During the closed gloving process the scrub person keeps the hands inside the cuffs of the sterile gown.Either hand can be gloved first (right or left) when establishing the sterile field,
1.If the gloves are still in the folded inner paper wrapper, they need to be opened.Using the cuff-covered hands, place the wrapper in front of you like a book.Open the two sides.There is an inner fold to the glove wrapper.With the two cuffed-covered hands grasp the lower inner corners of the bottom fold.Lift both corners open and fold under at the same time.When this method is used the wrapper will remain open and not fall closed during the gloved process.
2.Extend the (right or left) forearm with the palm upward (supinated).
3.With the cuff-covered (right or left) hand, pick up the left glove from the inner wrap of the glove package by grasping the fingers, lifting straight up, and placing the glove on the left palm thumb side down.The glove fingers will be pointing toward the body.
4.Grasp the edges of the glove cuff with the cuffed (right or left) hand and the opposite edge with the cuffed (right or left) hand.Peel the glove over the (right or left) cuffed hand, over the end of the (right or left) sleeve, and wiggle the finders to extend them into the glove-covered (right or left) hand.The cuff of the (right or left) glove is now over the stockinette cuff of the gown, with the hand still inside the sleeve.
5.Grasp the cuff of the (left or right)) glove, and underlying (right or left) gown sleeve with the covered (right or left) hand.Pull the glove on over the extended left fingers, until it completely covers the stockinette cuff.
6.Glove the (left or right) hand in the same manner, reversing hands.Use the sterile gloved (right or left) hand to grasp the fingers of the (right or left) glove and position the glove on the (right or left) forearm.Be sure that the entire cuff of each sleeve is contained within the sterile glove.
Open Gloving Technique (page 279)
Gowning for the open gloving method is the same as for the closed gloving method.The only difference is that the scrubbed person extends the hands all the way through the cuffs and sleeves.The hands are totally exposed outside the cuffs.This method is not preferred for the person establishing the sterile field, but is used when changing a contaminated glove.Either hand can be gloved first.
The open gloving method uses a skin-to-skin, glove-to-glove technique.The hand, although scrubbed, is not sterile and must not contact the exterior of the sterile gloves.The everted cuff on the gloves exposes the inner surfaces.The first glove is put on with the skin-to skin technique, bare hand to inside cuff.The sterile fingers of that gloved hand then may touch the sterile exterior of the second glove (i.e.., glove-to-glove technique).
1.With the (right or left) hand, grasp the inner edge of the cuff of the (left or right) glove and lift from the wrapper.Take care not to touch the inner aspect of the wrapper or the sterile exterior portions of the glove.
2.Align the fingers of the (right or left) hand, and insert the (right or left) hand into the glove, pulling it on, leaving the cuff turned well down over the hand.Be sure to keep the thumb adducted into the palm of the hand until it is well inside the confines of the glove.Do not adjust the cuff.This will be done as a last step.
3.Slip the fingers of the sterile gloved (right or left) hand under the everted (right or left) cuff, on the sterile side of the (right or left) glove.Pick up the glove, and step back.
4.Align the fingers of the (right or left) hand and insert the (right or left) hand into the (right or left) glove, keeping the thumb adducted until well inside the glove.Pull the (right or left) glove on all the way, unfolding the cuff, and enclosing the knitted (right or left) cuff at the wrist.
5.With the sterile gloved fingers of the (right or left) hand, pull the cuff of the (left or right) glove up and over the knitted cuff of the sleeve.Avoid touching the bare wrist.Sterile surfaces may touch only sterile surfaces.
We're very familiar with the method, we've been using/teaching it for many years.
What I'm looking for is evidence (not theory) supporting that it is the preferred method to open gloving - I'll check out the text you named, Kathy, to see if their bibliography includes good references for evidence. We are reaching out to procedural areas as well, but was hoping one of you would have it at your fingertips.
Anyone else have evidence?
Thanks,
Mari
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
Gowning for the open gloving method is the same as for the closed gloving method.The only difference is that the scrubbed person extends the hands all the way through the cuffs and sleeves.The hands are totally exposed outside the cuffs.This method is not preferred for the person establishing the sterile field, but is used when changing a contaminated glove.Either hand can be gloved first.
The above is right out of Berry and Kohn. That is the statement you want the reference for. they suggest closed gloveing for person estsablishing stereile field
I will relook at the AORN guidelines I have and see if they make a statement
I don't have a reference for you but it's a no brainer. To use open gloving technique with a sterile gown takes lots of practice to do correctly. I was taught the procedure in OR Tech school in the Navy 26 years ago. I have been in the OR ever since until I got this PICC Nurse job. We were required to close glove for the first 5 months of school so it was ingrained in our brain. In over 20 years in the OR I have never seen it done correctly without potential for contamination. I have asked OR Nurses and Surgical Techs and have never found one who knew how to do it correctly. I asked a Surgical Tech Instructor if he taught the technique and he didn't know what I was talking about. You can teach anyone to closed glove in 5 minutes. There is zero chance of contamination as long as your hands remain inside the gown. The only time open gloving is to be used, if they know how, is when one glove is contaminated and you don't have another person scrubbed in to glove you. With a gown, open gloving requires that the end of the glove is stretched over the entire cuff of the gown. The cuff is not considered sterile once you have put your hand through it. It's not easy unless you have done it 4 or 500 times. I would just tell them they don't understand the principles of sterile technique if they think open gloving while gowning is better than closed. We don't need research based evidence for everything. Some things are just too obvious. IMHO
What is "closed gloving"? Thank you!
Artie Hansford, BSN, CRNI, VA-BC
For evidence, check with your surgical nurses. I'm sure they have the answer there.
To answer the question of what is closed gloving, here is a good youtube video
youtu.be/vCjoo6LOwz8
Darilyn
This video is a little shorter, describing just the closed gloving sequence.
wikivet.mediacore.tv/media/clinical-skills-how-to-closed-glove
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
Closed Gloving Technique (Berry p 279)
During the closed gloving process the scrub person keeps the hands inside the cuffs of the sterile gown. Either hand can be gloved first (right or left) when establishing the sterile field,
1. If the gloves are still in the folded inner paper wrapper, they need to be opened. Using the cuff-covered hands, place the wrapper in front of you like a book. Open the two sides. There is an inner fold to the glove wrapper. With the two cuffed-covered hands grasp the lower inner corners of the bottom fold. Lift both corners open and fold under at the same time. When this method is used the wrapper will remain open and not fall closed during the gloved process.
2. Extend the (right or left) forearm with the palm upward (supinated).
3. With the cuff-covered (right or left) hand, pick up the left glove from the inner wrap of the glove package by grasping the fingers, lifting straight up, and placing the glove on the left palm thumb side down. The glove fingers will be pointing toward the body.
4. Grasp the edges of the glove cuff with the cuffed (right or left) hand and the opposite edge with the cuffed (right or left) hand. Peel the glove over the (right or left) cuffed hand, over the end of the (right or left) sleeve, and wiggle the finders to extend them into the glove-covered (right or left) hand. The cuff of the (right or left) glove is now over the stockinette cuff of the gown, with the hand still inside the sleeve.
5. Grasp the cuff of the (left or right)) glove, and underlying (right or left) gown sleeve with the covered (right or left) hand. Pull the glove on over the extended left fingers, until it completely covers the stockinette cuff.
6. Glove the (left or right) hand in the same manner, reversing hands. Use the sterile gloved (right or left) hand to grasp the fingers of the (right or left) glove and position the glove on the (right or left) forearm. Be sure that the entire cuff of each sleeve is contained within the sterile glove.
Open Gloving Technique (page 279)
Gowning for the open gloving method is the same as for the closed gloving method. The only difference is that the scrubbed person extends the hands all the way through the cuffs and sleeves. The hands are totally exposed outside the cuffs. This method is not preferred for the person establishing the sterile field, but is used when changing a contaminated glove. Either hand can be gloved first.
The open gloving method uses a skin-to-skin, glove-to-glove technique. The hand, although scrubbed, is not sterile and must not contact the exterior of the sterile gloves. The everted cuff on the gloves exposes the inner surfaces. The first glove is put on with the skin-to skin technique, bare hand to inside cuff. The sterile fingers of that gloved hand then may touch the sterile exterior of the second glove (i.e.., glove-to-glove technique).
1. With the (right or left) hand, grasp the inner edge of the cuff of the (left or right) glove and lift from the wrapper. Take care not to touch the inner aspect of the wrapper or the sterile exterior portions of the glove.
2. Align the fingers of the (right or left) hand, and insert the (right or left) hand into the glove, pulling it on, leaving the cuff turned well down over the hand. Be sure to keep the thumb adducted into the palm of the hand until it is well inside the confines of the glove. Do not adjust the cuff. This will be done as a last step.
3. Slip the fingers of the sterile gloved (right or left) hand under the everted (right or left) cuff, on the sterile side of the (right or left) glove. Pick up the glove, and step back.
4. Align the fingers of the (right or left) hand and insert the (right or left) hand into the (right or left) glove, keeping the thumb adducted until well inside the glove. Pull the (right or left) glove on all the way, unfolding the cuff, and enclosing the knitted (right or left) cuff at the wrist.
5. With the sterile gloved fingers of the (right or left) hand, pull the cuff of the (left or right) glove up and over the knitted cuff of the sleeve. Avoid touching the bare wrist. Sterile surfaces may touch only sterile surfaces.
We're very familiar with the method, we've been using/teaching it for many years.
What I'm looking for is evidence (not theory) supporting that it is the preferred method to open gloving - I'll check out the text you named, Kathy, to see if their bibliography includes good references for evidence. We are reaching out to procedural areas as well, but was hoping one of you would have it at your fingertips.
Anyone else have evidence?
Thanks,
Mari
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
Open Gloving Technique (page 279)
Gowning for the open gloving method is the same as for the closed gloving method. The only difference is that the scrubbed person extends the hands all the way through the cuffs and sleeves. The hands are totally exposed outside the cuffs. This method is not preferred for the person establishing the sterile field, but is used when changing a contaminated glove. Either hand can be gloved first.
The above is right out of Berry and Kohn. That is the statement you want the reference for. they suggest closed gloveing for person estsablishing stereile field
I will relook at the AORN guidelines I have and see if they make a statement
kathy
I don't have a reference for you but it's a no brainer. To use open gloving technique with a sterile gown takes lots of practice to do correctly. I was taught the procedure in OR Tech school in the Navy 26 years ago. I have been in the OR ever since until I got this PICC Nurse job. We were required to close glove for the first 5 months of school so it was ingrained in our brain. In over 20 years in the OR I have never seen it done correctly without potential for contamination. I have asked OR Nurses and Surgical Techs and have never found one who knew how to do it correctly. I asked a Surgical Tech Instructor if he taught the technique and he didn't know what I was talking about. You can teach anyone to closed glove in 5 minutes. There is zero chance of contamination as long as your hands remain inside the gown. The only time open gloving is to be used, if they know how, is when one glove is contaminated and you don't have another person scrubbed in to glove you. With a gown, open gloving requires that the end of the glove is stretched over the entire cuff of the gown. The cuff is not considered sterile once you have put your hand through it. It's not easy unless you have done it 4 or 500 times. I would just tell them they don't understand the principles of sterile technique if they think open gloving while gowning is better than closed. We don't need research based evidence for everything. Some things are just too obvious. IMHO
Dale
am just trying to help a physician out who asked for it.
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
If I am wearing a sterile gown...I close glove and teach that way!!!!