A Recommendation Grounded in Data
AORN's Guidelines for Perioperative Practice recommend double gloving for scrubbed surgical team members based on a substantial body of research showing that a second glove layer significantly reduces the rate of inner glove perforation reaching the skin. Studies consistently show that when a puncture occurs through both glove layers, the outer glove is far more likely to have already been compromised by an earlier undetected perforation, meaning double gloving provides a real, measurable barrier benefit rather than a symbolic one.
Understanding Perforation Rates
Glove perforations happen far more often than most new surgical technologists expect, and they frequently go unnoticed by the wearer since sharp instrument contact through glove material does not always cause immediate sensation. Research cited in AORN guidance has found single-glove perforation rates reaching well into double digits across longer procedures, particularly in orthopedic and other bone-heavy cases where sharp instrumentation and bone fragments create elevated puncture risk.
Indicator Glove Systems
Many facilities pair double gloving with an indicator glove system, where the inner glove is a bright, contrasting color, most often green, dyed specifically so that if the outer glove is perforated, fluid wicking through the puncture reveals a visible colored spot rather than requiring the wearer to notice a change in the transparent surgical glove alone. This visual cue allows the surgical technologist to change gloves proactively the moment a breach is suspected rather than continuing to work with compromised protection.
Proper Donning Technique
The undergloves are typically donned first using standard closed gloving technique, sized to fit snugly against the hand for tactile sensitivity. The outer glove is then donned over the undergloved hand, usually a half size larger than the standard glove size to accommodate the added bulk without restricting circulation or dexterity. Some surgical technologists find their fine motor precision is affected during the adjustment period, and this is worth practicing during lower-stakes cases before relying on it during technically demanding procedures.
When Triple Gloving or Reinforced Gloves Are Used
In particularly high-risk procedures, such as orthopedic cases involving significant bone work or procedures on patients with known bloodborne pathogen exposure, some facilities use triple gloving or specially reinforced puncture-resistant gloves for even greater protection. The CST exam expects candidates to understand double gloving as the general standard while recognizing that facility policy and procedure type may call for additional protection.
- Double gloving significantly reduces the rate of perforations reaching the skin
- Indicator glove systems use a contrasting inner color to reveal breaches visually
- Outer gloves are typically sized a half size larger to fit over the underglove
- Higher-risk procedures may call for triple gloving or reinforced glove materials
Facility Policy Variation
Although AORN recommends double gloving broadly, exact facility policy on when it is mandatory versus optional can vary, with some institutions requiring it universally for all scrubbed personnel on all cases and others reserving a strict mandate for higher-risk procedures such as orthopedic cases or procedures on patients with known bloodborne pathogen exposure. Understanding your specific facility's policy, and the reasoning behind any variation from a universal mandate, matters both for compliance and for being able to explain the practice confidently if a patient or team member asks about it.
New surgical technologists sometimes find double gloving affects their tactile sensitivity enough to notice during delicate tasks like handling small suture, and rather than avoiding the practice, working through this adjustment period during lower-stakes cases builds the fine motor adaptation needed before you rely on double gloving during more technically demanding procedures. Most technologists report the sensitivity difference becomes negligible within a relatively short adjustment period once the habit is established.
Documenting and Reporting Glove Perforation Events
Many facilities maintain formal tracking systems for reported glove perforation events, since aggregated data on perforation rates by procedure type helps infection prevention teams identify which surgical specialties or specific procedures carry elevated risk and may warrant additional protective measures beyond standard double gloving. Surgical technologists who consistently report suspected perforations, even when uncertain, contribute valuable data to this ongoing safety monitoring effort rather than simply managing the individual glove change silently.
This reporting culture connects to the broader patient safety data collection discussed throughout our content, reinforcing that consistent, honest reporting of seemingly minor events, not just major complications, supports the kind of continuous improvement that strengthens safety practices across an entire surgical department over time.
A Habit Worth Building From Day One
New surgical technologists benefit from establishing double gloving as an automatic habit from their very first cases, rather than treating it as an optional practice to adopt later once more comfortable with basic technique. Habits formed early in training tend to persist more reliably throughout a career than practices adopted after other habits have already become established.
Building this habit early also normalizes the slight adjustment period in fine motor sensitivity discussed throughout this content, ensuring that adjustment happens during foundational training rather than requiring a disruptive change to established technique later in one's career.
Review the full gowning and gloving sequence in our related step-by-step guide, and revisit AORN's sterile field boundary standards in our related content. For OSHA's bloodborne pathogen requirements that underlie these practices, see our Preoperative Patient Care domain review. Explore our exam prep plans for more sterile technique content.