Abstract
Background: The maintenance of an aseptic barrier between the surgical team and patient aids in the prevents the exposure of the patient to pathogens. Variations in gloving practice may have safety implications due to glove failure. Indicator gloving, where two pairs of different colored gloves are worn, is thought to add protection as it alerts the wearer to a breach. The aim of this systematic review and meta-synthesis was to assess the evidence in the literature on the benefit of indicator systems versus other forms of double gloving on puncture identification during surgery. Methods: A four-arm, parallel, systematic review of the literature was undertaken in accordance with the PRISMA statement using four distinct research questions regarding glove fit, double gloving, indicator gloves, and the association between glove damage and glove change frequency. Searches on PubMed, Embase, Cochrane Collaboration of Systematic Reviews and Metanalyses, and Google Scholar were performed between 1 May 2022 and 24 January 2023. Studies were assessed for eligibility against pre-defined inclusion and exclusion criteria. Risk of bias was determined using multiple assessment tools. Results: This systematic review included 32 studies, 10 of which were high-quality Level IA trials, alongside multiple observational analyses. Across studies, indicator glove systems consistently demonstrated a two- to six-fold higher detection rate of glove perforations compared with standard double-gloving using identical glove colors. The majority of studies confirmed that early perforation identification significantly reduces intraoperative contamination risk and improves maintenance of the aseptic barrier. However, evidence regarding the direct impact on surgical site infections remains limited due to study heterogeneity. Conclusions: The use of an indicator glove provides a two- to six-fold higher rate of glove perforation detection, compared to two standard gloves of the same color, therefore aiding the maintenance of the aseptic barrier between surgical team members and patients. Further research into the impact of double gloving on the incidence of surgical site infections is required.