***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Surgeons have the highest risk of contact with patients ' blood and body fluids , and breaches in gloving material may expose operating room staff to risk of infections . This prospect i ve r and omised study was done to assess the effectiveness of the practice of double gloving compared with single gloving in decreasing finger contamination during surgery . In 66 consecutive surgical procedures studied , preoperative skin abrasions were detected on the h and s of 17.4 % of the surgeons . In the double gloving pattern , 32 glove perforations were observed , of which 22 were in the outer glove and 10 in the inner glove . Only four outer glove perforations had matching inner glove perforations , thus indicating that in 82 % of cases when the outer glove is perforated the inner glove will protect the surgeon 's h and from contamination . The presence of visible skin contamination was also higher in perforation with the single gloving pattern ( 42.1 % ) than with the double gloving pattern ( 22.7 % ) . An overwhelming majority of glove perforations ( 83.3 % ) went unnoticed . Double gloving  was accepted by the majority of surgeons , especially with repeated use . It is recommended that double gloves are used routinely in all surgical procedures in view of the significantly higher protection it provides Double-glove perforation rates and perforation rates in st and ard single-gloved operating teams were compared , in order to determine whether double gloving provides additional protection for the operating team . Patients were r and omized to undergo surgery with a double-gloved or single-gloved operating team . All gloves worn during the operation were tested for perforations by water-filling and individual digital distension ; 115 single-gloved operations and 103  double-gloved  operations were performed . There were 841 individual operating team members ' at risk ' . In the single-glove group , 20.8 % of individuals had perforations , but only 2.5 % had perforations in both inner and outer gloves ( dual perforation ) in the double-glove group ( P less than 0.0001 ) . The surgeon was most at risk of glove perforation ( 34.7 % of cases in the single-glove group , 3.8 % dual perforation in the double-glove group ) . Longer operations were associated with increased risk of glove perforation .  Double-gloving significantly reduces the risk of skin contamination by blood and body fluids and is recommended for all high risk cases To assess the value of double‐gloving in gynaecological surgery BACKGROUND Surgical teams rely on surgical gloves as a barrier to protect themselves against blood-borne pathogenic infections during surgery . Double-gloving is adopted by surgeons to tackle the problem of glove perforation . Nevertheless , double-gloving is not practice d commonly by operating room nurses and there are only limited studies about double-gloving that targets only perioperative nurses . The aim of this research was to assess the effectiveness of double-gloving in protecting perioperative nurses by comparing the frequency of glove perforation between single-gloving and double-gloving groups . METHODS A prospect i ve and r and omized study was performed . Nurses were assigned r and omly to single-gloved and double-gloved groups for comparison of the glove perforation rate . Water-leakage and air-inflation tests were used to detect glove perforation . RESULTS Glove perforations was detected in 10 of 112 sets of single-gloves ( 8.9 % ) and 12 of 106 sets of outer gloves in the double-gloved group ( 11.3 % ) . There was no inner double-glove perforation ( 0 % ) . Glove perforations were found in 6 and 4 of the 112 sets of single-gloves for the first assistants ( 5.36 % ) and the scrub nurses ( 3.57 % ) , and 5 and 7 of 106 sets of outer gloves in the double-gloved group for the first assistants ( 4.72 % ) and the scrub nurses ( 6.60 % ) , respectively . The average occurrence of perforation was 69.8 minutes ( range , 20 - 110 min ) after the beginning of surgery . The sites of perforation were localized mostly on the left middle finger ( 42 % ) and the left ring finger ( 33.3 % ) . CONCLUSIONS Based on the findings of the study , double-gloving is indeed effective in protecting operating room nurses against blood-borne pathogen exposure . It should be introduced as a routine practice EDITORIAL COMMENT : We accepted this paper for publication because all surgeons are concerned , or should be concerned , about the possibility of contracting hepatitis or the immunodeficiency virus due to contamination with the patient 's blood when operating . It goes without saying that all surgeons should be immunized against hepatitis B. There have been a number of studies recommending double‐gloving either as a routine or in high‐risk patients . We believe the Royal Australian and New Zeal and College of Surgeons video recommends double‐gloving as a routine ! There have been comments that double‐gloving  causes clumsiness which could indeed be counter‐productive in rendering glove perforation more likely . However the review er of this paper made the point that with his experience with the double‐gloving technique the initial impression of clumsiness soon resolves An intact barrier between the h and s of the surgeon and the patient remains the single most important factor in protection against infection for both . Increasing the awareness of possible glove perforation without skin penetration will decrease the risk of contamination . We performed a prospect i ve , r and omised trial comparing the incidence of glove perforation using a new type of glove ( Regent Biogel Reveal ) and st and ard double-gloves in total hip and knee replacement .  One or more perforations was detected in 14.6 % of all gloves . The new gloves increased significantly the awareness of perforation . Multiple perforations at the base of the ring finger were found in surgeons who wore wedding rings during the operation and we recommend that rings be removed before undertaking surgery BACKGROUND Little is known about long-term improvements in medical students ' knowledge , attitudes , and use of blood and body fluid pre caution s following pre clinical training . METHODS We evaluated an educational and skills-training program emphasizing double gloving for high-risk surgical procedures . Baseline surveys measuring knowledge , attitudes , and readiness to use specific pre caution s were completed by second-year ( experimental ) students before skills training and by third-year students ( control ) after their first clinical year . Follow-up surveys were completed 1 year later . Use of  double gloves  and  protective eyewear  during surgery clerkships was observed at baseline and follow-up . RESULTS Of 149 students returning both surveys , the experimental group ( n = 91 ) showed improvements in attitudes toward double gloving ( P = 0.038 ) and use of double gloves during surgery at follow-up ( relative risk = 1.95 , 95 % confidence interval = 1.06 , 3.59 ) . They expressed better attitudes toward ( P = 0.003 ) and greater readiness to use ( P = 0 . 020 ) double gloves compared with controls at follow-up . They expressed better attitudes toward ( P = 0.002 ) and greater readiness to use ( P = 0.001 ) double gloves compared with controls when each had completed their first clinical year . CONCLUSION The intervention was associated with improved attitudes toward and use of double gloves during surgery . The experimental group also expressed better attitudes and readiness to use double gloves compared with controls at follow-up Glove perforation during surgery represents a potential risk of infection for the surgeon . The authors postulated that thicker latex gloves may offer greater protection . The perforation rates for the Ansell Gammex glove and the thicker Baxter Triflex gloves were compared in single- and double-glove usage and no difference was found between the two br and s , in either usage . The authors recommend double-gloving for all orthopaedic operations with regular glove changes during major procedures PURPOSE This is a prospect i ve study of the efficacy of three different techniques of triple gloving during the application of Erich arch bars . Two different cut-resistant glove liners and three layers of latex gloves were compared with double gloving . METHODS AND MATERIAL S Thirty patients underwent Erich arch bar placement from first molar bilaterally on both arches . Two surgeons per case were arbitrarily placed into one of four groups that included double latex gloving , triple gloving with kevlar or stainless steel glove liners , or triple layer latex gloving , based on the availability of glove liners . All gloves were collected postoperatively and tested for perforation using water insufflation . RESULTS One hundred eight of 120 outer gloves were perforated . There were 16 perforations in 11 inner gloves of the double latex glove group , but no perforations in the inner gloves of the triple latex glove group . There were two inner gloves with one perforation each in the stainless steel group and one glove with a perforation in the kevlar group . All techniques of triple gloving were found to be superior to double gloving . There was no difference between the techniques of triple gloving . CONCLUSION During certain high-risk procedures greater protection to the surgeon can be obtained by triple gloving . The use of cut-resistant glove liners or triple layer latex gloving is superior to double layer latex gloving Health care workers , particularly surgeons , underst and the importance of preventing contamination from blood of patients infected with deadly viruses . One of the most common areas of contamination is the h and s and fingers due to the failure of glove protection . There are varying opinions regarding the frequency of glove failure , the necessity of wearing two gloves for added protection , and the ability to operate when wearing two gloves . We performed a prospect i ve , r and omized , trial of 143 procedures involving 284 persons to answer these questions for surgeons and first assistants . Overall , the glove failure rate ( blood contamination of the fingers ) was 51 % when one glove was worn and 7 % when two gloves were worn . Acceptability was 88 % in the group who agreed to wear two gloves , and 88 % of these did not perceive that tactile sense was significantly impaired . We believe that double gloving should be , and can be , used routinely during major surgical procedures to protect surgeons from blood contamination BACKGROUND In surgery intact gloves act as a sterile barrier between surgeon and patient . The impermeable gloves protect the surgeon from bloodborne pathogens such as HIV , hepatitis B , and hepatitis C. On the other h and , the surgical wound is protected from micro-organisms from the skin of the surgeon . One objective of this study was to compare puncture rates between the double gloving color indication system and single-use gloves and the other to determine the extent to which glove perforations remain undetected during the course of vascular surgical operations . PATIENTS AND METHODS The study material comprised all  gloves used in vascular surgical operations at Satakunta Central Hospital for a period of two months . The analysis was made by the glove type in a prospect i ve and r and omised manner . Gloves were tested immediately after the surgical procedure using the approved st and ardized water-leak method . With this method the glove is filled with water using a special filling tube , and the water-filled glove is then checked for two minutes to detect any holes . The gloves used in this study were either double gloves with indicator , or the st and ard glove used at our hospital . RESULTS In 73 operations altogether 200 gloves were tested , half of them were double gloves and half were single gloves . The perforation occurred in the double gloves 3 times and with single gloves 12 times . The overall perforation rate was 15 out of 200 gloves ( 7.5 % ) . The detection of perforation during surgery was 60 % . Most frequently the perforation was located in the second finger of the left h and , 9 out of 15 perforations . CONCLUSION In view of the critical importance of safety at work both transmitting the pathogens from the skin of the surgeon to the wound and transmitting the bloodborne pathogens from the patient to the surgeon , it is very important to use double gloving at least in operations where there is a high risk of glove perforation A r and omized trial was conducted to evaluate the quality of four different br and s of surgical gloves in terms of the perforation rate , ventilation , fitness , allergic reaction , elasticity , thickness , powder , and satisfaction .  Gloves of four different manufactures which were used by various medical centres were distributed to participants according to a computer-generated r and omization table . A structured question naire was self-administered by volunteers immediately after the surgical procedure to gather the information from participants , including the demographic data , allergy history , length of use , and variables of quality measures . Two br and s , A and D , were significantly inferior to the best manufacture among the four , B , in terms of the ventilation , elasticity , and thickness , odds ratios ranging from 6 to 24 , p < 0.05 . For the amount of corn starch powder and satisfaction , all three other br and s were inferior to br and B , odds ratios ranging from 6 to 44 , p < 0.05 . Gloves worn longer than 2 hours had a slightly higher perforation rate post procedures ( 11.5 % vs. 2.1 % , p = 0.048 ) . The rate of latex allergic reaction was not significantly different between surgeons ( 8.3 % ) and the others ( 6.7 % ) . No difference of the allergic reaction rate was found between subjects with allergy history ( 7.7 % ) and those without the history ( 7.5 % ) . The quality of surgical gloves differs from 
    Output:
    
Thicker gloves did not perform better than thinner gloves .
There is moderate- quality evidence that double gloving compared to single gloving during surgery reduces perforations and blood stains on the skin , indicating a decrease in percutaneous exposure incidents .
There is low- quality evidence that triple gloving and the use of special gloves can further reduce the risk of glove perforations compared to double gloving with normal material gloves .