Surgical gloves need a better fit: Promoting equity in operating rooms

Surgical gloves worn by a female cardiac surgery healthcare worker.

Central Message.

There is a need for sex-specific surgical gloves. Poor fit resulted in subjective decreases in performance and satisfaction for 50% of women, with the fingertip area being the key issue.

The first surgical gloves were created by the Goodyear Rubber Company in 1889 to protect the hands of the female head scrub nurse of Dr William Halsted. Women generally have smaller hands compared with men, with the median glove size being 6.0 versus 7.5, respectively, among surgeons.¹ Despite anatomic differences in male and female hand measurements, there exists a paucity of research regarding the fit of these gloves. Improper glove sizing could result in musculoskeletal pain, reduced fine motor performance, and dissatisfaction.² We investigate sex-specific hand measurements and perceptions of current surgical glove size fit and determine if a poor fit results in subjective poorer performance or satisfaction. Our research aims to improve equity in operating rooms.

Material and Methods

Surveys were offered to adult healthcare workers who use surgical gloves at St Michael's Hospital (Toronto, Ontario) and Jewish General Hospital (Montreal, Québec, Canada) and were present and available during the data-collection period of July 1, 2024, to August 31, 2024. The survey included demographic questions, current glove size, and subjective questions related to glove size fit (Appendix E1). We obtained comprehensive anthropometric dominant hand measurements, including circumference, length, palm width size, and digit lengths (Figure E1). It is important to note that the majority of manufacturers still use only 1 measurement, either hand circumference or hand length,¹ and each specific glove size has fixed finger lengths.³

Figure E1.

Hand measurements that were taken from participants are shown using colored arrows. The hand width/circumference (pink arrow) is the circumference of the hand measured around the knuckles, hand length (orange arrow) is the distance from the distal tip of the third digit to the first wrist crease of the dominant hand, palm width size (green arrow) is the largest horizontal distance of the palm, and the distance from the distal tip of each digit to its corresponding base crease (blue arrows).

Summary statistics were used to characterize the distribution of responses. Two-sided Student t test was used to determine statistical differences between hand measurements among men and women for similar glove sizes (STATA version 15). Two-sided statistical significance and the 95% CIs were reported.

Results

This study included 200 participants (156 women [78%]), and all surveys that were offered to healthcare workers during the data-collection period were completed. The average glove size for women and men was 6.5 and 7.4, respectively. Average hand measurements were found to be larger for men than for women (Table 1). The glove range reported for men was between 6.5 and 8.5, whereas for women it was between 5 and 8. Men and women in our study shared 4 common glove sizes (6.5, 7, 7.5, 8). Approximately 44% of women thought that their current surgical glove size was not a good fit, whereas the majority of men (64%) were satisfied with their current fit. A lack of a suitable fit resulted in subjective fatigue and decreases in performance and satisfaction for 50% of women. The fingertip area was the main issue for women and men who do not think their current surgical glove size is a good fit. Some participants reported multiple issues, with 32% of women reporting both fingertip and palm area as being issues (Table 2).

Table 1.

Hand anthropometric measurement summary statistics

	Age group (y)	No. of participants (N = 200)	Average hand width (cm)	Average hand length (cm)	Average palm width (cm)	Average distal tip of digit 1 (cm)	Average distal tip of digit 2 (cm)	Average distal tip of digit 3 (cm)	Average distal tip of digit 4 (cm)	Average distal tip of digit 5 (cm)	Average glove size
Female		156	18.6	17.7	8.6	6.2	7.0	7.7	7.0	5.6	6.5
Nurse		126	18.6	17.6	8.7	6.2	7.0	7.7	6.9	5.6	6.5
	≤30	44	18.4	17.9	8.3	6.1	7.0	7.7	7.0	5.5	6.6
	31-40	45	18.5	17.3	9.3	6.2	6.9	7.7	6.9	5.5	6.6
	41-50	20	19.1	18.0	8.6	6.3	7.1	7.8	7.1	5.8	6.5
	51-60	15	18.7	17.3	8.0	6.1	6.9	7.5	6.8	5.5	6.5
	61-70	2	18.5	17.5	8.6	6.0	6.7	7.5	6.8	5.4	6.5
Other		19	19.2	18.3	8.5	6.4	7.2	8.0	7.2	5.8	6.4
	≤30	7	18.5	18.1	8.4	6.5	7.3	8.0	7.2	5.9	6.1
	31-40	6	19.3	19.2	8.5	6.9	7.8	8.5	7.8	6.3	6.8
	41-50	1	19.0	18.6	9.0	6.0	6.8	8.1	7.4	5.7	6.5
	51-60	5	20.0	17.3	8.8	6.0	6.6	7.3	6.6	5.2	6.6
Resident		10	17.9	17.9	8.2	6.5	7.1	7.7	7.2	5.7	6.2
	≤30	6	18.2	18.1	8.4	6.3	7.0	7.7	7.3	5.8	6.3
	31-40	4	17.5	17.6	7.9	6.8	7.1	7.7	7.0	5.5	6.1
Surgeon		1	17.0	16.3	8.0	6.0	6.1	7.7	6.5	5.4	5.5
	41-50	1	17.0	16.3	8.0	6.0	6.1	7.7	6.5	5.4	5.5
Male		44	21.4	19.2	9.6	6.9	7.6	8.4	7.6	6.2	7.4
Nurse		19	22.3	19.5	9.8	6.7	7.6	8.4	7.5	6.2	7.5
	≤30	4	21.8	19.4	9.6	6.7	7.6	8.4	7.7	6.4	7.8
	31-40	8	22.1	19.3	9.5	6.6	7.4	8.5	7.3	6.1	7.4
	41-50	4	24.4	20.5	10.6	7.1	7.8	8.7	7.8	6.7	7.8
	51-60	3	21.1	18.7	9.8	6.7	7.5	8.1	7.5	5.9	7.3
Other		13	20.2	18.5	9.4	7.0	7.7	8.3	7.6	6.2	7.2
	≤30	1	21.0	18.2	9.5	7.0	7.2	8.2	7.8	5.5	7.5
	31-40	5	20.0	16.9	9.1	7.2	7.6	8.3	7.6	6.2	7.1
	41-50	3	19.8	20.5	10.1	7.2	8.1	8.7	7.9	6.7	7.7
	51-60	4	20.5	19.1	9.3	6.7	7.6	8.1	7.4	6.0	7.0
Resident		8	21.2	19.6	9.7	6.9	7.7	8.3	7.6	6.4	7.4
	≤30	5	21.3	19.6	9.8	6.9	7.6	8.2	7.5	6.3	7.4
	31-40	2	21.1	19.8	9.5	6.9	7.7	8.5	7.6	6.4	7.5
	41-50	1	21.0	19.2	10.0	7.0	8.0	8.6	8.0	6.6	7.0
Surgeon		4	20.9	19.8	9.2	7.2	7.6	8.3	7.5	6.2	7.3
	31-40	2	21.0	19.7	9.3	7.8	7.8	8.5	7.6	6.2	7.3
	41-50	1	21.0	20.0	9.3	7.0	7.5	7.9	7.4	6.0	7.0
	71+	1	20.5	20.0	9.0	6.1	7.2	8.3	7.5	6.3	7.5

Table 2.

Summary results of the responses to the survey

Questions	Sex-specific category	Participants N (%; 95% CI)
Is your current glove size a suitable/perfect fit?	Female (N = 156)
	No	68 (43.6%; 95% CI, 35.7-51.8)
	Yes	54 (34.6%; 95% CI, 27.2-42.6)
	Unsure	34 (21.8%; 95% CI, 15.6-29.1)
	Male (N = 44)
	No	9 (20.5%; 95% CI, 9.8-35.3)
	Yes	28 (63.6%; 95% CI, 47.8-77.6)
	Unsure	7 (15.9%; 95% CI, 6.6-30.1)
Does a lack of a suitable/perfect fit result in fatigue	Female (N = 68)
and/or decreases in performance/satisfaction?	No	18 (26.5%; 95% CI, 16.5-38.6)
	Yes	34 (50.0%; 95% CI, 37.6-62.4)
	Unsure	16 (23.5%; 95% CI, 14.1-35.4)
	Male (N = 9)
	No	5 (55.6%; 95% CI, 21.2-86.3)
	Yes	4 (44.4%; 95% CI, 13.7-78.8)
	Unsure	0 (0%)
What part of the glove does not fit properly?	Female (N = 68)
	Near the fingertips	53 (77.9%; 95% CI, 66.2-87.1)
	Near the knuckles	13 (19.1%; 95% CI, 10.6-30.5)
	Between thumb and index finger	17 (25.0%; 95% CI, 15.3-37.0)
	Palm area	17 (25.0%; 95% CI, 15.3-37.0)
	Male (N = 9)
	Near the fingertips	7 (77.8%; 95% CI, 40.0-97.2)
	Near the knuckles	1 (11.1%; 95% CI, 0.28-48.3)
	Between thumb and index finger	0 (0%)
	Palm area	2 (22.2%; 95% CI, 2.8-60.0)
Participants who reported multiple issues	Female (N = 22)
	Near the fingertips, knuckles	3 (13.6%; 95% CI, 2.9-34.9)
	Near the fingertips, between thumb and index finger	3 (13.6%; 95% CI, 2.9-34.9)
	Near the fingertips, palm area	7 (31.8%; 95% CI, 2.9-34.9)
	Knuckles, between thumb and index finger	2 (9.1%; 95% CI, 1.1-29.2)
	Between thumb and index finger, palm area	1 (4.5%; 95% CI, 0.12-22.8)
	Near the fingertips, between thumb and index finger, palm area	2 (9.1%; 95% CI, 1.1-29.2)
	Near the fingertips, knuckles, between thumb and index finger, palm area	4 (18.2%; 95% CI, 5.2-40.3)
	Male (N = 1)
	Near the fingertips, knuckles	1 (100%; 95% CI, 2.5-100)

We found a statistically significant pooled difference between female and male glove sizes, as well as between female and male glove sizes for the glove size range of 6.5 to 8 (Figure E2). For glove sizes 6.5 and 7, we found a statistically significant difference between female and male hand width (difference of −1.6 cm; CI, −2.3 to −0.8) and digits 1 to 5 length measurements (Figure 1, A). For glove sizes 7.5 and 8, we found a statistically significant difference between female and male palm width (difference of −0.7 cm; CI, −1.3 to 0.0) and hand length (difference of −1.2; CI, −1.8 to −0.5) measurements (Figure 1, B). Thus, men and women had statistically different hand measurements if similar glove sizes are compared. Across all measurements, female sizes were smaller than male sizes. Our results suggest the need for sex-specific gloves.

Figure E2.

A, Boxplot depicting sex-specific glove size distribution. B, Boxplot depicting sex-specific glove distribution for the glove size range of 6.5 to 8. P values are indicated. The median is indicated with a middle horizontal line inside the box. The lower and upper borders of the box represent the lower and upper quartiles (25th and 75th percentiles). The lower and upper whiskers represent the minimum and maximum values of nonoutliers. Outliers are represented by extra dots.

Figure 1.

Sex-based mean measurements (cm) were plotted according to measurement type. D1: distance from tip of digit 1 (thumb) to its corresponding base crease; D5: distance from tips of digit 5 (pinky) to its corresponding base crease. Mean difference = mean (female) – mean (male), which is less than 0, indicated above each bar. The lower and upper whiskers on each bar represent the lower and upper 95% CI. A, Sex-specific hand measurement differences for glove sizes 6.5 and 7. B, Sex-specific hand measurement differences for glove sizes 7.5 and 8.

Discussion

In our study, many female participants reported a poor surgical glove fit, with the major issue being loose or tight fingertips resulting in fatigue or subjective decreases in performance. We found a statistical difference in sex-specific hand measurements for men and women wearing the same glove size. Glove sizes have largely been the same despite changes in demographics of surgeons over the past few decades. Hand anthropometry studies conducted in firefighters⁴ and surgeons¹ noted considerable variation in hand size, palm length, and finger length, recommending changes in glove manufacturing for a better fit. One study found that a high percentage of glove users have variable finger lengths despite concordant palm measurements with current glove sizes.³ A study compared 4 different glove brands and found that on average, the majority of the participants had complaints of poor fitting, with finger length being the main complaint.⁵ Oversized gloves are known to cause deteriorated tactile sensibility and reduced grip, and undersized gloves are known to cause discomfort and fatigue.²

Important limitations of our study include the modest sample size, as well as data collection that took place during the summer months, a period when surgical case volumes tend to decrease, resulting in a lower number of surgeon participants in our sample, which may limit the generalizability of our findings. Another limitation is the lack of evaluation of user-perceived glove fit across different surgical glove brands and collection of additional subjective information such as a preference for tight- or loose-fitted surgical gloves.

Conclusions

A higher proportion of women experienced poor glove fit compared with men, with the fingertip area being the key issue. Future efforts would be best suited addressing our limitations, including a larger sample size with greater surgeon representation, additional subjective information (eg, loose-fitted surgical glove preference), and potential differences across surgical glove brands. Our results suggest the need for sex-specific gloves, with the goal of improving comfort and performance, to ultimately promote equity in operating rooms.

Conflict of Interest Statement

The authors reported no conflicts of interest.

The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Appendix E1. Supplement

Survey

Instructions:

For each question, please check the box next to the response most applicable to you.

• 1)
  What is your sex?

  • □
    Male □ Female
• 2)
  What age range (y) do you fit in?

  • □
    ≤30 □ 31-40 □ 41-50 □ 51-60 □ 61-70 □ 71+
• 3)
  What height in ∼ft range do you fit in?

  • □
    ≤5 (<1.5 m) □ 5.1-5.5 (1.55-1.67 m) □ 5.6-5.11 (1.7-1.8 m) □ 6.0-6.5 (1.83-1.98 m) □ 6.6+ (2 m+)
• 4)
  What weight in ∼pounds range do you fit in?

  • □
    ≤100 (<45 kg) □ 101-130 (46-59 kg) □ 131-150 (60-68 kg) □ 151-170 (69-77 kg) □ 171+ (78 kg+)
• 5)
  What is your profession?

  • □
    Surgeon/Attending □ Resident/Fellow □ Nurse □ Other
• 6)
  Which hand do you consider as your dominant hand?

  • □
    Left □ Right
• 7)
  What is your current preferred surgical glove size?

  • □
    5 □ 5.5 □ 6 □ 6.5 □ 7 □ 7. □ 8 □ 8.5
• 8)
  Do you double glove?

  • □
    Yes □ No

If yes, what sizes of gloves?

• First surgical glove.

  • □
    5 □ 5.5 □ 6 □ 6.5 □ 7 □ 7.5 □ 8 □ 8.5
• Second surgical glove.

  • □
    5 □ 5.5 □ 6 □ 6.5 □ 7 □ 7.5 □ 8 □ 8.5
• 9)
  Do you feel that your current surgical glove size is a perfect fit?

  • □
    Yes □ No □ Unsure
• If no, does this result in musculoskeletal pain, easier fatigue, potential decreases in performance and/or satisfaction?

  • □
    Yes □ No □ Unsure
• If no, what part of the current surgical glove size does not fit properly (eg, tight or loose)?

  • □
    Near the fingertips □ Near the knuckles Between the thumb and index finger □ Palm area

Other: _____________________________________________________________________