How often does glove perforation occur in surgery? Comparison between single gloves and a double-gloving system

Evaluation of sterile glove usage on digital tactile sensitivity using the Grating Orientation Task

Introduction

Surgical glove use may be associated with a decrease in tactile sensitivity, with thicker gloves or double-gloving techniques further altering sensation. This study evaluates digital tactile sensitivity by use of a Grating Orientation Task (GOT) with multiple sterile gloving techniques (no gloves, single standard gloving, double standard gloving, orthopedic gloves, and micro-thickness gloves).

Methods

Each participant performed the GOT at increasing grating widths until correctly noting orientation in ≥8 of 10 trials with multiple glove types or double-gloving technique. Glove order was randomly assigned and participants were blinded to the orientation and dome size.

Results

All gloves except micro-thickness gloves showed increased threshold sensitivity values (i.e. worse fingertip sensitivity) when compared to control (micro:control, p = 0.105, others:control, p < 0.05). Single-layer gloves showed no significant difference in sensitivity when compared to orthopedic (p = 0.06) or double-layer latex gloves (p = 0.26).

Discussion

Standard latex gloves decreased fingertip sensitivity when evaluated with the GOT. Double-layer and orthopedic latex gloves do not decrease sensitivity when compared with single-layer gloving. Micro-thickness gloves may provide similar tactile sensitivity to no surgical glove.

Time to consider blunt needles for implant surgery? A systematic review and meta-analysis shows that blunt suture needles reduce glove perforation

BACKGROUND

Despite a recent Cochrane Review demonstrating blunt suture needles are safer for surgeons, the use of blunt suture needles has not become widely adopted. In the 'Implant Era', with the value of medical implant companies to surpass $145 billion by 2027, should we re-examine the use of blunt suture needles, especially to reduce infection in implant surgery? We performed a systematic review and meta-analysis of randomised controlled trials (RCTs) assessing whether blunt suture needles reduce risks to surgeons and patients.

METHODS

A systematic review and meta-analysis was performed per PRISMA guidelines. PubMed, Cochrane and EMBASE databases were searched for RCTs. Dichotomous variables were pooled as risk ratios (RR) and associated 95% confidence intervals (CI) using the MH method. Random or fixed effects modelling use was based on statistical heterogeneity (I2).

RESULTS

14 RCTs were identified with 2488 patients. The RCTs included laparotomies, caesarean sections, episiotomies, and orthopaedic surgeries. Blunt suture needles when compared with sharp needles resulted in a significant reduction in glove perforation; RR: 0.47, 95% CI [0.37 to 0.60] and needlestick injuries, RR: 0.50, 95% CI [0.26 to 0.97]. Sharp needles caused more wound infections, but the result was not statistically significant; RR: 2.73, 95% CI [0.54 to 13.76], p 0.22. Surgeon's satisfaction decreased with blunt needles compared with sharp (RR: 1.22, 95% CI [1.09 to 1.37]).

CONCLUSION

Blunt suture needles are safer than sharp needles for surgeons and likely reduce risks to patients. This, however, comes at the cost of decreased ease of use. The authors recommend the routine use of blunt suture needles, especially in implant surgery.

Effect of glove use on manual dexterity of nursing students

Background

Manual dexterity is vital in nursing. Nurses need to carry out applications requiring manual dexterity in the quickest and most accurate way. However, gloves are also necessary during such applications as a precaution against infections. Therefore, manual dexterity and the effect of gloves on manual dexterity are essential subjects to be investigated in the nursing field.

Aims

This study aims to determine the effect of using gloves on the manual dexterity of nursing students.

Materials and Method

The sample of the semi-experimental study consisted of 80 nursing students. The data were collected using a questionnaire and Purdue Pegboard Test.

Results

The participants were 22.03 ± 1.35 years of age on average; 61.2% of them were 22 years of age or above, 50% were female, 50% were male, 50% were in the third grade, 50% were in the fourth, 80% were high school graduates, and 97.5% did not work in any job. As a result, 47.5% reported that gloves impacted their manual dexterity, 52.5% reported only a partial effect, 12.5% indicated that gloves increased their manual dexterity, 66.3% stated that it reduced their manual dexterity, and 21.2% reported no change. The right-hand and assembly scores were found to be significantly higher in the tests performed with bare hands than in the tests performed with gloves (P < 0.05).

Conclusions

Using latex gloves impacts the dominant-hand dexterity and assembly dexterity. Therefore, designing more ergonomic gloves, increasing nurses' habit of working with gloves already in school, and supporting the improvement of their manual dexterity with gloves are recommended.

National Survey of Sharps Injuries Incidence Amongst Healthcare Workers in the United States

Purpose

Reporting sharps injuries is crucial for healthcare worker occupational safety. However, these incidents are often underreported, thus posing potentially dangerous working environments. Previous small and limited studies have quantified this underreporting in specific groups of healthcare workers. This study aims to expand on these studies by further quantifying sharps injury incidences through a national study, thus better understanding healthcare reporting behaviors and the reasons for underreporting.

Patients and Methods

This is a national, multi-center, cross-sectional study conducted via an online anonymous survey distributed through email among United States attending physicians, fellows, residents, medical students, and nurses of all specialties (ie, surgery, medicine, pediatrics). Data analysis used descriptive statistics and regressive modeling with significance defined as p<0.05.

Results

Of over 3000 surveys emailed, 460 (15.3%) healthcare workers responded. The most vulnerable cohort to report sharps injuries were medical students (0.87 injuries per year ±0.69, n=92) and Postgraduate Year (PGY) 1 (0.67±0.81, n=71), PGY2 (0.86±-0.82, n=48), and PGY3 (0.92±0.8, n=45) resident physicians. Healthcare workers in surgical fields reported significantly higher likelihoods (odds ratio=4.61, p<0.001, 95% confidence interval 2.83-7.26) of sharps injuries. Medical students reported sharps injuries the least (40%) and nurses reported sharps injuries the most frequently (71%). The three most common reasons for not reporting sharps injuries included (1) healthcare workers perceiving low infection risk based on patient medical history, (2) fear of peer perception, and (3) belief of lack of reporting utility or that reporting is inconsequential.

Conclusion

Medical students and physicians early in training, especially those in surgical fields, are more vulnerable to sharps injuries, but are less likely to report, while nurses are the most likely to report. Dedicated sharps training, education to reduce stigma around injury, and implementing a simplified reporting process may help encourage reporting as well as consistency in reporting, leading to improved workplace safety.

The global incidence and associated factors of surgical gloves perforation: A systematic review and meta-analysis

BACKGROUND

Surgeon's hands are exposed to a range of chemical and physical stressors that influence the integrity of gloves. Thus, glove perforation facilitates pathogen transmission through the holes. Numerous studies have shown that glove perforation is of great importance, but there is still no complete consensus.

OBJECTIVE

This study aimed to investigate the safety conditions of surgical gloves based on the incidence of glove perforation among surgical teams.

METHODS

A literature review was conducted by searching PubMed, Embase, Scopus, ISI, and ProQuest databases. The incidence of glove perforation was reviewed in eight categories. A total of 580 articles were found in the initial search.

RESULTS

109 articles containing 130 datasets were analyzed. The overall incidence of glove perforation was 14.44 %. Surgeons had the highest incidence of glove perforation (23.09 %). An increase in the duration of surgery increased the odds of perforation. It was found that 68.58% of the glove perforations were not identified by practitioners.

CONCLUSION

Despite major advances in the design of surgical gloves, the issue of safety and integrity of gloves has not improved. Due to the high incidence of surgical glove perforations, most of which had not been identified, it is imperative to consider strategies to minimize the incidence of perforation. The results of the present study can be used to integrate information related to the rate of perforation of surgical gloves in different surgeries.

Preventing Infection in Implant-based Breast Reconstruction: Evaluating the Evidence for Common Practices and Standardized Protocols

Infection following implant-based breast reconstruction (IBBR) results in increased rates of hospital readmission, reoperation, patient and hospital expenses, and reconstructive failure. IBBR is a complex, multistep procedure, and there is a relative lack of high-quality plastic surgery evidence regarding "best practices" in the prevention of implant infections. In the absence of strong data, standardizing procedures based on available evidence can reduce error and improve efficacy and outcomes.

Methods

We performed a focused literature review of the available evidence supporting specific interventions for infection prevention in the preoperative, intraoperative, and postoperative phases of care that are applicable to IBBR. In addition, we examined previously published standardized perioperative protocols for implant reconstruction.

Results

Preoperative, intraoperative, and postoperative planning and organization is crucial in IBBR. Preoperative planning involves skin decolonization in advance of surgery with either chlorhexidine gluconate or mupirocin. Intraoperative methods that have shown potential benefit include double-gloving, breast pocket irrigation, separate closing instruments, and the utilization of "no-touch" techniques. In the postoperative period, the duration of drain removal and postoperative antibiotic administration play an important role in the prevention of surgical site infection.

Conclusions

There is a crucial need to establish an evidence-based set of "best practices" for IBBR, and there exists a paucity of evidence in the breast literature. These data can be utilized to develop a standardized protocol as part of a rigorous quality improvement methodology.

Recognition of intraoperative surgical glove perforation: a comparison by surgical role and level of training

Background:

The aim of this study was to characterize the risk of glove perforation among surgical team members performing a typical set of trauma procedures, as well as to identify the rate at which these people recognize potential perforations.

Methods:

Gloves used in orthopedic trauma room procedures were collected from all participating team members over 2 weeks and were subsequently examined for perforations. Perforation rates based on glove position, type, wearer and procedure were assessed.

Results:

Perforations were found in 5.9% of gloves; 4.3% of the perforations were found in outer gloves and 1.6% in inner gloves. Among the outer gloves, 30.7% of the perforations were recognized by the wearer at the time of perforation; none of the inner glove perforations were recognized, even when they were associated with an accompanying outer glove perforation. Significantly more perforations were identified in the gloves of attending staff than in those of other team members. Attending staff experienced more perforations than other wearers, regardless of whether they were acting as the primary surgeon or as an assistant. Perforations were more common in open reduction internal fixation and amputation procedures. For open reduction internal fixation procedures, longer operative times were associated with more frequent glove perforations.

Conclusion:

The rates of glove perforation are high in orthopedic trauma surgeries, and often these perforations are not recognized by the wearer. Attending staff are at an elevated risk of glove perforation. It is recommended that all members of the surgical team change both pairs of gloves whenever an outer glove perforation is observed.

Comparison of Unnoticed Glove Perforations during Minimally Invasive versus Open Surgeries: A Systematic Review and Meta-Analysis

Objective: Various studies have depicted the incidence of glove perforations during open (OS) and minimally invasive surgeries (MIS). The aim of this meta-analysis was to compare the incidence of macroscopic and microscopic glove perforations during MIS and OS. Methods: The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Scientific databases (PubMed, Web of Science, Scopus, and EMBASE) were systematically searched for comparative studies depicting the glove perforation rates during MIS and OS. Risk ratios (RR) were calculated for both the outcomes (dichotomous) and the Mantel–Haenszel method was utilized for the estimation of pooled RR. The methodological quality assessment was performed by two independent investigators using the Downs and Black scale. The main outcomes of the study were the proportion of gloves with gross (macroscopic) perforations and the proportion of gloves with microscopic perforations. Results: Four comparative studies including a total of 1428 gloves (435 from the MIS group) were included. Pooling the data demonstrated no difference in the incidence of macroscopic glove perforations among the MIS and OS groups (RR 0.57, 95% CI 0.21 to 1.54, p = 0.27). On the other hand, the incidence of microscopic perforations was significantly higher in the OS group versus the MIS group (RR 0.72, 95% CI 0.55 to 0.95, p = 0.02). However, all the studies had a moderate risk of bias. Conclusions: When compared to OS, the macroscopic glove perforation rate during MIS showed no significant difference. The incidence of microscopic glove perforations was significantly higher during OS as compared to MIS. However, due to the moderate risk of bias of the available comparative studies, the level of evidence of these studies is limited.

The impact of gel fingernail polish application on the reduction of bacterial viability following a surgical hand scrub

OBJECTIVE

To determine the effect of gel nail polish application on the reduction of bacterial viability immediately after a surgical hand scrub.

STUDY DESIGN

Randomized controlled trial.

SAMPLE POPULATION

Ten fingernails each from 40 female health care professionals and students.

METHODS

Participants' fingernails were randomized to receive no polish or gel nail polish during a manicure from a licensed manicurist. One day and 14 days after manicure, participants' fingernails were sampled before and after a surgical hand scrub with chlorhexidine gluconate. The samples for each fingernail were serially diluted, plated on a Trypsin sheep blood agar and MacConkey's agar plate, and incubated for 36 h. For each plate, bacterial colony forming units (CFU)/ml were determined. Mixed linear models were used to assess factors associated with the logarithmic reduction of viable bacterial counts from pre- to post-surgical scrub.

RESULTS

In the final model, no association was detected between gel nail polish and reduction of viable bacterial count (p = .09). On Day 14, among longer nail lengths (2 to <3-mm and ≥3-mm), surgical scrubs resulted in greater reduction in bacterial counts in left-handed than right-handed participants (p < .01). Increasing nail length was correlated with increased CFU/ml post-scrubbing (p < .001).

CONCLUSION

Application of gel nail polish did not seem to affect the ability of surgical scrub to reduce bacterial viability 1 and 14 days after a manicure.

CLINICAL IMPACT

This study does not provide evidence to prevent application of gel nail polish on short fingernails in surgeons prior to surgical hand scrub with chlorhexidine gluconate.

Surgical glove perforation during laparoscopic colorectal procedures

Background

It has been reported that in conventional open surgery, approximately 10% of surgical gloves are perforated during surgery without being noticed. To protect both the patient and medical staff from harm, double gloving or changing gloves routinely at certain intervals during surgery is recommended. However, whether these protective measures are also necessary for laparoscopic colorectal surgery is unknown because the actual perforation rate during laparoscopic procedures is unclear.

Methods

Seventy-seven laparoscopic colorectal surgeries were evaluated, and a total of 616 surgical gloves used in the surgeries were collected for analysis. The presence of glove perforation was tested by the standard water-leak test method (EN455-1).

Results

Seven perforations were detected (1.1%). The duration of the laparoscopic procedure was not a statistically significant risk factor for glove perforation (p = 0.41). Postoperative surgical site infections (SSIs) were observed in 12 cases (15.6%), but there was no significant correlation between the presence of glove perforation and SSI (p = 0.92). According to the bacterial cultivation results, the majority of causative agents of SSI were enterobacteria, which belong to the major gut flora.

Conclusion

Although the perforation rate was considerably lower than that in open surgery, surgical glove perforation occurred during laparoscopic procedures. Double gloving in laparoscopic colorectal surgery is recommended not to prevent SSI but to protect medical workers from harmful infections after direct contact with the patient.

Do surgeons use double gloves during surgery? Results of a survey

&lt;b&gt;Introduction:&lt;/b&gt; The perforation of gloves during surgical procedures is quite common. A cheap and quite effective method of reducing the risk of blood-borne infections is wearing two pairs of gloves. Unfortunately, some surgeons are reluctant to it, and they report decreased dexterity and sensation. The aim of the study was to evaluate surgeons' double-gloving practices to determine the factors related to compliance. &lt;br&gt;&lt;b&gt;Material and methods:&lt;/b&gt; An anonymous, 21-question survey in Polish was sent by post to 41 surgical departments. The questions concerned: demographic data, type of surgical gloves used, allergy to latex, number of surgeries performed, frequency of using double gloves and negative impressions from using them and finally, the frequency of needlestick injuries during surgical procedures. &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; We received 179 questionnaires back. More than 62% of the surgeons believe that double gloves provide better protection than a single pair, 24% do not believe in this, and 14% have no opinion. Only 0.6% of respondents always use double gloves during surgery, 19% double glove in at least 25% of cases and 68% do it occasionally. 13% of the surgeons declared that they had never worn double gloves. During high-risk procedures, 86% of respondents wear double gloves. About half of respondents (50.3%) report discomfort while wearing double gloves; 45% - decreased dexterity; about 30% complain of numbness and tingling; and 64% - decreased sensation. &lt;br&gt;&lt;b&gt;Conclusion:&lt;/b&gt; Due to the high number of surgical glove perforations and relatively high prevalence of needlestick injuries, it is necessary to use methods that reduce the risk of transmission of pathogens. The habit of using a double pair of gloves should be implemented especially among young surgeons starting to train in their specialities. Consequently, the period of initial discomfort will be combined with the acquisition of surgical skills, which will allow for gradual acclimatization.

Effectiveness of double-gloving method on prevention of surgical glove perforations and blood contamination: A systematic review and meta-analysis

AIMS

To determine the effectiveness of the double-gloving method on preventing surgical glove perforation and blood contamination compared with single gloving.

DESIGN

Systematic review.

DATA SOURCES

Seven electronic databases were searched including: Embase, CINAHL, OVID, Medline, Pubmed, Web of Science, and Foreign Medical Literature Retrieval Service in March 2020.

REVIEW METHOD

Our systematic review and meta-analysis was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guideline. Risk of bias of Cochrane Handbook (Version 5.1.0) was applied to evaluate the study quality. Revman 5.3 was used to calculate the effect size of odds ratio (OR) with 95% confidence interval (CI). Meta-analysis with forest plot and funnel plot was performed to compare the rate of surgical glove perforation and to determine the published bias, respectively. This review has been registered with ID: CRD42020189694 on the web site of PROSPERO.

RESULTS

Seven randomized controlled trials regarding the efficacy of double gloving on reducing surgical glove perforation were identified and a total of 7090 gloves were tested. After analyzing the pooled data, we identified that the rate of surgical glove perforation in the double-gloving group was lower than that of single gloving with statistical significance (OR = 0.75, 95% CI: 0.64-0.89, p < .05). It was statistically significant that surgical glove perforation was lower in the double-inner gloves as well as matched outer-inner perforated gloves compared with that of single glove (OR = 0.05, 95% CI: 0.03-0.07, p < .05).

CONCLUSION

Findings of this systematic review demonstrate that double gloving could reduce the rate of surgical-glove perforation. Meanwhile, the risk of being contaminated by a blood-borne pathogen during surgery could be reduced by wearing double gloves. We strongly suggest that surgical team members when operating should wear double gloves to protect themselves and reduce the risk of occupational blood exposure.

IMPACT

The necessity of double gloving for preventing blood contamination was demonstrated. The rate of surgical glove perforation is statistically significant in double-gloving group compared to single gloving. Double gloving could reduce the risk of being contaminated during surgery by blood-borne pathogen. Evidence is provided for surgical team and decision makers that double gloving could reduce occupational exposure.

Do your surgical glove characteristics and wearing habits affect your tactile sensibility?

Backround

Tactile sensibility plays a critical role in medicine, especially in surgical practice. In order to prevent surgical site infections and protect the surgeon, the use of surgical gloves is standard practice. However, wearing these might affect the sensibility of the hand disadvantageously, especially in disciplines that require precision work.

Methods

We evaluated the influence of six different glove types, as well as gloves wearing habits (double gloving, over- and undersized gloves) on tactile sensibility using two-point-discrimination and Semmes-Weinstein monofilament testing in 27 non-surgeons.

Results

There were significant differences regarding tactile sensibility of gloved compared to bare hands and between different types of gloves. While undersized gloves and double gloving did not affect tactile sensibility, oversized gloves were associated with a significant deterioration of the sensibility of the hand in the Semmes-Weinstein monofilament test.

Conclusion

This study demonstrates that surgical gloves negatively affect the sensibility of the hand and show significant differences between different types of gloves.

•

There were significant differences regarding tactile sensibility of gloved compared to bare hands.

•

There were significant differences between different types of gloves.

•

Undersized gloves and double gloving did not affect tactile sensibility.

•

Oversized gloves were associated with a significant deterioration of the sensibility.

Association Between the Frequency of Glove Change and the Risk of Blood and Body Fluid Exposure in Gastrointestinal Surgery

BACKGROUND

Surgical gloves are used to prevent the transmission of microorganisms from the surgeon's hands to the patient and vice versa. Little is known on the optimal frequency of glove changing. Therefore, we aimed to examine the optimal frequency of glove change during surgery by assessing the glove perforation rate in gastrointestinal surgery.

METHODS

In this observational prospective cohort study, we investigated the incidence of perforation of 5,267 gloves during gastrointestinal surgeries.

RESULTS

The overall glove perforation rate was 10.1%. There was no significant difference between single gloving (10.2%) and double gloving (10.0%; p = 0.8491). However, the perforation rate of the inner glove (5.7%) was found to be significantly lower than that of the outer glove (11.6%) (p < 0.0001). A significant difference in perforation rate was observed after wearing inner gloves for 240 min (< 240 min, 4.4%; ≤ 240 min, 7.2%; p = 0.0314), and outer gloves for 60 min (< 60 min, 7.1%; ≤ 60 min, 12.6%; p < 0.0001). We found cumulative perforation rate to rapidly increase until the wear time was 90 min.

CONCLUSION

The inner gloves and outer gloves have a higher perforation rate as the wear time increased. To reduce the risk of intraoperative blood and fluid exposure and prevent healthcare-associated infection, gloves should be changed for approximately every 60-90 min for outer gloves and approximately every 240 min for inner gloves.

Incidence of sharps injuries in surgical units, a meta-analysis and meta-regression

BACKGROUND

Sharps injuries occur often among surgical staff, but they vary considerably.

METHODS

We searched PubMed and Embase for studies assessing the incidence of sharps injuries. We combined the incidence rates of similar studies in a random effects meta-analysis and explored heterogeneity with meta-regression.

RESULTS

We located 45 studies of which 11 were randomized control trials, 15 were follow-up studies, and 19 were cross-sectional studies. We categorized injuries as self-reported, glove perforations, or administrative injuries. We calculated the population at risk as person-years and as person-operations (po). Meta-analysis of the incidence rate based on the best outcome measure resulted in 13.2 injuries per 100 time-units (95% confidence interval [CI], 4.7-37.1; I² = 100%). Per 100 person-years, the injury rate was 88.2 (95% CI, 61.3-126.9; 21 studies) for self-reported injuries, 40.0 for perforations (95% CI, 19.2-83.5; 15 studies), and 5.8 for administrative injuries (95% CI, 2.7-12.2; 5 studies). Per 100 po, the respective figures were 2.1 (95% CI, 0.8-5.0; 4 studies), 11.1 (95% CI, 6.6-18.9, 15 studies), and 0.1 (95% CI, 0.05-0.21). I² values were all above 90%. Meta-regression indicated lower incidence rates in studies that used perforations per po.

CONCLUSIONS

A surgeon will have a sharps injury in about 1 in 10 operations . Reporting of sharps injuries in surgical staff should be standardized per 100 po and be assessed in prospective follow-up studies.

Damages with High Consequences: Analysis of Perforations in Surgical Latex Operation Gloves from Orthopedic Surgeries

Introduction

To prevent surgical site infections (SSIs) during operation, the use of sterile surgical latex gloves is common. The aim of this study was to examine the damage of the gloves in surgeries with different mechanical stress and the influence on the kind of damages. Gloves were collected during primary arthroplasty, revision arthroplasty (hip and knee), and arthroscopy (shoulder, hip, and knee).

Materials and methods

Surgical latex operation gloves were collected from surgeons after the operation and were tested with watertightness test (ISO EN 455-1:2000).

Results

A total of 1460 surgical gloves were retrieved from 305 elective operations. On average, 15.9% of the gloves showed postoperative lesions, with the highest incidence occurring in revision arthroplasty with 25%. In primary and revision arthroplasty, the index finger of the dominant hand was most frequently affected (62.7% and 58.6%); in contrast, gloves from arthroscopies had most lesions on thumb and middle finger (42.9% each). Tear and perforation size differed from ≤1 mm to >5 mm, and primary and revision arthroplasty showed bigger damages.

Conclusions

Surgical gloves have a high malfunction, which increases with growing mechanical stress. A high rate of perforation occurred mostly in revision arthroplasty. Breaching the integrity of the gloves, especially by high mechanical loads, could lead to an increased rate of infection.

Evaluation of surgical glove integrity and factors associated with glove defect

BACKGROUND

Surgical glove perforation may expose both patients and staff members to severe complications. This study aimed to determine surgical glove perforation rate and the factors associated with glove defect.

MATERIAL AND METHODS

This descriptive cross-sectional study was conducted between January and March 2017 at a Tunisian university hospital center in 3 different surgical departments: urology, maxillofacial, and general and digestive. The gloves were collected and tested to detect perforations using the water-leak test as described in European Norm NF EN 455-1. For percentage comparisons, the χ² test was used with a significance threshold of 5%.

RESULTS

A total of 284 gloves were collected. Of these, 47 were found to be perforated, a rate of 16.5%. All perforations were unnoticed by the surgical team members. The majority of perforated gloves (61.7%) were collected after urology procedures (P = .00005), 77% of perforated gloves were detected when the duration of the procedure exceeded 90 minutes (P = .001), and 96% were from brand A, which were the thicker gloves (P = .015).

CONCLUSIONS

This study highlighted an important problem neglected by surgical teams. The findings reaffirm the importance of double-gloving and changing gloves in surgeries of more than 90 minutes' duration.

The Effects of Double Gloving on Microsurgical Skills

Objective

To determine whether double gloving would negatively affect participants’ ability to perform a simulated microsurgical task.

Study Design

Randomized single-blinded controlled crossover trial.

Setting

Temporal bone laboratory of an academic otolaryngology department.

Subjects and Methods

This study involved the simulated insertion of a stapes prosthesis into a model of the ossicular chain under microscopy. Forty-one participants were recruited from our medical and dental school and randomized into 2 groups. All groups began by performing the task without gloves, acting as their own control arm. The first group (A) then performed the task with a single pair of gloves while the second group (B) next performed the task with 2 pairs of gloves. The groups then switched gloving methods. The total time taken to perform the task was recorded for each participant and the results subjected to a series of statistical measures.

Results

This study found a statistically significant difference in the average time taken to complete the task between the “no-glove” arm of the study and both experimental groups but no difference between the 2 experimental groups. Likewise, no significant difference was found between the 2 experimental groups when comparing the rate at which they improved at performing the task.

Conclusion

These data suggest that wearing 2 pairs of surgical gloves does not negatively affect the speed at which a microsurgical procedure may be performed, lending support to the practice of double gloving, even in the setting of microsurgical fine motor tasks.

Prospective data collection and analysis of perforations and tears of latex surgical gloves during primary endoprosthetic surgeries

Introduction: Surgical gloves are used to prevent contamination of the patient and the hospital staff with pathogens. The aim of this study was to examine the actual effectiveness of gloves by examining the damage (perforations, tears) to latex gloves during surgery in the case of primary hip and knee prosthesis implantation.

Materials and methods: Latex surgical gloves used by surgeons for primary hip and knee replacement surgeries were collected directly after the surgery and tested using the watertightness test according to ISO EN 455-1:2000.

Results: 540 gloves were collected from 104 surgeries. In 32.7% of surgeries at least one glove was damaged. Of all the gloves collected, 10.9% were damaged, mainly on the index finger. The size of the perforations ranged from ≤1 mm to over 5 mm. The surgeon’s glove size was the only factor that significantly influenced the occurrence of glove damage. Surgeon training level, procedure duration, and the use of bone cement had no significant influence.

Conclusions: Our results highlight the high failure rate of surgical gloves. This has acute implications for glove production, surgical practice, and hygiene guidelines. Further studies are needed to detect the surgical steps, surface structures, and instruments that pose an increased risk for glove damage.

Visible glove perforation in total knee arthroplasty

PURPOSE

The risk of superficial surgical site infection (SSI) and periprosthetic joint infection (PJI) after glove perforation is not evident. This study was to identify risk factors for glove perforation in primary TKR (total knee replacement) and the risk of subsequent superficial SSI and PJI.

METHODS AND MATERIALS

Results of visible glove perforation of both inner and outer gloves during TKR were reviewed. A case-control analysis was performed on the preoperative and operative variables to identify predictive risk factors for glove perforation. Rate of SSI and PJI was compared between perforation and non-perforation groups, including 1226 series and 183 case-control subset.

RESULTS

One thousand two hundred twenty-six primary TKR from 2011 to 2014 was reviewed. Fifty-five knees had visible glove perforations. The operation perforation rate was 4.5%. Risk factors identified were body mass index (BMI) > 30, bilateral surgery, operation time >120 min and non-trainee surgeons. Superficial SSI was significantly higher in glove perforation group (9.15 vs. 0.51% and 0.55%). PJI was not significantly different (1.82% vs. 0.60% and 1.1%). The adjusted odds ratio for superficial SSI after perforation was 15.2, independent of BMI and operation time.

CONCLUSION

Visible glove perforation in TKR is associated with several risk factors. The risk of superficial SSI is higher after perforation.

A Cross-sectional Analysis of Glove Perforation in Primary and Revision Total Hip Arthroplasty

The number of total hip arthroplasties is ever increasing. Literature about glove perforation rates in arthroplasties in India is very scarce. The purpose of our study was to determine the incidence of glove perforation and increasing the awareness of possible glove perforations to decrease the risk of infection. We performed a prospective study in which we tested gloves worn by all scrubbed personnel. A total of 1408 gloves were collected from 42 primary total hip and 13 revision total hip arthroplasties. Incidence of glove perforation was found to be more in revision total hip arthroplasty. We found a greater outer glove perforation rate of about 38.33% as compared to 25 % inner glove perforation rate. Outer glove perforation was recognized 100% of time intraoperatively but inner glove perforation was noted only 17% of time. First assistant recorded highest rate of glove perforation.

Dental Student Hand Hygiene Decreased With Increased Clinical Experience

OBJECTIVE

To investigate the effectiveness, related knowledge, attitudes, and practices of hand hygiene (HH) among dental students with different levels of clinical experience.

DESIGN

This was a cross-sectional analytical study. Bacterial samples on the participants' hands were obtained using a swab technique before and after handwashing, for oral surgical procedures. After culturing, the colony-forming units were counted. Self-reported questionnaires reflecting the knowledge, attitudes, and practices related to HH were completed by the participants.

SETTING

This study was performed in a primary oral health care institution, Faculty of Dentistry, Chulalongkorn University (Bangkok, Thailand). Bacterial samples and self-reported questionnaires were collected in the Department of Oral and Maxillofacial Surgery. Bacterial culture was performed in the Department of Microbiology.

PARTICIPANTS

The 120 participants comprised first, second, third-year clinical training students (CTs), and postgraduate dental students (PGs) (32, 34, 30, and 24 participants, respectively).

RESULTS

More than 99% of the bacteria were eliminated from the participants' hands after handwashing. Significantly higher numbers of bacteria were recovered from the hands of the PGs compared with those of the CTs, and the hands of the third-year CTs compared with those of the first-year CTs (p < 0.001), after HH. The first-year CTs had the highest attitude scores, whereas the PGs had the lowest practice scores. The knowledge scores were similar in all groups.

CONCLUSION

HH effectiveness, attitudes, and practices of dental students decreased as students gained more clinical experience, whereas knowledge did not. Our results suggest that HH instruction should be given throughout the duration of dental students' education.

Adherence to surgical hand rubbing directives in a hospital district of Southwest Finland

BACKGROUND

The primary objective was to measure the compliance with alcohol-based surgical hand rubbing (SHR) among operation room personnel. The secondary objective was to evaluate the effect of feedback sessions on compliance.

METHODS

This was a prospective observational before-after intervention study. Between October 2010 and June 2012 the hygiene nurses observed SHR among operation room personnel in the hospital district of Southwest Finland. After feedback sessions a second observation round was conducted in the main operation room of Turku University Hospital. The first observation round comprised 477 observations: 259 (54%) were doctors, 190 (40%) nurses and 28 (5%) other personnel. In the second observation round a total of 210 observations were made.

RESULTS

During the first round in 42% of observations the 3 min SHR time recommended by WHO was used. Median times for SHR were 1 min 50 s (range 0 min to 5 min 44 s) for doctors and 3 min 25 s (range 1 min 1 s to 8 min 15 s) for nurses, respectively (p < 0.0001). In 40% of observations hands were not properly dried after a wash before applying SHR and in 45% hands were not allowed to dry properly after SHR before donning surgical gloves. After feedback, time for SHR did not significantly improve but technique did.

CONCLUSIONS

SHR was performed incorrectly in most observations even after feedback. The results stress the importance of more effective education, helping techniques and positive role models for operation room personnel to promote SHR.

Sharps injury prevention guidance among health care professionals: A comparison between self-reported and observed compliance

BACKGROUND

This study was performed to compare self-report and observation methods for measuring compliance with double gloving (DG) and the hands-free technique (HFT).

METHODS

The participants were 81 health care professionals (29 nurses, 52 doctors) working in 22 operating rooms in a tertiary hospital in Busan (South Korea). All participants were asked to complete a self-report questionnaire. Additionally, compliance with DG and the HFT was observed from March-May 2014. Data were analyzed using descriptive statistics, χ(2) test, and κ statistic using SPSS version 18.0 (SPSS, Chicago, IL).

RESULTS

The participants who always complied with DG and the HFT were 30.9% and 7.7% according to the self-report method, respectively, and 30.9% and 0.0% according to direct observation, respectively. The κ value comparing the self-report and observation methods was 0.557 for all study participants, 0.259 for nurses, and 0.668 for doctors for DG. The κ value was 0.027 for all participants, 0.131 for nurses, and 0.020 for doctors for the HFT.

CONCLUSION

DG compliance and HFT compliance showed moderate and low levels of agreement between the 2 methods, respectively. Doctors showed higher agreement than nurses between the 2 methods for DG compliance but similar to nurses for HFT compliance. Therefore, the levels of compliance with DG may be measured by either the self-report or observation methods for doctors.

Perforation of Surgical Gloves during Lower Extremity Fracture Surgery and Hip Joint Replacement Surgery

Purpose

To assess the frequencies and sites of surgical glove perforations in lower extremity fracture surgery and hip joint replacement (HJR) surgery. Additionally, we also studied the usefulness of an indicator system glove.

Materials and Methods

We assessed surgical glove perforations in 30 cases of lower extremity fracture surgery and 18 cases of HJR surgery conducted by one right handed 1st operator from April 2013 to July 2013. We assessed frequencies and sites of perforation in 152 gloves; 95 used in lower extremity fracture surgery and 57 used in HJR surgery. We studied the perforation rates and sites according to participants and operation types. Using the Biogel indicator system glove, which is well known as a fast indicator of glove perforation, we were also able to assess the time difference between operative participant detection of perforation and inspector nurse detection while observing in the operative field.

Results

There were 18 of 30 cases in lower extremity fracture surgeries and 12 of 18 cases in HJR surgeries which had more than one surgical glove perforation event. Of all 152 gloves used, perforation occurred in 15 of 57 gloves (26.3%) in HJR surgery and 23 of 95 gloves (24.2%) in lower extremity fracture surgery. Perforation occurred more frequently in operators than assistant doctors or scrub nurses. The most frequent perforation site was the second digit of the left hand. On average, the time difference between operative participant notice of perforation and inspector nurse notice of perforation was 20.6 seconds.

Conclusion

The perforation of surgical gloves happened in approximately one out of every four persons. Importantly, we noted a 37.0% prevalence of glove perforation in 1st operators. Considering that glove perforation is a critical factor responsible for intra-operative infection, surgeons must be conscious of the risk of surgical glove perforation and use double gloving regularly. Furthermore, indicator double gloving is recommended for fast detection of outer glove perforation.

Risk of Sharp Device–Related Blood and Body Fluid Exposure in Operating Rooms

Objective.

The risk of percutaneous blood and body fluid (BBF) exposures in operating rooms was analyzed with regard to various properties of surgical procedures.

Design.

Retrospective cohort study.

Setting.

A single university hospital.

Methods.

All surgical procedures performed during the period 2001–2002 (n = 60,583) were included in the analysis. Administrative data were linked to allow examination of 389 BBF exposures. Stratified exposure rates were calculated; Poisson regression was used to analyze risk factors. Risk of percutaneous BBF exposure was examined separately for events involving suture needles and events involving other device types.

Results.

Operating room personnel reported 6.4 BBF exposures per 1,000 surgical procedures (2.6 exposures per 1,000 surgical hours). Exposure rates increased with an increase in estimated blood loss (17.5 exposures per 1,000 procedures with 501–1,000 cc blood loss and 22.5 exposures per 1,000 procedures with >1,000 cc blood loss), increased number of personnel ever working in the surgical field (20.5 exposures per 1,000 procedures with 15 or more personnel ever in the field), and increased surgical procedure duration (13.7 exposures per 1,000 procedures that lasted 4–6 hours, 24.0 exposures per 1,000 procedures that lasted 6 hours or more). Associations were generally stronger for suture needle–related exposures.

Conclusions.

Our results support the need for prevention programs that are targeted to mitigate the risks for BBF exposure posed by high blood loss during surgery (eg, use of blunt suture needles and a neutral zone for passing surgical equipment) and prolonged duration of surgery (eg, double gloving to defend against the risk of glove perforation associated with long surgery). Further investigation is needed to understand the risks posed by lengthy surgical procedures.

Evaluation of surgical glove integrity during surgery in a Brazilian teaching hospital

BACKGROUND

A cross-sectional study was conducted in a large university hospital in Belo Horizonte, Minas Gerais, Brazil to evaluate surgical glove integrity after use during surgery.

METHODS

This 6-month study was conducted by a gastroenterological, cardiovascular, and pediatric surgical team consisting of surgeons (main surgeon and first and second assistants), medical students, and scrub nurses. The gloves used during surgery were examined postsurgery for microperforations using the watertight test as described in European Norm EN 455-1.

RESULTS

A total of 116 medical professionals conducted the 100 surgeries monitored. Of the 1090 gloves analyzed, 131 (12%) had a perforation detected postsurgery, 39 of which (37.5%) were recognized by users at the time of occurrence. The highest incidence of perforations occurred among surgeons (P = .033) in the index finger, followed by the thumb of the nondominant hand; in outer gloves (76.9%) when double-gloving was used (P = .014); in open surgery (P = .019); and in surgeries lasting ≥ 150 minutes (P < .05).

CONCLUSION

These findings reaffirm the importance of double-gloving, using a perforation indicator system, and changing gloves in surgeries of ≥ 150 minutes duration, especially in procedures involving open incisions.

Implementing AORN recommended practices for sharps safety

Prevention of percutaneous sharps injuries in perioperative settings remains a challenge. Occupational transmission of bloodborne pathogens, not only from patients to health care providers but also from health care providers to patients, is a significant concern. Legislation and position statements geared toward ensuring the safety of patients and health care workers have not resulted in significantly reduced sharps injuries in perioperative settings. Awareness and understanding of the types of percutaneous injuries that occur in perioperative settings is fundamental to developing an effective sharps injury prevention program. The AORN "Recommended practices for sharps safety" clearly delineates evidence-based recommendations for sharps injury prevention. Perioperative RNs can lead efforts to change practice for the safety of patients and perioperative team members by promoting the elimination of sharps hazards; the use of engineering, work practice, and administrative controls; and the proper use of personal protective equipment, including double gloving.

Is the surgical knot tying technique associated with a risk for unnoticed glove perforation? An experimental study

BACKGROUND

The issue of safety in the surgical procedure has recently been widely and openly discussed at the World Health Organization. The use of latex gloves is the current standard of protection during surgery, as they remain intact throughout the procedure. The present study was designed to evaluate the rate of glove perforation during a two-hand technique using polyester sutures in a controlled experimental study.

METHODS

Hypothesis was that the gloves used during a two-hand technique using polyester suture suffer punctures. We used 150 pairs of gloves during the experiment. Each investigator performed 30 tests always using double gloving. They made five surgical knots on each test over a custom-made table specifically developed for the experiment. Ten tests were done at a time with a week- interval. The Control Group (CG) has 30 pairs of intact surgical gloves. The gloves were tested to impermeability by water filling and leaking was observed at three different times. Statistics relating to the perforation rate were analyzed using the chi-square test. A P value less than 0.05 was considered statistically significant.

RESULTS

During the experiment there was no loss of gloves by drilling or inadvertent error in performing the impermeability test. No perforations were detected at any time during the impermeability test with the gloves used for sutures. Also, the CG presented no leakage of the liquid used for the test. There was no statistical difference between the groups underwent suture nor between them and the GC.

CONCLUSION

Under the studied conditions, the authors' hypotheses could not be proved. There was no damage to the surgical gloves during the entire experiment. The authors believe that the skin abrasions observed in the ulnar side of the little finger, constant throughout the experiment, must be caused by friction. We feel there is no risk of perforation of surgical gloves during a two-hand technique using polyester suture.

Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel

BACKGROUND

Healthcare workers are at risk of acquiring viral diseases such as hepatitis B, hepatitis C and HIV through exposure to contaminated blood and body fluids at work. Most often infection occurs when a healthcare worker inadvertently punctures the skin of their hand with a sharp implement that has been used in the treatment of an infected patient, thus bringing the patient's blood into contact with their own. Such occurrences are commonly known as percutaneous exposure incidents.

OBJECTIVES

To determine the benefits and harms of extra gloves for preventing percutaneous exposure incidents among healthcare workers versus no intervention or alternative interventions.

SEARCH METHODS

We searched CENTRAL, MEDLINE, EMBASE, NHSEED, Science Citation Index Expanded, CINAHL, NIOSHTIC, CISDOC, PsycINFO and LILACS until 26 June 2013.

SELECTION CRITERIA

Randomised controlled trials (RCTs) with healthcare workers as the majority of participants, extra gloves or special types of gloves as the intervention, and exposure to blood or bodily fluids as the outcome.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed study eligibility and risk of bias, and extracted data. We performed meta-analyses for seven different comparisons.

MAIN RESULTS

We found 34 RCTs that included 6890 person-operations as participating units and reported on 46 intervention-control group comparisons. We grouped interventions as follows: increased layers of standard gloves, gloves manufactured with special protective materials or thicker gloves, and gloves with puncture indicator systems. Indicator gloves show a coloured spot when they are perforated. Participants were surgeons in all studies and they used at least one pair of standard gloves as the control intervention. Twenty-seven studies also included other surgical staff (e.g. nurses). All but one study used perforations in gloves as an indication of exposure. The median control group rate was 18.5 perforations per 100 person-operations. Seven studies reported blood stains on the skin and two studies reported self reported needlestick injuries. Six studies reported dexterity as visual analogue scale scores for the comparison double versus single gloves, 13 studies reported outer glove perforations. We judged the included studies to have a moderate to high risk of bias.We found moderate-quality evidence that double gloves compared to single gloves reduce the risk of glove perforation (rate ratio (RR) 0.29, 95% confidence interval (CI) 0.23 to 0.37) and the risk of blood stains on the skin (RR 0.35, 95% CI 0.17 to 0.70). Two studies with a high risk of bias also reported the effect of double compared to single gloves on needlestick injuries (RR 0.58, 95% CI 0.21 to 1.62).We found low-quality evidence in one small study that the use of three gloves compared to two gloves reduces the risk of perforation further (RR 0.03, 95% CI 0.00 to 0.52). There was similar low-quality evidence that the use of one fabric glove over one normal glove reduces perforations compared to two normal gloves (RR 0.24, 95% CI 0.06 to 0.93). There was moderate-quality evidence that this effect was similar for the use of one special material glove between two normal material gloves. Thicker gloves did not perform better than thinner gloves.There was moderate to low-quality evidence in two studies that an indicator system does not reduce the total number of perforations during an operation even though it reduces the number of perforations per glove used.There was moderate-quality evidence that double gloves have a similar number of outer glove perforations as single gloves, indicating that there is no loss of dexterity with double gloves (RR 1.10, 95% CI 0.93 to 1.31).

AUTHORS' CONCLUSIONS

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. The preventive effect of double gloves on percutaneous exposure incidents in surgery does not need further research. Further studies are needed to evaluate the effectiveness and cost-effectiveness of special material gloves and triple gloves, and of gloves in other occupational groups.

Methodology for evaluating gloves in relation to the effects on hand performance capabilities: a literature review

The present study was conducted to review the literature on the methods that have been considered appropriate for evaluation of the effects of gloves on different aspects of hand performance, to make recommendations for the testing and assessment of gloves, and to identify where further research is needed to improve the evaluation protocols. Eighty-five papers meeting the criteria for inclusion were reviewed. Many studies show that gloves may have negative effects on manual dexterity, tactile sensitivity, handgrip strength, muscle activity and fatigue and comfort, while further research is needed to determine glove effects on pinch strength, forearm torque strength and range of finger and wrist movements. The review also highlights several methodological issues (including consideration of both task type and duration of glove use by workers, guidance on the selection and allocation of suitable glove(s) for particular tasks/jobs, and glove design features) that need to be considered in future research. Practitioner Summary: The relevant literature on the effects of protective gloves on different aspects of hand performance was reviewed to make recommendations for the testing and assessment of gloves, and to improve evaluation protocols. The review highlights research areas and methodological issues that need to be considered in future research.

A prospective analysis of glove perforation in primary and revision total hip and total knee arthroplasty

Literature in regard to glove perforation rates in revision total joint arthroplasty (TJA) is scarce. Our purpose was to determine the incidence of perforation in revision TJA. Gloves from all scrubbed personnel were tested based on the American Society for Testing and Materials. A total of 3863 gloves were collected from 58 primary and 36 revision arthroplasty cases. Surgeons had a 3.7% outer-glove perforation rate in primary TJA compared with 8.9% in revision TJA. When both gloves were perforated, the outer-glove perforation was recognized intraoperatively 100% of the time, and the inner-glove perforation was noted only 19% of the time. The surgeon has the highest rate of glove perforation. Outer-glove perforations should prompt careful inspection of the inner glove.

Risk of surgical glove perforation in oral and maxillofacial surgery

Oral and maxillofacial surgery, which involves several sharp instruments and fixation materials, is consistently at a high risk for cross-contamination due to perforated gloves, but it is unclear how often such perforations occur. This study aimed to address this issue. The frequency of the perforation of surgical gloves (n=1436) in 150 oral and maxillofacial surgeries including orthognathic surgery (n=45) was assessed by the hydroinsufflation technique. Orthognathic surgery had the highest perforation rate in at least 1 glove in 1 operation (91.1%), followed by cleft lip and palate surgery (55.0%), excision of oral soft tumour (54.5%) and dental implantation (50.0%). The perforation rate in scrub nurses was 63.4%, followed by 44.4% in surgeons and first assistants, and 16.3% in second assistants. The odds ratio for the perforation rate in orthognathic surgery versus other surgeries was 16.0 (95% confidence interval: 5.3-48.0). The protection rate offered by double gloving in orthognathic surgery was 95.2%. These results suggest that, regardless of the surgical duration and blood loss in all fields of surgery, orthognathic surgery must be categorized in the highest risk group for glove perforation, following gynaecological and open lung surgery, due to the involvement of sharp objects.

Determination of antiseptic efficacy of rubs on the forearm and consequences for surgical hand disinfection

While hands are acknowledged to be the most important source of pathogens from the skin of the surgical team, the transmission of pathogens from the forearms may also be relevant. Preoperative hand disinfection is recommended, but evidence-based standards for the forearms are lacking. As neither the European standard EN 12791 nor the American guidelines ASTM 1115 are applicable to the forearms, a new test method based on the European standard EN 12791 and the German Society for Hygiene and Microbiology (DGHM) method for testing for the efficacy of skin antiseptics was developed to address the forearms. The antiseptic efficacy of a commercially available alcohol-based hand rub [76.7% (w/w) ethanol] was assessed on the upper arm after 15s, 2.5 min, and 30 min, and on the lower arm after 2.5 min, 30 min, and 3 h. On the upper arm, application of the product followed the DGHM standard procedure. On the forearm, the product was applied by the participants themselves with the right hand over the left forearm and vice versa as performed during preoperative hand disinfection. Sampling and culture were performed according to the DGHM method for skin antisepsis on the upper arm. Twenty-two volunteers were investigated. The efficacy of the antiseptic treatment on the forearm was not significantly lower than on the upper arm for any of the areas tested (P > 0.05). Reduction factors for all tested areas and times were quite similar, with confidence intervals ranging between 1.43 and 2.31 log₁₀. We suggest that an application time of 10s may be sufficient for the treatment of the forearm as part of preoperative hand disinfection, provided that an appropriate product is used.

Reducing needle stick injuries in healthcare occupations: an integrative review of the literature

Needlestick injuries frequently occur among healthcare workers, introducing high risk of bloodborne pathogen infection for surgeons, assistants, and nurses. This systematic review aims to explore the impact of both educational training and safeguard interventions to reduce needlestick injuries. Several databases were searched including MEDLINE, PsycINFO, SCOPUS, CINAHL and Sciencedirect. Studies were selected if the intervention contained a study group and a control group and were published between 2000 and 2010. Of the fourteen studies reviewed, nine evaluated a double-gloving method, one evaluated the effectiveness of blunt needle, and one evaluated a bloodborne pathogen educational training program. Ten studies reported an overall reduction in glove perforations for the intervention group. In conclusion, this review suggests that both safeguard interventions and educational training programs are effective in reducing the risk of having needlestick injuries. However, more studies using a combination of both safeguards and educational interventions in surgical and nonsurgical settings are needed.

Evaluation of an innovative antimicrobial surgical glove technology to reduce the risk of microbial passage following intraoperative perforation

BACKGROUND

Surgical gloves provide a protective barrier for patients and members of the surgical team. Although glove integrity is important in an era of blood-borne pathogens, little data exist on bacterial passage after glove perforation. This study evaluated the impact of antimicrobial surgical gloves in reducing microbial passage after glove puncture in a model of wound contamination.

METHODS

Staphylococcus aureus (ATCC 6538) and Brevundimonas diminuta (DSM 1639) were used to prepare a standardized suspension for testing bacterial passage after glove puncture in volunteers wearing single-layer gloves (group A), double-layer gloves (group B), or antimicrobial trilayer gloves (group C). After exposure periods of 5, 10, 30 and 45 minutes, the outer test gloves were removed and microbial passage was measured on the inner surface of the base gloves. Multiple repetitions (5 or 6) were performed at each sampling time.

RESULTS

Microbial passage at 5-, 10-, 30-, and 45-minute exposures were analyzed both separately and combined (5 and 10 minutes and 30 and 45 minutes). No difference was observed in microbial passage between group A and group B at the 10-, 30-, and 45-minute exposures for S aureus, whereas a significant reduction in microbial passage was observed in group C compared with group A (P ≤ .05 to < .005) at the 5-, 30-, and 45-minute exposures for both S aureus and B diminuta. When timed groups were combined (5 and 10 minutes and 30 and 45 minutes), a significant reduction (P ≤ .01 to ≤ .005) in microbial passage of S aureus and B diminuta was observed in group C compared with both group A and group B.

CONCLUSION

These findings represent the first evidence that microbial passage across surgical gloves can be reduced significantly using an innovative antimicrobial glove technology.

Needlestick an sharps injuries among theatre care professionals

Health care professionals are exposed to blood and other body fluids in the course of their work: (Al-Benna et al 2008). The World Health Organisation (2003) estimates that 9% of the 35 million healthcare professionals worldwide will experience percutaneous exposure to bloodborne pathogens each year (WHO 2003). In the U.K. about 100,000 sharps injuries occur in NHS hospitals each year (Trim & Elliott 2003). This is 17% of all accidents involving NHS staff (NAO 2003). Four percent of NHS staff sustain from 1 to 6.2 sharps injuries each year. These injuries occur mainly in clinical areas such as wards and theatres, but also in non-clinical areas due to accidental handling of inappropriately discarded sharps (Trim & Elliott 2003, Waterson 2004). Percutaneous injuries involving hollowbore needles remain the most commonly reported occupational exposures in the healthcare setting (HPA 2010). Consequently, workers are at risk of infection with bloodborne viruses including human immunodeficiency virus, hepatitis B virus, hepatitis C virus and bacterial infections (Al-Benna et al 2008).

A comparison of the effect of different surgical gloves on objective measurement of fingertip cutaneous sensibility

INTRODUCTION

The prudent selection of surgical gloves can deliver significant efficiency savings. However, objective data are lacking to compare differences in cutaneous sensibility between competing gloves. Therefore, the present study examined the use of a single comparable model of sterile surgical glove from two competing providers, Gammex PF HyGrip(®) (Ansell Limited, Red Bank, NJ, USA) with Biogel(®) (Mölnlycke Health Care AB, Göteborg, Sweden).

SUBJECTS AND METHODS

Cutaneous pressure threshold, static and moving two-point discrimination were measured as indices of objective surgical glove performance in 52 blinded healthcare professionals.

RESULTS

The mean cutaneous pressure threshold was 0.0680 ± 0.0923 g for skin, 0.411 ± 0.661 g for Ansell gloves and 0.472 ± 0.768 g for Biogel gloves. Skin was significantly more sensitive than Ansell (P < 0.0001) or Biogel (P < 0.0001) gloves (Wilcoxon signed rank test). There was no statistical difference between Biogel and Ansell gloves (P = 0.359). There was no significant difference between static or moving 2-point discrimination of skin and Ansell gloves (P = 0.556, P = 0.617; Wilcoxon signed rank test), skin and Biogel gloves (P = 0.486, P = 0.437; Wilcoxon signed rank test) or Ansell and Biogel gloves (P = 0.843, P = 0.670; Wilcoxon signed rank test).

CONCLUSIONS

No demonstrable objective difference was found between competing gloves in the outcome measures of cutaneous sensibility and two-point discrimination. However, a difference in subjective preference was noted. Untested factors may underlie this discrepancy, and further research should employ more sophisticated measurements of surgical performance using competing models of surgical glove.

Glove perforation in hip and knee arthroplasty

BACKGROUND

The transmission of blood-borne pathogens during surgery is a major concern. Surgical gloves are the primary barrier between the surgeon and the patient. Surgical procedures that need manual handling of bony surfaces or sharp instruments have the highest risk of glove perforations. The frequencies and the sites of surgical glove perforations in arthroplasty procedures were assessed.

METHODS

We assessed the surgical glove perforations in total hip and knee arthroplasty procedures. Double standard latex gloves were used. A total of 983 outer and 511 inner gloves were tested. The gloves of all the surgical team members were tested for perforations during the first and second hours of surgery.

RESULTS

There were 18.4% outer and 8.4% inner glove perforations. The most frequent site of perforation was the second digit of the nondominant hand (25.5%). We found that hip and knee arthroplasty had significantly more glove perforation risk for the surgeon in the first half of the operation rather than the second half, and 57.8% of the perforations were at the index finger and the thumb.

CONCLUSIONS

Arthroplasty procedures still have high glove perforation rates despite the use of double gloving with frequent changes. Extra augmentation of the gloves in selected areas of the hand, in addition to double gloving, may be safer and more cost-effective than double gloving alone.

Bacterial migration through punctured surgical gloves under real surgical conditions

Background

The aim of this study was to confirm recent results from a previous study focussing on the development of a method to measure the bacterial translocation through puncture holes in surgical gloves under real surgical conditions.

Methods

An established method was applied to detect bacterial migration from the operating site through the punctured glove. Biogel™ double-gloving surgical gloves were used during visceral surgeries over a 6-month period. A modified Gaschen-bag method was used to retrieve organisms from the inner glove, and thus-obtained bacteria were compared with micro-organisms detected by an intra-operative swab.

Results

In 20 consecutive procedures, 194 gloves (98 outer gloves, 96 inner gloves) were examined. The rate of micro-perforations of the outer surgical glove was 10% with a median wearing time of 100 minutes (range: 20-175 minutes). Perforations occurred in 81% on the non-dominant hand, with the index finger most frequently (25%) punctured. In six cases, bacterial migration could be demonstrated microbiologically. In 5% (5/98) of outer gloves and in 1% (1/96) of the inner gloves, bacterial migration through micro-perforations was observed. For gloves with detected micro-perforations (n = 10 outer layers), the calculated migration was 50% (n = 5). The minimum wearing time was 62 minutes, with a calculated median wearing time of 71 minutes.

Conclusions

This study confirms previous results that bacterial migration through unnoticed micro-perforations in surgical gloves does occur under real practical surgical conditions. Undetected perforation of surgical gloves occurs frequently. Bacterial migration from the patient through micro-perforations on the hand of surgeons was confirmed, limiting the protective barrier function of gloves if worn over longer periods.