assessorUnclear riskNot reported

Incomplete outcome data (attrition bias)Low riskLess than 10% of gloves excluded: intervention: 44 out of 720; control: 20 out of 364

Selective outcome reporting (reporting bias)Low riskNumber of gloves with perforations

Outcome measure (combined air and water test used?)High riskWater test only

Underwood 1993

MethodsStudy design: randomised controlled trial
Object of randomisation: patient (n = 80)


ParticipantsUK
Surgeons (first and assistant) performing sternal wiring (following cardiac surgery)

Number of inner gloves: intervention group: 80 pairs; control group: 80 pairs


InterventionsIntervention group: double gloving including special material glove (inner latex and outer cotton)

Control group: double standard (inner and outer standard latex glove)


OutcomesOutcome: inner gloves with perforations

Perforation detection: the gloves were filled with water and perforations were noted as a jet of water


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationUnclear riskNot reported

Allocation concealmentUnclear riskNot reported

Blinding of study subjectsLow riskNot possible; knowledge about the gloving method judged as having a low risk of changing the outcome

Blinding of outcome assessorUnclear riskNot reported

Incomplete outcome data (attrition bias)Unclear riskNumber of used, collected and excluded gloves not reported

Selective outcome reporting (reporting bias)Low riskNumber of inner gloves with perforations

Outcome measure (combined air and water test used?)High riskWater leaking test only

Wilson 1996a

MethodsStudy design: randomised controlled trial
Object of randomisation: workers


ParticipantsOman
32 surgeons preforming different types of operations
Number studied: 384 operations
Intervention 1: n = 96; intervention 2: n = 96; intervention 3: n = 96; control group: n = 96


InterventionsComparison of 3 different double gloving combinations:
Intervention 1: normal size inner gloves and larger outer gloves
Intervention 2: larger inner gloves and normal outer gloves
Intervention 3: normal sized inner and outer gloves
Control group was single gloved


OutcomesOutcome measure: number of (inner) glove perforations per total number of operations (also in RevMan analyses) Perforation detection: the gloves were filled with water and perforations were noted as a jet of water
Secondary outcome: user comfort, dexterity


NotesWilson 1996a normal size inner gloves and larger outer gloves versus single gloving. Wilson 1996b larger inner gloves and normal outer gloves versus single gloving. Wilson 1996c normal sized inner and outer gloves versus single gloving


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskThe order of the gloving method was randomised by drawing the letters A, B, C, D out of a sealed envelope

Allocation concealmentUnclear riskNo information

Blinding of study subjectsLow riskNot possible; knowledge about the gloving method judged as having a low risk of changing the outcome

Blinding of outcome assessorUnclear riskNo information

Incomplete outcome data (attrition bias)Unclear riskNot reported how many operations or gloves were excluded or missing

Selective outcome reporting (reporting bias)Low riskAll outcomes reported

Outcome measure (combined air and water test used?)High riskInflating with water, trying to cuff and squeezing the palm and each finger in turn, looking for the fine spray of water (water test only, no air test)

Wilson 1996b

MethodsSame as Wilson 1996a


Participants


Interventions


Outcomes


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskSame as Wilson 1996a

Allocation concealmentUnclear risk

Blinding of study subjectsLow risk

Blinding of outcome assessorUnclear risk

Incomplete outcome data (attrition bias)Unclear risk

Selective outcome reporting (reporting bias)Low risk

Outcome measure (combined air and water test used?)High risk

Wilson 1996c

MethodsSame as Wilson 1996a


Participants


Interventions


Outcomes


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Adequate sequence generationLow riskSame as Wilson 1996a

Allocation concealmentUnclear risk

Blinding of study subjectsLow risk

Blinding of outcome assessorUnclear risk

Incomplete outcome data (attrition bias)Unclear risk

Selective outcome reporting (reporting bias)Low risk

Outcome measure (combined air and water test used?)High risk

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Brunton 2000The aim of the intervention was not to reduce perforations - two single, non-sterile, powder-free gloves compared

Caillot 1999Double versus single gloving; outcome: number of electronic alarms rather than exposure injuries

Duerink 2006No injury outcome

Gaujac 2007The aim of the intervention was not to reduce perforations - double gloving with sterile gloves compared to double gloving with one sterile and one non-sterile glove

Jeffe 1999No injury outcome

Kelly 1993Unclear randomisation and significant differences between intervention and control group

 
Characteristics of studies awaiting assessment [ordered by study ID]
Bliss 1992

MethodsStudy design: cluster-randomised controlled trial
Object of randomisation: calendar day

ParticipantsUK
Surgeons, assistants and scrub nurses
Number studied: 2604 gloves
Group 1: n = 1378; Group 2: n = 1226
Not reported which group is intervention and which is control

InterventionsComparison of 2 different glove types in single gloving situations

OutcomesOutcome: number of glove perforations per total number of gloves
Perforation detection: the gloves were filled with air, immersed in water and perforations were noted as air bubbles

NotesThe comparison was between cheaper and more expensive gloves; the authors did not report which is which

Guo 2012

MethodsStudy design: randomised controlled trial

ParticipantsNurses

InterventionsDouble versus single gloves

OutcomesPerforations

Notes

Hwang 1999b

MethodsStudy design: randomised controlled trial
Object of randomisation: workers

ParticipantsTaiwan
35 physicians, 30 nurses and 1 technician routinely wearing rubber gloves
Number studied: 336 gloves
Group 1: n = 80; Group 2: n = 148; Group 3: n = 46; Group 4: n = 62

InterventionsComparison of four different types of (single) gloves

OutcomesOutcome: number of perforated or torn gloves per total number of gloves
Perforation detection: visual examination
Secondary outcome: user satisfaction, allergic reactions

NotesNot reported which were intervention gloves and which were control gloves

Hwang 1999c

MethodsStudy design: randomised controlled trial
Object of randomisation: workers

ParticipantsTaiwan
35 physicians, 30 nurses and 1 technician routinely wearing rubber gloves
Number studied: 336 gloves
Group 1: n = 80; Group 2: n = 148; Group 3: n = 46; Group 4: n = 62

InterventionsComparison of four different types of (single) gloves

OutcomesOutcome: number of perforated or torn gloves per total number of gloves
Perforation detection: visual examination
Secondary outcome: user satisfaction, allergic reactions

NotesNot reported which were intervention gloves and which were control gloves

Hwang 1999d

MethodsStudy design: randomised controlled trial
Object of randomisation: workers

ParticipantsTaiwan
35 physicians, 30 nurses and 1 technician wearing routinely rubber gloves
Number studied: 336 gloves
Group 1: n = 80; Group 2: n = 148; Group 3: n = 46; Group 4: n = 62

InterventionsComparison of four different types of (single) gloves

OutcomesOutcome: number of perforated or torn gloves per total number of gloves
Perforation detection: visual examination
Secondary outcome: user satisfaction, allergic reactions

NotesNot reported which were intervention gloves and which were control gloves

Newsom 1998

MethodsStudy design: randomised controlled trial
Object of randomisation: operations

ParticipantsUK
General surgeons and urologists performing open and endoscopic surgery
Number studied: 670 gloves (317 operations)
Intervention group n = 348; control group n = 322

InterventionsUse of powder-free, non-latex surgical gloves
Control group used standard surgical gloves

OutcomesOutcome: 1. Number of perforated gloves per total number of gloves; 2. number of perforated glove pairs per total number of glove pairs; 3. number of perforated gloves per total number of operations
Perforation detection: the gloves were filled with water and perforations were noted as a jet of water

NotesUnclear if intervention intends to prevent needlestick injuries; comparison is possibly single thicker versus single thin; awaiting answer from manufacturer

 
Comparison 1. Double versus single gloves

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Inner glove perforations12Rate Ratio (Fixed, 95% CI)0.29 [0.23, 0.37]

    1.1 Number of perforations
10Rate Ratio (Fixed, 95% CI)0.33 [0.24, 0.44]

    1.2 Number of gloves with perforations
2Rate Ratio (Fixed, 95% CI)0.22 [0.15, 0.34]

 2 Matched inner glove perforations4Rate Ratio (Fixed, 95% CI)0.11 [0.05, 0.20]

    2.1 Number of perforations
4Rate Ratio (Fixed, 95% CI)0.11 [0.05, 0.20]

 3 Needlestick injuries2Rate Ratio (Fixed, 95% CI)0.58 [0.21, 1.62]

    3.1 Per pair of gloves
2Rate Ratio (Fixed, 95% CI)0.58 [0.21, 1.62]

 4 Incidences of blood contamination3819Rate Ratio (Fixed, 95% CI)0.35 [0.17, 0.70]

 5 Dexterity: VAS scoreOther dataNo numeric data

 6 Dexterity: outer glove perforations8Rate Ratio (Fixed, 95% CI)1.10 [0.93, 1.31]

    6.1 Number of perforations
6Rate Ratio (Fixed, 95% CI)1.05 [0.83, 1.33]

    6.2 Number of gloves with perforations
2Rate Ratio (Fixed, 95% CI)1.15 [0.90, 1.48]

 
Analysis 1.5 Comparison 1 Double versus single gloves, Outcome 5 Dexterity: VAS score.
Dexterity: VAS score

StudyNotesDouble glovesSingle gloves

Avery 1999aVAS 1 to 10 (1-2 = very poor, 3-4 = poor,

5-6 = average, 7-8 = good, 9-10 = very good)
Median (interquartile range):Median (interquartile range):

Avery 1999aComfort:Double standard: 4 (3 to 6) (poor)

Double indicator: 5 (4 to 6) (average)
Single surgical: 7 (6 to 8) (good)

Single Biogel: 8 (7 to 9) (good)

Avery 1999aSensitivity:Double standard: 4 (3 to 5) (poor)

Double indicator 5 (4 to 6) (average)
Single surgical 7 (6 to 9) (good)

Single Biogel 8 (7 to 8) (good)

Avery 1999a

Avery 1999a

Avery 1999a

Avery 1999a

Wilson 1996aVAS 1 to 5: (1 = poor, 2 = fair, 3 = good,

4 = very good, 5 = excellent)
MedianMedian

Wilson 1996aComfort:Double larger outside: 3 (good)Single standard: 4 (very good)

Wilson 1996aInstrument handling:Double larger outside: 3 (good)Single standard: 4 (very good)

Wilson 1996aNeedle loading:Double larger outside: 3 (good)Single standard: 4 (very good)

Wilson 1996aKnot tying:Double larger outside: 3 (good)Single standard: 4 (very good)

Wilson 1996aTissue handling:Double larger outside: 3 (good)Single standard: 4 (very good)

Wilson 1996aHand sensitivity:Double larger outside: 3 (good)Single standard: 4 (very good)

Wilson 1996bVAS 1 to 5: (1 = poor, 2 = fair, 3 = good,

4 = very good, 5 = excellent)
MedianSame group as Wilson 1996a

Wilson 1996bComfort:Double larger inside: 3 (good)

Wilson 1996bInstrument handling:Double larger inside: 3 (good)

Wilson 1996bNeedle loading:Double larger inside: 3 (good)

Wilson 1996bKnot tying:Double larger inside: 3 (good)

Wilson 1996bTissue handling:Double larger inside: 3 (good)

Wilson 1996bHand sensitivity:Double larger inside: 3 (good)

Wilson 1996cVAS 1 to 5: (1 = poor, 2 = fair, 3 = good,

4 = very good, 5 = excellent)
MedianSame group as Wilson 1996a

Wilson 1996cComfort:Double normal size: 2 (fair)

Wilson 1996cInstrument handling:Double normal size: 3 (good)

Wilson 1996cNeedle loading:Double normal size: 3 (good)

Wilson 1996cKnot tying:Double normal size: 3 (good)

Wilson 1996cTissue handling:Double normal size: 3 (good)

Wilson 1996cHand sensitivity:Double normal size: 2 (fair)

 
Comparison 2. Triple versus double gloves

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Inner glove perforations1Rate Ratio (Fixed, 95% CI)Totals not selected

    1.1 Number of perforations
1Rate Ratio (Fixed, 95% CI)0.0 [0.0, 0.0]

 
Comparison 3. Double special versus double normal

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Inner glove perforations4Rate Ratio (Random, 95% CI)Subtotals only

    1.1 Fabric glove, number of perforations
2Rate Ratio (Random, 95% CI)0.27 [0.03, 2.96]

    1.2 Fabric glove, number of gloves with perforations
1Rate Ratio (Random, 95% CI)0.17 [0.06, 0.43]

    1.3 Wire weave glove, number of gloves with perforations
1Rate Ratio (Random, 95% CI)0.73 [0.38, 1.38]

 2 Dexterity: VAS scoreOther dataNo numeric data

 
Analysis 3.2 Comparison 3 Double special versus double normal, Outcome 2 Dexterity: VAS score.
Dexterity: VAS score

StudyNotesDouble glovesSingle gloves

Tanner 2006VAS 0 to 1: double with fabric glove versus

double latex (0 = better than latex; 0.5 = same as latex, 1 = worse than latex)
Mean score (range) (N = 18)

Tanner 2006Tactile sensation0.83 (0.5 to 1)

Tanner 2006General dexterity0.76 (0.5 to 1)

Tanner 2006Precision instrumentation0.78 (0.25 to 1)

Tanner 2006Grip and power0.63 (0.25 to 1)

Tanner 2006Handling cement0.62 (0.43 to 1)

Tanner 2006Comfort0.62 (0.5 to 1)

 
Comparison 4. Triple special versus double normal

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Inner glove perforations5Rate Ratio (Fixed, 95% CI)0.24 [0.13, 0.45]

    1.1 Fabric
2Rate Ratio (Fixed, 95% CI)0.33 [0.11, 0.99]

    1.2 Spectra polyethylene fibre
1Rate Ratio (Fixed, 95% CI)0.33 [0.12, 0.88]

    1.3 Kevlar
1Rate Ratio (Fixed, 95% CI)0.06 [0.01, 0.50]

    1.4 Steel
1Rate Ratio (Fixed, 95% CI)0.12 [0.03, 0.59]

 
Comparison 5. Thicker versus thinner

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Inner glove perforations5Rate Ratio (Random, 95% CI)0.63 [0.37, 1.08]

    1.1 Number of perforations
2Rate Ratio (Random, 95% CI)0.34 [0.18, 0.65]

    1.2 Number of gloves with perforations
3Rate Ratio (Random, 95% CI)0.85 [0.53, 1.35]

 2 Matched perforations1Rate Ratio (Fixed, 95% CI)Totals not selected

    2.1 Number of gloves with matched perforations
1Rate Ratio (Fixed, 95% CI)0.0 [0.0, 0.0]

 
Comparison 6. Thick versus glove combinations

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Inner glove perforations1Rate Ratio (Random, 95% CI)Totals not selected

    1.1 Standard glove + fabric glove, number of perforations
1Rate Ratio (Random, 95% CI)0.0 [0.0, 0.0]

 
Comparison 7. Double indicator versus standard

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 First glove: inner perforations1Rate Ratio (Fixed, 95% CI)0.10 [0.02, 0.45]

    1.1 Double versus single, number of perforations
1Rate Ratio (Fixed, 95% CI)0.06 [0.01, 0.49]

    1.2 Double versus double, number of perforations
1Rate Ratio (Fixed, 95% CI)0.17 [0.02, 1.44]

 2 First glove: matched perforations2Rate Ratio (Random, 95% CI)0.09 [0.03, 0.29]

    2.1 Double versus single, number of glove pairs with perforations
1Rate Ratio (Random, 95% CI)0.13 [0.06, 0.31]

    2.2 Double versus single, number of gloves with perforations
1Rate Ratio (Random, 95% CI)0.04 [0.00, 0.26]

 3 All used gloves: inner glove perforations2Rate Ratio (Random, 95% CI)0.72 [0.36, 1.42]

    3.1 Double versus double, number of perforations
2Rate Ratio (Random, 95% CI)0.72 [0.36, 1.42]

 4 Dexterity: VAS scoreOther dataNo numeric data

 
Analysis 7.4 Comparison 7 Double indicator versus standard, Outcome 4 Dexterity: VAS score.
Dexterity: VAS score

StudyNotesDouble indicatorDouble standard

Avery 1999bVAS 1 to 10 (values not provided for

all scores; 7 = good, 6 = adequate)
Median (interquartile range):Median (interquartile range):

Avery 1999bComfortDouble indicator: 6 (5 to 7) (= adequate)Double standard: 6 (5 to 7) (= adequate)

Avery 1999bSensitivityDouble indicator: 5 (4 to 6) (= adequate)Double standard: 5 (4 to 6) (= adequate)

 
Comparison 8. Subgroup analysis: prevalence, double versus single

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Inner glove perforations12Rate Ratio (Fixed, 95% CI)0.29 [0.23, 0.37]

    1.1 HIV > 1% or hepatitis C > 2%
10Rate Ratio (Fixed, 95% CI)0.28 [0.22, 0.37]

    1.2 HIV < 1% and hepatitis C < 2%
2Rate Ratio (Fixed, 95% CI)0.38 [0.15, 0.96]

 
Comparison 9. Subgroup analysis: income of countries, double versus single

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Inner glove perforations12Rate Ratio (Fixed, 95% CI)0.29 [0.23, 0.37]

    1.1 Low and middle-income
6Rate Ratio (Fixed, 95% CI)0.34 [0.24, 0.47]

    1.2 High-income countries
6Rate Ratio (Fixed, 95% CI)0.23 [0.16, 0.34]

 
Comparison 10. Subgroup analysis: exposure, double versus single

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Inner glove perforations12Rate Ratio (Fixed, 95% CI)0.29 [0.23, 0.37]

    1.1 Low exposure: < 0.20 perforations
8Rate Ratio (Fixed, 95% CI)0.31 [0.22, 0.43]

    1.2 High exposure: > 0.20 perforations
4Rate Ratio (Fixed, 95% CI)0.27 [0.19, 0.39]

 
Summary of findings for the main comparison. Double gloves compared to single gloves for preventing percutaneous exposure injuries in healthcare personnel

Double gloves compared to single gloves for preventing percutaneous exposure injuries in healthcare personnel

Patient or population: healthcare personnel
Settings: operating theatre
Intervention: double gloves
Comparison: single gloves

OutcomesIllustrative comparative risks* (95% CI)Relative effect
(95% CI)
No of participants
(studies)
Quality of the evidence
(GRADE)
Comments

Assumed riskCorresponding risk

Single glovesDouble gloves

Inner glove perforations
Water leak test or air test
Follow-up: median 1 operation
Study populationRate ratio 0.29
(0.23 to 0.37)
3437
(12 studies)
⊕⊕⊕⊝
moderate1,2
Includes 10 studies which measured the number of perforations and 2 studies which measured the number of gloves with 1 or more perforation
Assumed risk calculated as the mean across the 10 studies that measured the number of perforations
Risk expressed as the number of perforations per 1000 person-operations

172 per 100050 per 1000
(40 to 64)

Low

7 per 10002 per 1000
(2 to 3)

High

280 per 100081 per 1000
(64 to 104)

Dexterity: outer glove perforations - number of perforations
Water leak test or air test
Follow-up: median 1 operation
Study populationRate ratio 1.10
(0.93 to 1.31)
2817
(8 studies)
⊕⊕⊕⊝
moderate2,3
Includes 6 studies that measured the number of perforations and 2 studies that measured the number of gloves with 1 or more perforations
Assumed risk calculated as the mean across the 6 studies that measured the number of perforations

Risk expressed as the number of perforations per 1000 person-operations

178 per 1000195 per 1000
(165 to 233)

Low

8 per 10009 per 1000
(7 to 10)

High

290 per 1000319 per 1000
(270 to 380)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

 1In most studies the outcome assessor was not blinded (n = 5) or it was unclear if the outcome assessors were blinded (n = 6). Only one study used a combined air and water test for the outcome assessment. In most studies the randomisation (sequence generation, concealment) was unclear (n = 9) and two studies had a high risk of bias.
2Heterogeneity: I² = 0%.
3In most studies the outcome assessor was not blinded (n = 5) or it was unclear if the outcome assessors were blinded (n = 2). Only one study used a combined air and water test for the outcome assessment. In most studies the randomisation (sequence generation, concealment) was unclear (n = 5) and two studies had a high risk of bias.
 
Table 1. Raw data: increasing glove layers

InterventionControlRate ratio95% CI





Study# Events# Persons

per

operation
# Operations

(or glove

pairs)
Rate per

person per

operation
# Events# Persons

per

operation
# Operations

(or glove

pairs)
Rate per

person per

operation
RRlnRRSE1LowerUpper

Intervention: increasing glove layers
Comparison: double versus single

Outcome: matched perforations per person-operation

Kovavisarach 199821.003290.0061531.003710.14290.043-3.1570.7203

Kovavisarach 200211.00820.0122201.00880.22730.054-2.9251.0247

Punyatanasakchai 200431.001500.0200271.001500.18000.111-2.1970.6086

Thomas 200141.00660.0606191.00660.28790.211-1.5580.5501

Outcome: inner glove perforations per person-operation

Gani 1990223.861030.05531083.851150.24390.227-1.48350.2339

Rudiman 199931.00600.0500151.00600.25000.200-1.6090.6325

Avery 1999a0.51.85670.004011.83710.00770.524-0.6461.7321

Kovavisarach 1998191.003290.0578531.003710.14290.404-0.9060.2674

Kovavisarach 199931.001500.0200161.001500.10670.188-1.6740.6292

Kovavisarach 200251.00820.0610201.00880.22730.268-1.3160.5000

Laine 2004b 2R61.41900.0473141.3681.00.12710.372-0.9890.4880

Punyatanasakchai 200471.001500.0467271.001500.18000.259-1.34990.4241

Thomas 2001101.00660.1515191.00660.28790.526-0.6420.3907

Wilson 1996a21.00960.02084.71.00320.14580.143-1.9460.8452

Wilson 1996b21.00960.02084.71.00320.14580.143-1.9460.8452

Wilson 1996c31.00960.03134.71.00320.14580.214-1.5400.7400

Outcome: matched perforations per glove pair

Jensen 199781000.0800401000.40000.200-1.6090.38730.090.43

Outcome: inner glove perforations per glove pair/gloves

Aarnio 20010.5196 (gloves)0.002612204 (gloves)0.05880.043-3.1381.4430.000.73

Jensen 1997121000.1200401000.40000.3-1.2040.3290.160.57

Marín Bertolin 1997143380.0414313280.09450.438-0.8250.3220.230.82

Doyle 19923790.038024680.35290.108-2.2290.6120.030.36

Outcome: number of inner glove perforations

Berridge 1998418

Laine 2001638

Outcome: outer glove perforations per person-operation

Avery 1999a31.85670.024211.83710.00773.14471.14571.1547

Gani 19901173.861030.29431083.851150.24391.20640.18770.1334

Kovavisarach 1998411.003290.1246531.003710.14290.8723-0.13660.2080

Kovavisarach 1999201.001500.1333161.001500.10671.25000.22310.3354

Kovavisarach 2002161.00820.1951201.00880.22730.8585-0.15250.3354

Punyatanasakchai 2004341.001500.2267271.001500.18001.25930.23050.2578

Rudiman 1999121.00600.2000151.00600.25000.8000-0.22310.3873

Thomas 2001221.00660.3333191.00660.28791.15790.14660.3132

Outcome: outer glove perforations per glove pair

Aarnio 200131960.0153122040.05880.2602-1.34630.64550.070.92

Doyle 199221790.265824680.35290.7532-0.28350.29880.421.35

Jensen 1997471000.4700401000.40001.17500.16130.21510.771.79

Marín Bertolin 1997383430.1108313350.09251.19720.18000.24200.751.92

Outcome: number of outer glove perforations

Berridge 19982818

Outcome: blood stains on the skin per person-operation

Avery 1999a01.856701.8371

Naver 200022.66980.0077152.661150.04900.156-1.85490.7528

Rudiman 199941.00600.0667131.00600.21670.308-1.17870.5718

Thomas 200151.00660.075881.00660.12120.625-0.47000.5701

Outcome: number of blood stains on the skin

Berridge 199848

Outcome: needlestick injuries per used glove pair

Doyle 19921790.01273680.04410.287-1.24861.15470.032.76

Marin-Bertolin 199753430.014673350.02090.698-0.36010.58550.222.20

Intervention: increasing glove layers
Comparison: triple versus double

Outcome: inner glove perforations per person-operation

Pieper 1995 l-l-l0.51.00150.0333161.00151.06670.031-3.4661.4361

 1Calculation: SE = SQRT(1/intervention events + 1/control events)
CI: confidence interval; RR: rate ratio; lnRR natural logarithm of the rate-ratio; SE: standard error
 
Table 2. Raw data: special gloves

InterventionControlRate ratio95% CI





Study# Events# Persons

per

operation
# Operations

(or glove

pairs)
Rate per

person

per

operation
# Events# Persons

per

operation
# Operations

(or glove

pairs)
RateRRlnRRSELowerUpper

Intervention: special gloves
Comparison: double special versus double normal

Outcome: inner glove perforations per person-operation

Hester 1992 o-c73.50250.080083.50250.09140.875-0.1340.5176

Louis 1998162.00250.3200222.00250.44000.727-0.3190.3286

Sanders 199021.00250.0800261.00251.04000.077-2.5650.7338

Underwood 199352.00400.0625302.00400.37500.167-1.7910.4830

Outcome: inner glove perforations per glove pair

Tanner 200612730.1644421100.38180.431-0.8430.32730.230.82

Intervention: special gloves
Comparison: thicker versus thinner gloves

Outcome: matched perforations per person-operation

Liew 1995 Double23.00320.02083373.00320.07290.286-1.2530.8018

Outcome: inner glove perforations per person-operation

Carter 1996611.001400.4357771.001400.55000.792-0.2330.1714

Chua 199691.001190.0756691.002380.28990.261-1.3440.3544

Liew 1995 Double123.00320.1250193.00320.19790.632-0.4590.3687

Liew 1995 Single93.00220.136443.00210.06352.1480.7640.6009

Sebold 199381.00250.3200141.00220.63640.503-0.6870.4432

Intervention: special gloves
Comparison: triple special versus double normal

Outcome: inner glove perforations per person-operation

Hester 1992 o-c-o43.50250.045783.50250.09140.500-0.6930.6124

Pieper 1995 l-k-k11.00150.066781.007.51.06670.063-2.7731.0607

Pieper 1995 l-s-s21.00150.133381.007.51.06670.125-2.0790.7906

Sebold 19930.51.00240.0208141.00220.63640.033-3.4191.4392

Sutton 199851.00560.0893171.00620.27420.326-1.1220.5088

Intervention: special gloves
Comparison: thick glove versus glove combination

Outcome: inner glove perforations per person-operation

Sebold 199381.00250.32000.51.00240.020815.3602.7321.458

Outcome: matched perforations per glove pair

Turnquest 1996121720.0698121690.07100.983-0.0180.40820.442.19

Outcome: blood stains on the skin per glove pair

Turnquest 199621720.011621690.01180.983-0.01761.00000.146.98

 See footnotes  Table 1.
 
Table 3. Raw data: indicator gloves

InterventionControlRate Ratio95% CI





Study# Events# Persons

per

operation
# Operations

(or glove

pairs)
Rate per

person

per

operation
# Events# Persons

per

operation
# Operations

(or glove

pairs)
Rate per

person

per

operation
RRlnRRSELowerUpper

Intervention: indicator gloves
Comparison: first glove: indicator glove versus standard glove

Outcome: matched perforations per person-operation

Laine 2004a11.001150.0087381.001560.24360.036-3.3331.0131

Naver 200062.66980.0230532.661150.17330.133-2.0190.4307

Outcome: inner glove perforations per person-operation

Laine 2004b DI (versus double)11.3888.50.008261.41900.04730.173-1.7531.0801

Laine 2004b DI (versus single)11.3888.50.0082141.36810.12710.064-2.7421.0351

Outcome: number of glove perforations

Laine 2001 (versus single)638

Laine 2001 (versus double)66

Intervention: indicator gloves
Comparison: all gloves: double indicator versus double standard

Outcome: inner glove perforations per person-operation

Duron 199611.00540.01850.51.00460.01091.70370.53281.7321

Nicolai 1997163.00130.4103163.0090.59260.6923-0.36770.3536

 See footnotes  Table 1.