The effect of polymethyl methacrylate on latex-free surgical gloves

Does exposure to polymethyl methacrylate bone cement increase the risk of surgical glove failure?

INTRODUCTION

Surgical glove perforation has been linked to a double-fold increased risk of surgical site infection. Infection in the context of arthroplasty can have devastating consequences. In orthopaedics, use of polymethyl methacrylate (PMMA) bone cement is commonplace, and the impact on glove strength and perforation risk is not fully understood. This study aimed to examine the resistance to perforation and thickness of gloves following PMMA exposure, in accordance with the International Organization for Standardization (ISO) standard for glove integrity.

METHODS

Pairs of gloves were separated and randomly sorted into exposure and control groups. Twenty pairs of latex and 40 pairs of polyisoprene gloves were used. Exposure group glove cuffs were in contact with cement from a single surface of the glove for 13 min as cement cured. Force to perforation and glove thickness were tested in accordance with ISO guidelines.

RESULTS

Latex gloves were found to have a significantly increased force to perforation following PMMA exposure (10.26 Newtons (N) vs. 9.81 N, P = 0.048). Both polyisoprene under- and over-gloves were shown to have no significant change in strength to perforation post exposure (9.69 N vs. 9.83 N, P = 0.561, and 10.26 N vs. 10.65 N, P = 0.168, respectively). All groups were over the ISO standard minimum strength of 5 N.

CONCLUSIONS

Exposure of latex and polyisoprene surgical gloves to PMMA bone cement does not appear to increase glove perforation risk and rather may improve natural rubber latex glove strength. This study supports the use of latex and polyisoprene surgical gloves in procedures that involve the handling of PMMA bone cement.

Latex Allergy as an Independent Risk Factor for Prosthetic Joint Infection

In response to increasing rates of self-reported latex allergies, changes have been made to prevent anaphylaxis in the operating room, including the use of latex-free gloves. However, the impact of these changes on the risk of prosthetic joint infection (PJI) after arthroplasty is unclear. This study evaluated whether documented latex allergy is an independent risk factor for PJI and aseptic revision surgery after total hip arthroplasty (THA) and total knee arthroplasty (TKA). A retrospective matched cohort study was conducted with an administrative claims database. A total of 17,501 patients who underwent TKA and had documented latex allergy were matched 1:4 with 70,004 control subjects, and 8221 patients who underwent THA and had documented latex allergy were matched 1:4 with 32,884 control subjects. Multivariable logistic regression showed that patients who had TKA and had a latex allergy showed significantly higher risk of PJI at both 90 days (odds ratio [OR], 1.26) and 1 year (OR, 1.22) and significantly higher risk of aseptic revision TKA at 1 year (OR, 1.21) after surgery compared with control subjects. Patients who had THA and had a latex allergy had significantly higher risk of PJI at 1 year (OR, 1.19) compared with control subjects. Rates of aseptic revision THA were higher in the latex allergy cohort but statistically comparable (P>.05). Latex allergy was associated with significantly increased risk of PJI and aseptic revision after TKA and significantly increased risk of PJI after THA. More work is needed to determine whether these risks can be mitigated or if latex allergy is an inherent, nonmodifiable risk factor requiring modification to typical arthroplasty pathways. [Orthopedics. 2022;45(4):244-250.].

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.

[Recurrent effusion and granulomatous synovitis following total knee arthroplasty in association with latex allergy]

An increasing number of articles report about allergic reactions in association with total knee arthroplasty. While most studies focus on allergic reactions to metallic components, few reports exist about reactions to bone cement or its ingredients. Allergy to natural rubber latex is a major occupational problem in the health care sector and a problem even in other occupations in which protective gloves are used. The allergic reaction to latex ranges from a minor skin rash to anaphylactic shock. Preventing exposure to latex is the key to managing and preventing this allergy. We report about a patient who developed recurrent effusion and granulomatous synovitis following total knee arthroplasty in association with latex allergy.

Postoperative integrity of veterinary surgical gloves

A multicenter, prospective study was performed to document the incidence of defective gloves postoperatively in veterinary surgery and to correlate defects with a variety of influencing factors. Gloves were collected after surgical procedures performed by the small animal clinical services at two veterinary teaching hospitals and one institution's student surgery laboratories. Gloves were evaluated for defects using electrical resistance testing. The overall incidence of glove defects was 23.3%. Significantly more defects occurred in gloves used for nonsoft-tissue procedures and in gloves worn on the nondominant hand. Eighty-four percent of all defects occurred in procedures lasting >60 minutes. No differences were detected in the brands of gloves used nor among surgeons of different experience levels. The individuals performing the surgery were not able to accurately predict the presence of a defect in their gloves. Surgeons should remain alert for possible glove defects and consider measures such as changing gloves every 60 minutes or double-gloving to minimize potential complications.

The changing face of hand protection

Perioperative nurses are empowered to act as patient advocates. As such, it is their responsibility to critically evaluate all products used in the surgical environment, including gloves. A basic understanding of the history of surgical gloves, health issues associated with their use, glove materials, and the essential properties of hand scrubs can help perioperative nurses choose appropriate products. This article explores these issues so that nurses and other health care workers can develop a framework for making informed decisions based on clinical reasoning.