title: Double-Gloving Impairs the Quality of Surgical Knot Tying: A Randomised Controlled Trial.
abstract: Double-gloving is endorsed by a number of healthcare authorities worldwide, on the basis that it promotes patient and surgeon safety; adoption of this practice amongst surgeons remains limited, based upon anecdotal reporting that double-gloving may compromise surgical technique due to impaired dexterity and sensation. The aim of this study is to formally investigate and demonstrate the effect of double-gloving upon the quality of knot tying, an essential surgical skill.
  
  
  
  An international cohort of practising general surgeons hand tied surgical knots, under both single-gloved and double-gloved conditions, using monofilament and braided sutures, at two different gauges. Half of the participants tied single-gloved first. The mechanical strength of the knots was determined by tensile testing, and each knot was given a knot quality score (KQS), a validated assessment of knot quality.
  
  
  
  1466 knots were tested. Double-gloving was shown to reduce KQS for all suture types, compared to knots tied under single-gloved conditions (p = 0.001). There was no difference in the KQS of the double-gloved ties between those who routinely double-gloved and those who did not (p = 0.640). The OR showed that double-gloving reduced the KQS by 24 % overall, with the effect being much more prominent when the finer 4.0 suture was used, as knot quality was reduced by almost 50 % (95 % CI 13-93 %). Double-gloving impairs the quality of knot tying, and therefore, surgeons should consider other precautions to ensure patient and surgeon safety. These findings also question the validity of recommendations that surgeons should double-glove as a routine.
authors.affiliation: Department of Clinical Engineering, UK Centre for Tissue Engineering, University of Liverpool, Liverpool, UK. christopherbattersby@nhs.net.|Mersey School of Surgery, Liverpool, UK. christopherbattersby@nhs.net.|Department of Colorectal Surgery, Royal Liverpool University Hospital, 9Z Link, Prescot Street, Liverpool, L7 8XP, UK. christopherbattersby@nhs.net.
authors.forename: Christopher L F
authors.initials: CL
authors.lastname: Battersby
authors.affiliation: Department of Clinical Engineering, UK Centre for Tissue Engineering, University of Liverpool, Liverpool, UK.|Wessex School of Surgery, Winchester, UK.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Battersby
authors.affiliation: Severn School of Surgery, Bristol, UK.
authors.forename: Marianne
authors.initials: M
authors.lastname: Hollyman
authors.affiliation: Department of Clinical Engineering, UK Centre for Tissue Engineering, University of Liverpool, Liverpool, UK.
authors.forename: John A
authors.initials: JA
authors.lastname: Hunt
mesh_terms: D005260:Female; D005932:Gloves, Surgical; D006801:Humans; D008297:Male; D061214:Patient Safety; D013536:Suture Techniques / Q000592:standards*; D013537:Sutures; D013718:Tensile Strength