International Journal of Industrial Ergonomics 81 (2021) 103062

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International Journal of Industrial Ergonomics

journal homepage: http://www.elsevier.com/locate/ergon

How do medical gloves affect manual performance? Evaluation of

ergonomic indicators
Asma Zare a, Alireza Choobineh b, *, Mehdi Jahangiri b, Mahdi Malakoutikhah a
a
Student Research Committee, Department of Occupational Health Engineering, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
b
Research Center for Health Sciences, Institute of Health, Shiraz University OfMedical Sciences, Shiraz, Iran

A R T I C L E I N F O A B S T R A C T

Keywords: Medical gloves have a direct effect on the safety of clinical staff and patients as well as optimal performance.
Manual performance Thus, it is necessary to identify the quantitative impact of gloves on hand performance indicators. This study
Dexterity aimed to investigate the effect of medical gloves on manual performance. This study was conducted on 40
Tactile sensitivity
hospital clinical staff. The participants’ dexterity, tactile sensitivity, and grip strength were evaluated with and
Grip strength
Medical gloves
without gloves and were compared by Purdue pegboard, two-point discrimination, and dynamometer tests.
Additionally, the participants were required to rate their performance under different conditions using the visual
analogue scale. The results showed that medical gloves had a significant effect on all studied indices. Double
gloving caused the most significant reduction in touch sensitivity. Grip strength was also significantly reduced by
the use of inappropriate gloves. Despite its negative effects on the ergonomic indices, single gloving provided the
same functional performance as did the condition without gloves.
Relevance to industry: Despite a significant decrease in manual performance, single gloving can be a good
alternative for the condition without gloves with regard to individuals’ mental performance. The present study
results also indicated that medical gloves had a significant impact on ergonomic indicators related to manual
performance. Hence, it is necessary to consider manual function dimensions when designing gloves.

1. Introduction used two different pegboard tests to evaluate medical gloves. The results
showed a significant loss of dexterity when donning gloves compared to
In almost all industrial tasks, the use of gloves is essential to protect bare hand performance (Mylon et al., 2016b). Johnson et al. also studied
the hands against such factors as sharp edges of tools, extremely cold or the tactile performance of five different types of medical gloves. There
hot environments, and chemical and microbial agents (Aliabadi et al., were statistically significant differences in touch sensitivity for all nerve
2014). Medical gloves have been considered a barrier that can prevent distributions, with all glove types resulting in less sensitivity compared
the transmission of microorganisms between healthcare workers and to a bare hand (Johnson et al., 2013). Furthermore, Moore evaluated the
patients (Goldman et al., 2016). Therefore, the main consideration in tactile sensitivity of latex gloves, and indicated that latex gloves did not
glove evaluation has rightly been barrier integrity. However, it seems affect tactility (Moore, 1994).
that manual performance is affected by gloves and this effect has been The effect of using gloves on grip strength is relatively constant as
recently begun to be explored (Shih et al., 2001). gloves reduce the strength (Buhman et al., 2000). This reduction is a
Numerous studies have been conducted on the effect of gloves on feature associated with the glove material properties (Cochran et al.,
task performance (Gnaneswaran et al., 2008; Mylon et al., 2016a; Wells 1988; Larivière et al., 2004). The decrease in grip strength has been
et al., 2010; Cabeças and Milho, 2011). The findings on industrial and justified by the fact that gloves reduce the pressure between the fingers
other gloves have been clear, revealing a decrease in strength and other and change the feedback from the hands and fingers (Batra et al., 1994).
performances. However, the results with thin gauge gloves like medical However, the effect of gloves on torque has not been fully understood;
ones have not been consistent. For example, Branson et al. measured some studies have shown improved performance (increased torque),
hand dexterity performance and reported that manual dexterity was not while some others have shown reduced performance (reduced torque)
affected by medical gloves (Branson et al., 1988). Moreover, Mylon et al. (MITAL et al., 1994; Shih and Wang, 1996). The key question is why

* Corresponding author.
E-mail address: [email protected] (A. Choobineh).

https://doi.org/10.1016/j.ergon.2020.103062
Received 12 February 2020; Received in revised form 11 November 2020; Accepted 12 November 2020
Available online 21 November 2020
0169-8141/© 2020 Elsevier B.V. All rights reserved.
A. Zare et al. International Journal of Industrial Ergonomics 81 (2021) 103062

performance changes when using gloves. One answer may be that gloves first session. The reasons for doing this separately included avoiding
reduce the range of motion capabilities, reduce touch sensitivity, and hand fatigue, reducing learning effects, and increasing the availability of
increase the effective size of objects for grip (Mylon et al., 2017). The the participants (each trial lasted for 15–20 min, and the participants
decrease in motor ability and tactile sensitivity is expected to be affected preferred to complete the tests separately). Furthermore, the order of the
by the appropriate size of the gloves, the mechanical properties of the three gloved conditions was randomized to counterbalance the carry-
gloves, and the characteristics of their constituents (Mylon et al., over and order effects. The first set of tests was performed with no
2016b). gloves to provide a baseline measure independent of learning behavior
One thing that all clinical staff agree on is that performance affects or glove type, to which the individual gloved tests could be compared.
safety. Gloves with undesirable friction properties increase the likeli­ This also allowed for some learning to be done before the gloved con­
hood of tool slipping and the incidence of error when performing sen­ ditions were tested, an important point for comparison. Ideally, the
sitive tasks. The stress levels are also likely to increase when trying to participants would have performed the test multiple times before
make up for a mistake. Moreover, people who cannot feel the underlying recording the results, but the available time did not allow this. The order
bumps while wearing gloves are less likely to wear gloves and be at risk of the two parts of the dexterity test was randomized to allow a fair
of infection (Mylon, 2012). Another important issue is the mental and comparison between the tests in terms of their discrimination, so that
subjective dimensions of performance that should be considered. In this one test was more affected by hand fatigue compared to the other.
context, the clinical staff’s convenience may affect their concentration To assess the participants’ perceived mental performance after doing
and consequently their ability to perform different tasks over time. all tests in each condition (with and without gloves), they were asked to
In summary, the decrease in manual function due to wearing medical rate their performance by a visual analog scale (Fig. 1) for each hand
gloves is very important among medical staff. The ergonomic indicators condition separately.
of manual performance should be sufficient to provide appropriate
performance for individuals since hospital tasks such as medical exam­ 2.4. Evaluation of dexterity
ination, finding a pulse, inserting a needle into vessels, suturing,
working with surgical razors and sharp tools, and using scissors and Previous works have shown that dexterity consists of a variety of
syringes are very sensitive and too risky. If the tools and the protective factors (Fleishman and Hempel, 1954) and several tests exist for
equipment used by healthcare workers (including medical gloves) fail to measuring these factors. The Purdue pegboard test shown in Fig. 2 was
provide good manual function, it can put a person at risk. On the other applied because it measures both large and small movements of the
hand, errors due to improper manual performance of healthcare workers arms, hands, and fingers, reflecting manipulations carried out in medical
can endanger patients’ safety. Furthermore, studies that have measured tasks. The pegboard measures both ‘gross dexterity’, which is the gross
performance effects of thin gauge gloves have not reported consistent movement of hands, fingers, and arms, and ‘fine finger dexterity’, which
results. Therefore, the present study aims to assess the effects of medical is defined as the ability to coordinate finger movements in performing
gloves on human hand performance and the related ergonomic fine manipulations using a series of tests (Fleishman and Hempel, 1954;
indicators. Tiffin and Asher, 1948).
The Purdue pegboard test and its instruction were presented by
2. Method Triffin and Asher in 1948 (Tiffin and Asher, 1948). According to Mylon
et al., this test is a good way to check manual performance when using
The present cross-sectional study was performed on the medical staff medical gloves (Mylon et al., 2016b). The test consists of a plate with
of a hospital in Shiraz, south of Iran in 2019. According to the previous two perforated columns and three cup-shaped containers containing
studies, a suitable sample size of 40 was considered (Mylon et al., 2016a; metal pins, collars, and washers. Gross dexterity is measured using the
Allahyari et al., 2014; Hatzfeld et al., 2018). Each participant was combination test, which is the sum of the number of pegs placed first by
compared to oneself in different situations. The participants had to be the dominant and then by the non-dominant hand and then by both
generally healthy and suffer from no known sensorimotor deficiencies. hands in the holes in 30 s for each part of the test (the number of holes
The participants participated in the experiments voluntarily and signed with pins and the score for the two-handed mode is the number of pairs
a written consent form after receiving a full explanation of the experi­ of holes filled). The assembly test measures fine finger dexterity and
mental procedure. requires the construction of ‘assemblies’ of washers, pegs, and collars
using both hands. The participants were given 60 s to assemble as many
2.1. Variables sets as they could. The score of this step was computed by summing up
the number of the assembled parts (one assembly equaled four pieces).
For all tests, independent variables were hand conditions, including Since the tools or materials falling in medical tasks are very important,
no gloves, best fit-single gloving, best fit-double gloving, and larger size. the number of falling pieces was carefully recorded. The participants
The dependent variables were hand dexterity, tactility, and grip were instructed to take a new piece and continue the test instead of
strength. trying to pick up the fallen pieces.
To perform this test, the participants sat on height-adjustable seats.
2.2. Gloves The height of the seat was adjusted so that the height of the pegboard
was in the individual’s elbow height. The participants were asked to
The studied gloves were non-powdered latex and had five common perform the speed test once with the dominant hand, once with the non-
sizes; i.e., very small (XS), small (S), medium (M), large (L), and very dominant hand, and once with both hands, and then do the assembly
large (XL). The participants were allowed to choose the size of glove that test. The participants rested for a few minutes between each experiment.
fitted them best, for the “best fit single gloving” condition. The “larger The results of the test including the number of holes with pins and the
size” gloves were chosen at one size larger than the best fit. For the “best- number of drops (as dependent variables) were recorded for further
fit double gloving’, the participants wore two layers of “best fit” latex analysis.
gloves.
2.5. Evaluation of tactile sensitivity
2.3. Performance evaluation
For each hand condition, the two-point discrimination test shown in
The tests were performed in four separate stages, with each type of Fig. 3 was used. The test tool consisted of a handle with two thin metal
glove being worn for one session and the ‘non-glove’ condition for the strings. The distance between the two metal strings was adjustable. To

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A. Zare et al. International Journal of Industrial Ergonomics 81 (2021) 103062

Fig. 1. Visual analog scale.

Fig. 2. Purdue pegboard test.

Fig. 3. Right: the tool used in the two-point discrimination test; left: assessment of tactile sensitivity.

perform this test, the participants sat on a height-adjustable seat. The

height of the seat was adjusted so that the height of the table was in the
individual’s elbow height. The palm was facing up. The participants’
eyes were closed and the researcher held the end of the test device,
placed the tip on the individuals’ skin, and gradually reduced the dis­
tance between the two tips until they could distinguish between the two
tips of the device. The participants were required to mention whether
they felt one or two points on their fingers. The experimenter held the
apparatus from the end and its weight rested on the participants’ fingers.
This procedure ensured that a constant force was applied to the fingers
in all conditions. The minimum distance between the two tips that the
individuals were able to identify was termed as the distance threshold
(as a dependent variable). When the participants could not distinguish
the distance, the researchers increased the distance between the two tips
slightly and performed the test process again. If the two results were the
same, it was recorded; otherwise, the procedure was repeated.

2.6. Evaluation of grip strength

At this stage, the maximum grip force (as the dependent variable)
was measured by a dynamometer (Sammons® Preston 563213, China)
at the neutral wrist posture and elbow angle of 90ᵒ in standing position
(Fig. 4). Grip strength was measured three times in each condition and Fig. 4. Grip strength assessment.
the maximum force gained (Kg) was reported. The individuals were
tested with and without gloves and were allowed to rest for a few

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minutes between each trial. effect on performance (p = 0.012 for the combined test and p = 0.026
for the assembly test). The results of Bonferroni post-hoc for different
2.7. Statistical analysis hand conditions have been presented in Table 2. The results of the
combined Purdue pegboard test revealed a significant difference in
The data were analyzed using the Statistical Packages for the Social performance in all conditions (p ≤ 0.05). There were statistically sig­
Sciences (SPSS, Version 22) software. Because of the ‘repeated mea­ nificant differences in the assembly test for all glove types, resulting in
sures’ nature of the experiments (i.e., the same participants were used less fine finger dexterity compared to a bare hand, except for the single
for each hand condition), the results were analyzed using paired dif­ gloving condition.
ference tests. The null hypothesis was that the difference between the
paired responses (i.e., two tests performed by the same participant with 3.2. Tactile sensitivity, two-point discrimination
different hand conditions) had a mean value of zero. The descriptive
statistics were shown in the form of mean (standard deviation). One-way The means (SD) of thresholds for the discriminations between two
ANOVA and Bonferroni post hoc were used to compare the results. P < points on the hand in different conditions including “no gloves”, “best fit
0.05 was considered statistically significant. single”, “best fit double”, and “larger size” were 2 (0.35), 2.5 (0.33), 3.7
(0.44), and 3 (0.35) mm, respectively. The sensitivity threshold was the
3. Results lowest in the non-glove condition and the highest in the double gloving
condition. The participants’ relative performance in the three conditions
This study was conducted on 40 right-handed female hospital clinical with gloves compared to the condition without gloves has been depicted
staff with the mean age (SD) of 27.35 (2.36) years and the mean work in Fig. 6. Accordingly, the average tactile sensitivity with double gloving
experience (SD) of 8.1 (1.83) years. The results of the tests for various was 85% lower in comparison to the average tactile sensitivity without
ergonomic indicators are as follows: gloves.
In the tactile sensitivity test, repeated-measures ANOVA was used,
3.1. Manual dexterity, purdue pegboard revealing the significant effect of hand conditions on the discrimination
power (p = 0.003). The results of Bonferroni post-hoc for different hand
Four stages (dominant hand, non-dominant hand, both hands, and conditions have been presented in Table 3. Accordingly, there was no
assembly) were carried out in the Purdue pegboard test. The results of significant difference between the double gloving condition and the
the dominant hand, non-dominant hand, and both-hand tests were larger size glove with respect to tactile sensitivity.
combined and averaged, while those of the assembly test were reported
separately. 3.3. Grip strength, dynamometry
Gross dexterity: The combined results of the dominant hand, non-
dominant hand, and both-hand modes have been presented in Table 1. The means (SD) of grip strength in different conditions including
Accordingly, the best score was obtained in the non-glove condition and “non-glove”, “best fit single”, “best fit double”, and “larger size” were
the worst score in the larger size condition. Besides, most of the pieces 22.08 (0.89), 18.86 (0.71), 16.22 (1.47), and 15.2 (0.84) Kg, respec­
fell off in the double gloving condition (0.73 per test). The participants’ tively. The best score was obtained in the non-glove condition and the
relative performance in the three conditions with gloves compared to worst score in the larger size condition. The participants’ relative per­
the condition without gloves has been presented in Fig. 5. While doing formance in the three conditions with gloves compared to the condition
tasks rapidly, the average performance was 33.01% lower with larger without gloves has been depicted in Fig. 7. Accordingly, the average grip
size gloves compared to the non-glove condition. strength with the larger size gloves was 31.15% lower compared to the
Fine dexterity: The results of the assembly test have been depicted in average grip performance without gloves.
Table 1. Accordingly, the best score was obtained in the non-glove In the grip strength test, repeated-measures ANOVA was used. The
condition and the worst score in the larger size condition. Besides, the results indicated that hand conditions had a significant effect on per­
largest number of pieces fell when the larger size gloves were used (0.34 formance (p = 0.011). The results of Bonferroni post-hoc between
per test). The participants’ relative performance in the three conditions different hand conditions have been shown in Table 3. Accordingly,
with gloves compared to the condition without gloves has been pre­ there were statistically significant differences in grip strength for all
sented in Fig. 5. Accordingly, the average performance with larger glove types, resulting in less grip strength compared to a bare hand.
gloves was 59.52% lower compared to the non-glove condition. The However, there was no significant difference between the double
results also demonstrated that hand performance in the assembly task gloving condition and the larger size gloves with respect to grip strength.
was more affected by the use of gloves than by fast performance.
In the combined and assembly Purdue Pegboard, repeated-measures 3.4. Performance score using the visual analog scale
ANOVA was used. Hand conditions were found to have a significant
The means (SD) of the participants’ judgments about their overall
Table 1 performance in each hand condition including “non-glove”, “best fit
The mean scores of Purdue Pegboard tests. single”, “best fit double”, and “larger size” on a 100 mm visual analog
scale were 90 (6.6), 76 (4.1), 57 (6.7), and 38 (3.8) mm, respectively.
Purdue Pegboard tests Hand conditions
The participants reported high performance in non-glove and single
No Best fit Best fit Larger
gloving conditions. The reported performance was moderate in the
gloves single double glove
double gloving and low in the larger size conditions. The participants’
Mean Mean Mean (SD) Mean relative performance in the three conditions with gloves compared to
(SD) (SD) (SD)
the condition without gloves has been illustrated in Fig. 7. Accordingly,
Score of combined Purdue 41.8 38.2 34.6 28.0 the average performance rating with larger gloves was 57.78% lower
Pegboard (0.83) (0.83) (2.30) (1.52)
compared to the average performance rating in the non-glove condition.
Number of drops in combined 0.2 0.27 0.73 0.55
Purdue Pegboard (0.42) (0.45) (0.45) (0.49) For comparison of performance scores, repeated measures ANOVA
Score of assembly Purdue 8.4 7.2 (0.44) 5.2 (0.83) 3.4 (0.89) was used. The results indicated that hand conditions had a significant
Pegboard (0.54) effect on the individuals’ performance (p = 0.001). The results of Bon­
Number of drops in assembly 0.12 0.24 0.26 0.34 ferroni post-hoc between different hand conditions have been presented
Purdue Pegboard (0.33) (0.11) (0.21) (0.58)
in Table 3. Accordingly, no significant difference was observed between

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A. Zare et al. International Journal of Industrial Ergonomics 81 (2021) 103062

Fig. 5. Comparison of Purdue combined scores (dominant + non-dominant + both hands) and Purdue pegboard assembly scores for different hand conditions with
average ‘no gloves’ score (shown as the mean difference compared to the ‘no gloves’ score as a percentage of the mean ‘no gloves’ score).

Table 2 Table 3
The results of Bonferroni post-hoc among different hand conditions in the Pur­ The results of Bonferroni post-hoc among different hand conditions in tactile
due pegboard tests. sensitivity, grip strength, and perceived performance.
The combined Purdue pegboard test Tactile sensitivity test

Best fit single Best fit double Larger glove Best fit single Best fit double Larger glove

No glove S1 (0.002) S (0.001) S (0.000) No glove Sa (0.036) S (0.001) S (0.001)

Best fit single S (0.021) S (0.000)
Best fit single S (0.000) S (0.009)
Best fit double S (0.001)
Best fit double NSb (0.067)
The assembly Purdue pegboard test
Grip strength test
Best fit single Best fit double Larger glove
Best fit single Best fit double Larger glove
No glove NS2 (0.069) S (0.001) S (0.000)
No glove S (0.005) S (0.003) S (0.001)
Best fit single S (0.001) S (0.000)
Best fit single S (0.002) S (0.001)
Best fit double S (0.008)
Best fit double NS (0.061)
1 Performance rating
Significant (p ≤ 0.05).
2
Not significant. Best fit single Best fit double Larger glove
No glove NS (0.059) S (0.004) S (0.005)
Best fit single S (0.001) S (0.001)
Best fit double S (0.019)
a
Not significant.
b
Significant (p ≤ 0.05).

performance was significantly better compared to gloved performance.

However, gloves had different effects on ergonomic indicators.
Performing a task quickly and correctly is an important skill in
clinical practice like suturing or inserting a needle into vessels. Ac­
cording to the results of the Purdue pegboard test, the use of latex
medical gloves significantly reduced the speed of work, which could
reduce the quality of medical services. However, single-layer gloves
provided a faster performance compared to double-layer gloves. Alla­
hyari et al. stated that latex gloves significantly increased the task
duration, which was in line with the results of the present investigation
Fig. 6. Comparison of tactile sensitivity for different hand conditions to the
(Allahyari et al., 2014). Mylon et al. also reported that single gloves
average ‘no gloves’ score (shown as the mean difference compared to the ‘no
provide better manual dexterity in comparison to double gloves (Mylon
gloves’ score as a percentage of the mean ‘no gloves’ score).
et al., 2016b). On the other hand, larger size gloves greatly reduced the
hand skill. This could be attributed to the fact that loose-fitting gloves
the single gloving and non-glove conditions concerning the individuals’ apply more force when grabbing objects, especially the smaller pieces,
performance level. making it difficult to release pins, which can reduce individuals’ ability
for doing medical tasks. Furthermore, wearing two layers of gloves
4. Discussion significantly reduced performance compared to one-layer gloves. The
results of some studies have shown that dexterity is significantly affected
In the present study, ergonomic indices including manual dexterity, when thicker or double gloves are worn (Shih et al., 2001; Drabek et al.,
tactile sensitivity, and grip strength were investigated using validated 2010; Pourmoghani, 2004). One possible reason may be the decreased
tests. The results were in line with those of the previous studies (Mylon skin sensitivity caused by the extra layers. The extra thickness reduces
et al. (2016b) and Moore (1994)), which found that ungloved manual the ability of the touch terminals to receive sensory stimuli, and the

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Fig. 7. Comparison of grip strength and perceived performance for different hand conditions, with average ‘no gloves’ score (shown as the mean difference compared
to the ‘no gloves’ score as a percentage of the mean ‘no gloves’ score).

movement of two layers against each other can further distort the sig­ in touch sensitivity. As previously stated, the extra layer in the double
nals. This tactile feedback allows the person to detect tool slips and in­ glove condition reduced the ability of the touch receptors to correctly
crease grip strength; therefore, reducing cutaneous sensitivity can detect the stimuli, thereby causing an error in the delivery of the neural
increase the number of components falls and errors. Johnson et al. message. Previous investigations have examined the thickness of pro­
(2013) and Kopka et al. (2005) both showed that dexterity decreased tective gloves as a marker of touch sensitivity (Tiefenthaler et al., 2006).
when thicker gloves were worn. Thus, it seems reasonable to believe that In fact, touch sensitivity has been shown to increase with the use of extra
dexterity would be affected when multiple layers are worn, for the thin gloves, although this was associated with increased puncture rates
thickness increases, resulting in movement restriction. Anthropometric and cost (Kopka et al., 2005). In the same vein, Neiburger et al. studied
dimensions are yet other factors that may influence hand skills. Sawyer the tactile performance of medical examination gloves. The results
et al. explained that individuals with long and thin fingers exhibited indicated a 36% reduction in tactility when the participants donned
higher dexterity (Sawyer and Bennett, 2005). Selection of glove size gloves (Neiburger, 1992). In the study carried out by Warhekar et al., a
appropriated to the anthropometric dimensions of the hand can also be decrease in tactility was recorded in 78.6% of the volunteers with gloves
an important factor affecting hand skills (Allahyari et al., 2014). Since compared to the no gloves condition. Additionally, all latex gloves
each participant was compared to oneself in the current study, the brands showed similar tactile perception thresholds between 2 and 3
confounding factor of hand anthropometric dimensions was eliminated mm distance (Warhekar et al., 2015). Similar findings were reported by
automatically. On the other hand, Drabek et al. (2013) demonstrated Bucknor where the distance for two-point discrimination was between 2
that gloves did not affect performance when using a grooved pegboard and 4 mm for surgical gloves (Bucknor et al., 2011). The results of a
test (similar to the Purdue Pegboard), regardless of the size of the glove binary logistic regression model also suggested that the tactile sensation
used. However, the study found that the time taken to remove the pegs decreased by one to four times as the thickness of gloves increased. Park
from the board was significantly increased when best-fit gloves were et al. (2016), Novak et al. (1999), Tiefenthaler et al. (2006), Bucknoer
worn. Whereas Moore et al. (1995), Pourmoghani et al. (Pourmoghani, et al. (Bucknor et al., 2011), Che and Ge (Chen and Ge, 2017), and
2004), and Drabek et al. (2010) found that dexterity was decreased in Thompson and Lambert (1995) also stated that sensation was reduced
the Purdue pegboard test when the wrong sized glove was worn. Francis by wearing gloves. The glove creates a barrier between the stimulus
and Hamstra (Francis et al., 2001) and Dubrowksiet al (Hamstra and (tool tip) and the mechanical receptors that feel mechanical stimulation.
Dubrowski, 2005). demonstrated that the varied skill of professionals The soft polymer of the gloves will probably dampenthe impact and
was a factor in these assessments. They found that students had impaired spread the load across a larger area. Increasing the thickness of the
dexterity and dropped more pins in comparison to experienced surgeons barrier (such as two layers of gloves) increases the damping (Mylon
in the pegboard tests. This suggests that in order to accurately interpret et al., 2016b). Larger gloves, as expected, also distort the touch stimuli
the results of pegboard tests, recruited participants should all be at the and make it harder to detect. Not surprisingly, touch sensitivity was
same level of experience. For this reason, the participants in the present found to be inferior across all glove conditions compared to bare hands.
study were selected from a small work experience range and the same Despite differences in sensation compared to bare hands, recorded def­
job group. icits for the single layer glove condition (best fit single gloving)
Reduction of the sense of touch due to the use of medical gloves is of remained close to bare hand for tactile sensation, suggesting that sen­
great importance in clinical practice, such as medical examination, sory performance was not grossly impaired by single gloving. Based on
finding a pulse, or having bumps under the skin. In this context, the loss this finding, single gloving should not be avoided by healthcare pro­
of touch feel is the main reason for removing gloves during these tasks. viders based on the subjective claims that sensory performance is
In other words, tactile sensation is considered fundamental to proce­ reduced.
dural performance, as a loss of touch sensitivity is a primary barrier to Applying force and holding tools are very important in some medical
glove compliance (Harrison et al., 1990). Although Nelson et al. (Nelson tasks, such as cutting tissues or bones and inserting tools into the tissue.
and Mital, 1995) and Moore et al. (Moore, 1994) reported that latex The results of the present study showed a decrease in grip strength when
gloves did not affect the tactile performance of the wearer, the present using gloves compared to the non-glove condition. Additionally, wear­
study results revealed that double gloves caused the greatest reduction ing single gloves reduced grip strength by 14.58% compared to the non-

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glove condition. Consistently, Batra et al. showed that latex gloves and Author statement
other plastic gloves reduced grip strength by 12.1% (Batra et al., 1994).
However, grip strength seemed to be greatly reduced when using double Asma Zare: Methodology, Formal analysis, Investigation, Resources,
gloving and larger gloves. These results suggested that glove thickness Writing – original draft, Writing – review & editing. Alireza Choobineh:
and inappropriate size could have negative effects on grip strength. Conceptualization, Methodology, Supervision, Project administration,
Accurate force control for grip precision demands finer detailed infor­ Funding acquisition. Mehdi Jahangiri: Writing – review & editing,
mation from mechanoreceptors in the skin. Thus, when these are Visualization, Formal analysis, Mahdi Malakoutikhah: Validation,
blocked by a membrane, it would be reasonable to assume that grip force Formal analysis
would be impaired (Park et al., 2016). Numerous studies published on
this issue have also shown that gloves reduced grip strength, which Declaration of competing interest
might be associated with the characteristics of glove materials. The most
likely explanation for the decrease in grip strength is that gloves reduce The authors declare that they have no known competing financial
the interfacial pressure of the fingers and alter the feedback from the interests or personal relationships that could have appeared to influence
hands and fingers (Nelson and Mital, 1995). the work reported in this paper.
In the current research, the participants’ scores of overall perfor­
mance with single gloves were not significantly different from those of Acknowledgment
the non-glove condition, indicating a subjective satisfaction with the
performance of single gloving. However, the performance rating was This work was supported by the National Institute for Medical
50% lower in the double glove condition compared to the non-glove Research Development (NIMAD) under grant number 982754. Hereby,
condition. Germaine et al. demonstrated that double gloving was not the authors would like to acknowledge the support and assistance pro­
favored amongst surgeons. Out of the 170 medical staff asked, 78 said vided by all participants. They would also like to thank Ms. A. Keivan­
that they did not use double gloves as it decreased their dexterity, and 62 shekouh at the Research Improvement Center of Shiraz University of
said that it was not comfortable (Germaine et al., 2003). This could have Medical Sciences for improving the use of English in the manuscript.
occurred for a variety of reasons, such as decreased tactile sensation
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