An elegant solution to a high risk problem in the OR

Tiffany Thornton, DNP, CRNA, had read studies confirming that contamination in the operating room can be dramatically reduced if anesthesia providers double glove. By wearing two pairs of gloves and removing the outer one after intubation, the spread of microorganisms from the patient’s mouth, nose and face is reduced. But in the hectic and fast-paced environment of the operating room, too often, they forget this practice.

“Ideally you would thoroughly scrub your hands after intubating the patient, but because it’s such a busy time for anesthesia providers, people just can’t do it,” said Thornton. “Double gloving is not meant to replace hand hygiene, but to reduce the pathogen spread that happens all over the anesthesia workspace environment.”

Thornton made this problem the focus of her Doctor of Nursing Practice scholarly quality improvement project last year. She began by developing and testing an educational approach, thinking if CRNAs understood the effectiveness of double gloving, compliance would increase. But she found the education was insufficient to assure change in behavior, once providers entered the intense atmosphere of the OR.

She then introduced the technique of having a different colored glove worn over the typical glove.. The orange colored outer glove served as the visual cue to remind the nurse anesthetist to remove it after intubation.  This approach worked. More than half of the anesthesia team indicated that the orange gloves reminded them to double glove and remove the outer gloves at the appropriate time.

“I feel like it’s an important issue for every specialty of anesthesia because it’s pertinent to every practice environment and it’s so easy,” said Thornton.

Thornton’s work to reduce contamination and the spread of microorganisms in a fast-paced operating room by increasing the practice of double gloving exemplifies how DNP students take on real world problems and address them through an evidenced-based quality improvement approach.  Her project earned her the school’s Sandra R. Edwardson award for excellence in DNP scholarship.

 “This project illustrates that education only does not change the system, rather we need to understand the practice of the practitioners, the flow of the work and ultimately the outcomes we are tying to achieve so we can introduce solutions that change behavior.” said the program director, Dr. Judith Pechacek DNP, RN, CENP.

Thornton graduated from the School of Nursing’s Doctor of Nursing Practice program in December 2017 and is currently a cardiac and pediatric nurse anesthetist at the Mayo Clinic. There, she is working to get orange gloves mounted next to standard supply gloves.

“I think if you start training new anesthetists from the beginning that it could change the culture,” she said. “I’d like to see nurse anesthetists in general be more engaged in reading all anesthesia literature and developing evidence based means by which to bring best practices into the operating room.”

Tiffany Thornton in the operating room

Double gloving is not meant to replace hand hygiene, but to reduce the pathogen spread that happens all over the anesthesia workspace environment.