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Man T, Jiang J, Schulz M, Kükrek H, Betzl J, Machens HG, Erne HC, Moog P. Surgical experience and different glove wearing conditions affect tactile sensibility. Heliyon 2022; 8:e12550. [PMID: 36593852 PMCID: PMC9803715 DOI: 10.1016/j.heliyon.2022.e12550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/30/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background The fingers' tactile sensibility is essential in surgery, especially in microsurgery. Therefore, surgeons seeking to improve their performance often prefer certain glove brands and wearing habits. There is the need of objectively testing these glove wearing conditions and determine the effect of surgical experience with regard to tactile sensibility by comparing surgeons with non-surgeons. Methods This cross-sectional single-center pilot-study was conducted between June and August 2021. Two groups of 27 surgeons and 27 non-surgeons underwent two-point-discrimination (2PD) and Semmes-Weinstein monofilament testing (SWMT) of both index fingers with bare hands and with wearing six different brands of surgical gloves. Different wearing conditions, such as single-gloving, double-gloving, well-fitted, under- and oversized gloves, were evaluated within and between the groups. Results Most glove types decreased tactile sensibility (2PD and SWMT) of surgeons and non-surgeons. Interestingly, the thinnest gloves showed similar 2PD values to bare hands in both groups. Double-gloving negatively impacted SWMT, without influencing 2PD. Undersized gloves showed better 2PD and SWMT than well-fitted gloves, while oversized gloves showed no tactile drawbacks. With bare hands and certain glove conditions, the surgeons' 2PD and SWMT was significantly better than the non-surgeons', indicating a positive effect of surgical experience on tactile sensibility. Conclusion Our study demonstrated the positive impact of surgical experience on tactile sensibility, as demonstrated by the surgeons. The sensibility of the gloved hand varies on the surgical glove type, but favors thinner gloves, single gloving (rather than double gloving) and undersized or well-fitted gloves.
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Affiliation(s)
- Tanita Man
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, D-81675, Munich, Germany
| | - Jun Jiang
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, D-81675, Munich, Germany
| | - Manuela Schulz
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, D-81675, Munich, Germany,Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Haydar Kükrek
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, D-81675, Munich, Germany
| | - Julia Betzl
- Department of Anesthesiology and Intensive Care, KABEG – Klinikum Klagenfurt am Wörthersee, 9020, Klagenfurt am Wörthersee, Austria
| | - Hans-Günther Machens
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, D-81675, Munich, Germany
| | - Holger C. Erne
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, D-81675, Munich, Germany
| | - Philipp Moog
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, D-81675, Munich, Germany,Corresponding author.
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Moog P, Schulz M, Betzl J, Schmauss D, Lohmeyer JA, Machens HG, Megerle K, Erne HC. Do your surgical glove characteristics and wearing habits affect your tactile sensibility? Ann Med Surg (Lond) 2020; 57:281-286. [PMID: 32904254 PMCID: PMC7452141 DOI: 10.1016/j.amsu.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/04/2020] [Accepted: 08/04/2020] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Philipp Moog
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, D-81675, Munich, Germany
| | - Manuela Schulz
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, D-81675, Munich, Germany
| | - Julia Betzl
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, D-81675, Munich, Germany
| | - Daniel Schmauss
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, D-81675, Munich, Germany.,Department for Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Jörn A Lohmeyer
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, D-81675, Munich, Germany.,Department for Plastic, Reconstructive and Aesthetic Surgery, Agaplesion Diakonieklinikum Hamburg, Hamburg, Germany
| | - Hans-Günther Machens
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, D-81675, Munich, Germany
| | - Kai Megerle
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, D-81675, Munich, Germany
| | - Holger C Erne
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, D-81675, Munich, Germany
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Jernigan EW, Smetana BS, Rummings WA, Dineen HA, Patterson JMM, Draeger RW. The Effect of Intraoperative Glove Choice on Carpal Tunnel Pressure. J Hand Microsurg 2020; 12:3-7. [PMID: 32296267 PMCID: PMC7970659 DOI: 10.1055/s-0038-1674297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 05/28/2018] [Indexed: 10/28/2022] Open
Abstract
Abstract
Introduction The aim of this study was to quantify the effect of surgical gown and glove wear on carpal tunnel pressure. The authors hypothesized that gowning and gloving is associated with an increase in carpal tunnel pressure in cadaveric specimens wearing appropriately sized gloves. Furthermore, they hypothesized that increased glove thickness, double gloving, and smaller-than-appropriately sized gloves would all serve to increase carpal tunnel pressure.
Materials and Methods Baseline carpal tunnel pressure measurements were obtained in 11 cadaveric specimens. Each specimen was subsequently gowned and gloved. Carpal tunnel pressures were obtained for each specimen fitted with four different types of gloves in four scenarios: (1) appropriately sized gloves, (2) one full-size smaller, (3) one full-size larger, and (4) double gloved.
Results Mean carpal tunnel baseline value was 3.5 mm Hg. Appropriately sized single-glove wear more than doubled baseline carpal tunnel pressure. Double gloving and smaller-than-appropriately sized glove wear more than tripled baseline values. Among the single-glove subgroup, the thickest gloves (ortho) were associated with the highest increase in pressure from baseline values.
Conclusion Glove selection can have repercussions related to carpal tunnel pressure. Susceptible surgeons should consider these factors when making decisions regarding intraoperative glove wear.
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Affiliation(s)
- Edward W. Jernigan
- Department of Orthopaedics, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Brandon S. Smetana
- Department of Orthopaedics, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Wayne A. Rummings
- Department of Orthopaedics, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Hannah A. Dineen
- Department of Orthopaedics, University of North Carolina, Chapel Hill, North Carolina, United States
| | - J. Megan M. Patterson
- Department of Orthopaedics, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Reid W. Draeger
- Department of Orthopaedics, University of North Carolina, Chapel Hill, North Carolina, United States
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Abstract
Current standard management of a cut digital nerve is end-to-end microsurgical nerve coaptation where possible. A recent systematic review of adult digital nerve injuries that were either repaired or left unrepaired showed that the evidence for good nerve recovery or improved function following nerve repair is poor. In the 30 studies included, only 24% of repaired nerves regained sensory recovery close to or equivalent to estimated pre-injury levels. Neuroma rates were the same in those nerves repaired (4.6%) and those not repaired (5%). Questions under debate include proper assessment methods of outcomes, decision making for repair or no repair to different fingers or the thumb, levels of injury, age, and hand dominance. This review summarizes the major evidence available and debates the surgical dogma that surrounds this injury.
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Affiliation(s)
- Abhilash Jain
- 1 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,2 Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Rebecca Dunlop
- 3 Department of Hand Surgery, Royal Cornwall Hospital, Truro, UK
| | - Tim Hems
- 4 Trauma & Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Jin Bo Tang
- 5 Department of Hand Surgery, Affiliated Hospital of Nantong University, Jiangsu, China
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The Effect of Operating Room Temperature on the Performance of Clinical and Cognitive Tasks. Pediatr Qual Saf 2018; 3:e069. [PMID: 30280125 PMCID: PMC6132757 DOI: 10.1097/pq9.0000000000000069] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 02/12/2018] [Indexed: 12/26/2022] Open
Abstract
Introduction: Operating room (OR) temperature may impact the performance of health care providers. This study assesses whether hot or cold room temperature diminishes the performance of OR personnel measured by psychomotor vigilance testing (PVT) and self-report scales. Methods: This prospective observational study enrolled surgical/anesthesia trainees, student registered nurse anesthetists, and certified registered nurse anesthetists. Each provider participated in a test of psychomotor function and a questionnaire using a self-report scale of personal comfort and well-being. The PVT and questionnaires were completed after 30 minutes of exposure to 3 different conditions (temperature of 21°C, 23°C, and 26°C). Results: The cohort of 22 personnel included 9 certified registered nurse anesthetists, 7 anesthesia/surgical trainees, and 6 student registered nurse anesthetists. Mean reaction time on the PVT was comparable among baseline (280 ± 47 ms), hot (286 ± 55 ms; P = 0.171), and cold (303 ± 114 ms; P = 0.378) conditions. On the self-report score (range, 1–21), there was no difference in the self-rated subjective performance between baseline and cold conditions. However, the self-rated subjective performance scale was lower (12 ± 6, P = 0.003) during hot conditions. Discussion: No difference was noted in reaction time depending on the temperature; however, excessive heat in the OR environment was associated with worse self-rated subjective performance among health care providers. Particularly, self-rated subjective physical demand and frustration were greater under hot condition.
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Sung PC. Effects of glovebox gloves on grip and key pinch strength and contact forces for simulated manual operations with three commonly used hand tools. ERGONOMICS 2014; 57:1512-1525. [PMID: 24988950 DOI: 10.1080/00140139.2014.933888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
UNLABELLED This study examined the effects of glovebox gloves for 11 females on maximum grip and key pinch strength and on contact forces generated from simulated tasks of a roller, a pair of tweezers and a crescent wrench. The independent variables were gloves fabricated of butyl, CSM/hypalon and neoprene materials; two glove thicknesses; and layers of gloves worn including single, double and triple gloving. CSM/hypalon and butyl gloves produced greater grip strength than the neoprene gloves. CSM/hypalon gloves also lowered contact forces for roller and wrench tasks. Single gloving and thin gloves improved hand strength performances. However, triple layers lowered contact forces for all tasks. Based on the evaluating results, selection and design recommendations of gloves for three hand tools were provided to minimise the effects on hand strength and optimise protection of the palmar hand in glovebox environments. PRACTITIONER SUMMARY To improve safety and health in the glovebox environments where gloves usage is a necessity, this study provides recommendations for selection and design of glovebox gloves for three hand tools including a roller, a pair of tweezers and a crescent wrench based on the results discovered in the experiments.
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Affiliation(s)
- Peng-Cheng Sung
- a Department of Industrial Engineering and Management , Chaoyang University of Technology , Taichung , Taiwan, ROC
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Han CD, Kim J, Moon SH, Lee BH, Kwon HM, Park KK. A randomized prospective study of glove perforation in orthopaedic surgery: is a thick glove more effective? J Arthroplasty 2013; 28:1878-81. [PMID: 23747130 DOI: 10.1016/j.arth.2013.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 05/03/2013] [Accepted: 05/07/2013] [Indexed: 02/01/2023] Open
Abstract
We compared perforation rates among operative staff who were randomly assigned either thick latex surgical gloves or conventional gloves for use in performing total knee arthroplasty. A total of 1120 gloves were assessed in 70 total knee arthroplasties. Additionally, the degree of tactile sensitivity provided by the gloves was compared using a two-point discrimination (TPD) test. Perforation occurred in 27 surgeries (38.5%) and in 48 gloves (4.29%). Binary logistic regression analysis revealed that the operator was a risk factor for perforation rate (Odds ratio 14.448, P < .0.01) and that the type of glove was not (P = .896). In the TPD test, tactile sensitivity was lower for a thick outer glove than the conventional double glove (P < .001 for each site). Not only did thick surgical gloves lower tactile sensitivity, they also offered no superior protective effect over conventional gloves.
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Affiliation(s)
- Chang Dong Han
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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Clinical Issues. AORN J 2012. [DOI: 10.1016/j.aorn.2012.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Dianat I, Haslegrave CM, Stedmon AW. Methodology for evaluating gloves in relation to the effects on hand performance capabilities: a literature review. ERGONOMICS 2012; 55:1429-1451. [PMID: 22897425 DOI: 10.1080/00140139.2012.708058] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
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.
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Affiliation(s)
- Iman Dianat
- Department of Occupational Health, Faculty of Health and Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran.
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Askarian M, Malekmakan L, Memish ZA, Assadian O. Prevalence of needle stick injuries among dental, nursing and midwifery students in Shiraz, Iran. GMS KRANKENHAUSHYGIENE INTERDISZIPLINAR 2012; 7:Doc05. [PMID: 22558039 PMCID: PMC3334953 DOI: 10.3205/dgkh000189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: The risk of occupational exposure to blood borne pathogens (including hepatitis B, hepatitis C and HIV) via sharp injuries such as needle stick injuries (NSIs) among health care workers, especially dental, nursing and midwifery students is a challenging issue. Inadequate staff, lack of experience, insufficient training, duty overload and fatigue may lead to occupational sharp injuries. The aim of this prospective cross-sectional study was to evaluate the frequency of NSIs in Iranian dental, nursing, and midwifery students and their knowledge, attitude and practices regarding prevention of NSIs. Methods: A questionnaire was provided to 264 dental and 435 nursing and midwifery students during their under graduate clinical training. 52% of dental students and 48% of nursing and midwifery students responded to the questionnaire. The questionnaire was pre-tested for reliability on 9.2% of the 55 sample population and found to have a high (r=0.812) test-retest reliability. Results: 73% of students reported at least one NSI during the past year. Activities most frequently associated with injuries involved use of a hollow-bore needle during venous sampling or IV injection in both groups, followed by wound suturing in nursing and midwifery students and recapping in dental students. NSIs and non-reporting of NSIs were highly prevalent in these participants. The reason for not reporting injuries included not knowing the reporting mechanism or not knowing to whom to report. Conclusion: Education about transmission of blood borne infections, standard precaution and increasing availability of protective strategies must be enforced. Furthermore, an optimization of the management for reporting is warranted.
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Affiliation(s)
- Mehrdad Askarian
- Department of Community Medicine, Medicinal & Natural Products Chemistry research center, Shiraz University of Medical Sciences, Shiraz, Iran
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Korniewicz D, El-Masri M. Exploring the Benefits of Double Gloving During Surgery. AORN J 2012; 95:328-36. [DOI: 10.1016/j.aorn.2011.04.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 03/19/2011] [Accepted: 04/15/2011] [Indexed: 11/16/2022]
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Berguer R. Key Strategies for Eliminating Sharps Injuries During Surgery. AORN J 2011; 94:91-6. [DOI: 10.1016/j.aorn.2011.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 05/13/2011] [Indexed: 10/18/2022]
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Haines T, Stringer B, Herring J, Thoma A, Harris KA. Surgeons' and residents' double-gloving practices at 2 teaching hospitals in Ontario. Can J Surg 2011; 54:95-100. [PMID: 21251417 PMCID: PMC3116701 DOI: 10.1503/cjs.028409] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2009] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Surgeons and residents are at increased risk of exposure to blood-borne pathogens owing to percutaneous injury (PI) and contamination. One method known to reduce risk is double-gloving (DG) during surgery. METHODS All surgeons and residents affiliated with the University of Western Ontario (UWO) and McMaster University in 2005 were asked to participate in a Web-based survey. The survey asked respondents their specialty, the number of operations they participated in per week, their age and sex, the proportion of surgeries in which they double-gloved (DG in ≥75% surgeries was considered to be routine), and the average number of PIs they sustained per year and whether or not they reported them to an employee health service. RESULTS In total, 155 of 331 (47%) eligible surgeons and residents responded; response rates for UWO and McMaster surgeons were 50% and 39%, respectively, and for UWO and McMaster residents, they were 52% and 47%, respectively. A total of 43% of surgeons and residents reported routine DG; 50% from McMaster and 36% from UWO. Using logistic regression to simultaneously adjust for participant characteristics, we confirmed that DG was more frequent at McMaster than at UWO, with an odds ratio of 3.32 (95% confidence interval 1.35-8.17). Surgeons and residents reported an average of 3.3 surgical PIs per year (2.2 among McMaster participants and 4.5 among UWO participants). Of the 77% who reported at least 1 injury/year, 67% stated that they had not reported it to an employee health service. CONCLUSION Percutaneous injuries occur frequently during surgery, yet routine DG, an effective means of reducing risk, was carried out by less than half of the surgeons and residents participating in this study. This highlights the need for a more concerted and broad-based approach to increase the use of a measure that is effective, inexpensive and easily carried out.
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Affiliation(s)
- Ted Haines
- Departments of Clinical Epidemiology and Biostatistics and of Surgery, McMaster University, Hamilton, Ont
| | - Bernadette Stringer
- School of Environmental Health, University of British Columbia, Vancouver, BC
| | - Jeremy Herring
- Department of Epidemiology and Biostatistics, University of Western Ontario (at the time of writing), London, Ont
| | - Achilleas Thoma
- Departments of Clinical Epidemiology and Biostatistics and of Surgery, McMaster University, Hamilton, Ont
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Abstract
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).
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Affiliation(s)
- Sammy Al-Benna
- St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE.
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Bucknor A, Karthikesalingam A, Markar SR, Holt PJ, Jones I, Allen-Mersh TG. A comparison of the effect of different surgical gloves on objective measurement of fingertip cutaneous sensibility. Ann R Coll Surg Engl 2010; 93:95-8. [PMID: 21118618 DOI: 10.1308/003588411x12851639108150] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- A Bucknor
- Department of Plastic and Reconstructive Surgery, Chelsea and Westminster Hospital Foundation Trust, London, UK
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Wittmann A, Kralj N, Köver J, Gasthaus K, Lerch H, Hofmann F. Comparison of 4 different types of surgical gloves used for preventing blood contact. Infect Control Hosp Epidemiol 2010; 31:498-502. [PMID: 20334549 DOI: 10.1086/652158] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Needlestick injuries are always associated with a risk of infection, because these types of punctures may expose healthcare workers to a patient's blood and/or body fluids. OBJECTIVE To compare the efficacy of 4 different types of surgical gloves for preventing exposure to blood as a result of needlestick injury. METHODS For simulation of needlestick injury, a circular sample of pork skin was tightened onto a bracket, and a single finger from a medical glove was stretched over the sample. First, a powder-free surgical glove with a gel coating was used to test blood contact. Second, a glove with a patented puncture indication system was used to test blood contact with a double-gloved hand. Third, 2 powder-free latex medical gloves of the same size and hand were combined for double gloving, again to test blood contact. Finally, we tested a glove with an integrated disinfectant on the inside. The punctures were carried out using diverse sharp surgical devices that were contaminated with (99)Tc-marked blood. The amount of blood contact was determined from the transmitted radioactivity. RESULTS For the powder-free surgical glove with a gel coating, a mean volume of 0.048 microL of blood (standard error of the mean [SEM], 0.077 microL) was transferred in punctures with an automated lancet at a depth of 2.4 mm through 1 layer of latex. For the glove with an integrated disinfectant on the inside, the mean volume of blood transferred was 0.030 microL (SEM, 0.0056 microL) with a single glove and was 0.024 microL (SEM, 0.003 microL) with 2 gloves. For the glove with the patented puncture indication system, a mean volume of 0.024 microL (SEM, 0.003 microL) of blood was transferred. CONCLUSIONS Double gloving or the use of a glove with disinfectant can result in a decrease in the volume of blood transferred. Therefore, the use of either of these gloving systems could help to minimize the risk of bloodborne infections for medical staff.
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Affiliation(s)
- Andreas Wittmann
- Department of Safety Engineering, University of Wuppertal, D-42119 Wuppertal, Germany.
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Wittmann A, Kralj N, Köver J, Gasthaus K, Hofmann F. Study of blood contact in simulated surgical needlestick injuries with single or double latex gloving. Infect Control Hosp Epidemiol 2009; 30:53-6. [PMID: 19049439 DOI: 10.1086/593124] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Needlestick injuries are the most common injuries that occur among operation room personnel in the health care service. The risk of infection after a needlestick injury during surgery greatly depends on the quantity of pathogenic germs transferred at the point of injury. The aim of this study was to measure the quantity of blood transferred at the point of a percutaneous injury by using radioactively labeled blood. DESIGN This study was conducted to evaluate the risk of infection through blood contact by simulating surgical needlestick injuries ex vivo. The tests were conducted by puncturing single and double latex gloves with diverse sharp devices and objects that were contaminated with Technetium solution-labeled blood. RESULTS A mean volume of 0.064 microL of blood was transferred in punctures with the an automatic lancet at a depth of 2.4 mm through 1 layer of latex. When the double-gloving indicator technique was used, a mean volume of only 0.011 microL of blood was transferred (median, 0.007 microL); thus, by wearing 2 pairs of gloves, the transferred volume of blood was reduced by a factor of 5.8. CONCLUSIONS The results revealed that double gloving leads to a significant reduction in the quantity of blood transferred during needlestick injury.
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Affiliation(s)
- Andreas Wittmann
- Department of Safety Engineering, University of Wuppertal, and the Helios Klinikum Wuppertal, Klinik für Nuklearmedizin, Wuppertal, Germany.
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Dagi TF, Berguer R, Moore S, Reines HD. Preventable errors in the operating room--part 2: retained foreign objects, sharps injuries, and wrong site surgery. Curr Probl Surg 2007; 44:352-81. [PMID: 17588468 DOI: 10.1067/j.cpsurg.2007.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- T Forcht Dagi
- The Harvard-MIT Program in Health Sciences and Technology, The Uniformed Services University of the Health Sciences, Boston, MA, USA
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20
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Tiefenthaler W, Gimpl S, Wechselberger G, Benzer A. Touch sensitivity with sterile standard surgical gloves and single-use protective gloves. Anaesthesia 2006; 61:959-61. [PMID: 16978311 DOI: 10.1111/j.1365-2044.2006.04789.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to evaluate touch sensitivity and static two-point discrimination of the dominant index and middle finger in 20 anaesthetists wearing no gloves, single-use protective gloves or sterile standard surgical gloves. Semmes-Weinstein filaments were used to measure cutaneous pressure thresholds, and a Two-Point-Discriminator to estimate static two-point discrimination. Wearing gloves significantly reduced touch sensitivity (p < 0.01), but not two-point discrimination. No difference in touch sensitivity or two-point discrimination was found between different types of gloves. The results of our study suggest that the additional cost of sterile standard surgical gloves can not be justified in terms of touch sensitivity.
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Affiliation(s)
- W Tiefenthaler
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
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21
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Abstract
BACKGROUND The invasive nature of surgery, with its increased exposure to blood, means that during surgery there is a high risk of transfer of pathogens. Pathogens can be transferred through contact between surgical patients and the surgical team, resulting in post-operative or blood borne infections in patients or blood borne infections in the surgical team. Both patients and the surgical team need to be protected from this risk. This risk can be reduced by implementing protective barriers such as wearing surgical gloves. Wearing two pairs of surgical gloves, triple gloves, glove liners or cloth outer gloves, as opposed to one pair, is considered to provide an additional barrier and further reduce the risk of contamination. OBJECTIVES The primary objective of this review was to determine if additional glove protection reduces the number of surgical site or blood borne infections in patients or the surgical team. The secondary objective was to determine if additional glove protection reduces the number of perforations to the innermost pair of surgical gloves. The innermost gloves (next to skin) compared with the outermost gloves are considered to be the last barrier between the patient and the surgical team. SEARCH STRATEGY We searched the Cochrane Wounds Group Specialised Register (January 2006), and the Cochrane Central Register of Controlled Trials (CENTRAL)(The Cochrane Library Issue 4, 2005). We also contacted glove manufacturing companies and professional organisations. SELECTION CRITERIA Randomised controlled trials involving: single gloving, double gloving, triple gloving, glove liners, knitted outer gloves, steel weave outer gloves and perforation indicator systems. DATA COLLECTION AND ANALYSIS Both authors independently assessed the relevance and quality of each trial. Data was extracted by one author and cross checked for accuracy by the second author. MAIN RESULTS Two trials were found which addressed the primary outcome, namely, surgical site infections in patients. Both trials reported no infections. Thirty one randomised controlled trials measuring glove perforations were identified and included in the review. Fourteen trials of double gloving (wearing two pairs of surgical latex gloves) were pooled and showed that there were significantly more perforations to the single glove than the innermost of the double gloves (OR 4.10, 95% CI 3.30 to 5.09). Eight trials of indicator gloves (coloured latex gloves worn underneath latex gloves to more rapidly alert the team to perforations) showed that significantly fewer perforations were detected with single gloves compared with indicator gloves (OR 0.10, 95% CI 0.06 to 0.16) or with standard double glove compared with indicator gloves (OR 0.08, 95% CI 0.04 to 0.17). Two trials of glove liners (a glove knitted with cloth or polymers worn between two pairs of latex gloves)(OR 26.36, 95% CI 7.91 to 87.82), three trials of knitted gloves (knitted glove worn on top of latex surgical gloves)(OR 5.76, 95% CI 3.25 to 10.20) and one trial of triple gloving (three pairs of latex surgical gloves)(OR 69.41, 95% CI 3.89 to 1239.18) all compared with standard double gloves, showed there were significantly more perforations to the innermost glove of a standard double glove in all comparisons. AUTHORS' CONCLUSIONS There is no direct evidence that additional glove protection worn by the surgical team reduces surgical site infections in patients, however the review has insufficient power for this outcome. The addition of a second pair of surgical gloves significantly reduces perforations to innermost gloves. Triple gloving, knitted outer gloves and glove liners also significantly reduce perforations to the innermost glove. Perforation indicator systems results in significantly more innermost glove perforations being detected during surgery.
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Affiliation(s)
- J Tanner
- Derby Hospitals NHS FoundationTrust, Derby City General Hospital, Uttoxeter Road, Derby, Derbyshire, UK DE22 3NE.
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Florman S, Burgdorf M, Finigan K, Slakey D, Hewitt R, Nichols RL. Efficacy of double gloving with an intrinsic indicator system. Surg Infect (Larchmt) 2006; 6:385-95. [PMID: 16433603 DOI: 10.1089/sur.2005.6.385] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Blood-borne infection is an ever-present fear for medical professionals, especially surgeons and operating room personnel. Safety is paramount, and the reliability and efficacy of surgical gloves are crucial, as gloves are the most important barriers protecting hospital personnel and patients. Unfortunately, glove perforation rates are as high as 78% in high-risk procedures. As well as being efficacious, surgical gloves must be comfortable and easy to don, and when holes are present, it is imperative they be detected expeditiously. The purpose of this double-blind randomized study was to evaluate the ability of participants to locate 30-micron laser holes in surgical gloves while performing simulated surgery and to evaluate the Biogel Indicator Glove System, which reveals punctures. METHODS Twenty glove configurations (eight single, twelve double) were tested, half of which had laser-created holes. Each of the 25 participants tested and evaluated 20 configurations randomly. Simulated surgery terminated when a hole was identified by the participant or at the end of two minutes, whichever occurred first. Participants also rated their perceptions of each glove's features on questionnaires, all of which were returned, with 95.8% being complete. RESULTS Participants found 84% and 56% of the holes in the two indicator systems, latex and synthetic, in an average of 22 seconds and 42 seconds, respectively. In the worst-performing latex and synthetic glove configurations, participants found only 8% and 12% of the holes at an average of 47 seconds and 67 seconds, respectively. Indicator gloves were highly rated for comfort and ease of use. CONCLUSIONS Double gloving with an indicator system provides the best protection and allows the timeliest identification of perforations. Participants failed to identify most of the holes in the non-indicator gloves.
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Affiliation(s)
- Sander Florman
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana 70112, USA.
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Berguer R, Heller PJ. Strategies for preventing sharps injuries in the operating room. Surg Clin North Am 2006; 85:1299-305, xiii. [PMID: 16326210 DOI: 10.1016/j.suc.2005.09.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
With the discovery of AIDS and HIV, the medical community began to widely recognize the dangers of serious illnesses spread-ing through contact with contaminated blood and body fluids. In response, the Centers for Disease Control and other groups have developed guidelines for the operating room to prevent the spread of infection from, for example, accidental needle sticks. Unfortunately, those guidelines are not always strictly followed. This article reviews studies that have examined precautionary practices, including such practices as double gloving, the use of blunt suture needles, and the use of neutral zones for passing sharps. The article also provides related sources for further information.
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Affiliation(s)
- Ramon Berguer
- Contra Costa Regional Medical Center, Department of Surgery, 2500 Alhambra Avenue, Martinez, CA 94553, USA.
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Patterson JMM, Novak CB, Mackinnon SE, Ellis RA. Needlestick injuries among medical students. Am J Infect Control 2003; 31:226-30. [PMID: 12806360 DOI: 10.1067/mic.2003.44] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Concern about occupational exposure to bloodborne pathogens exists, and medical students, who lack in experience in patient care and surgical technique, may be at an increased exposure risk. METHODS This prospective cohort study evaluated needlestick injuries and practices regarding the use of protective strategies against bloodborne pathogens in medical students. A questionnaire was developed and sent to 224 medical students. RESULTS Of 224 students, 146 students (64%) returned questionnaires. Forty-three students (30%) reported needlestick injuries that most commonly occurred in the operating room; 86% of students reported always using double gloves in the operating room; 90% reported always wearing eye protection, and all but one student had been vaccinated against hepatitis B. A concern about contracting a bloodborne pathogen through work was noted in 125 students, although they usually reported that this concern only slightly influenced their decision regarding a career subspecialty. CONCLUSION Medical students have a high risk for needlestick injuries, and attention should be directed to protection strategies against bloodborne pathogens.
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Affiliation(s)
- J Megan M Patterson
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Gibson GO, Craig JC. Relative roles of spatial and intensive cues in the discrimination of spatial tactile stimuli. PERCEPTION & PSYCHOPHYSICS 2002; 64:1095-107. [PMID: 12489664 DOI: 10.3758/bf03194759] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Two psychophysical measures of tactile sensitivity--grating-orientation (GO) and smooth-grooved (SG) discrimination--were used to determine tactile spatial acuity with and without an intermediate surface (latex glove) interposed between the contactor and the skin. Measures were made at three locations that varied in sensitivity and in density of innervation of the primary afferent fibers: the index fingerpad (fingertip), palmar surface of the proximal phalanx (fingerbase), and the thenar eminence (palm). Neurophysiological studies have suggested that the density of innervation of SAI fibers is a limiting factor in spatial acuity. In the present study, without a glove, the GO thresholds varied as a function of location. With the glove, increases in the GO thresholds were relatively uniform and modest. Without a glove, however, the SG thresholds were well below the GO thresholds, and changing the site of stimulation had little effect on the threshold. With a glove, the SG thresholds increased by 100% to more than 300% as in comparison with those in the no-glove condition. The largest increases occurred at the less sensitive locations. The results of the GO task are consistent with the view that GO is a valid measure of spatial acuity. The results of the SG task, however, are inconsistent with previous results and suggest that both spatial and intensive factors are involved in this task.
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Affiliation(s)
- Gregory O Gibson
- Department of Psychology, Indiana University, Bloomington, Indiana 47405, USA.
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27
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Romanzi LJ, Groutz A, Feroz F, Blaivas JG. Evaluation of female external genitalia sensitivity to pressure/touch: a preliminary prospective study using Semmes-Weinstein monofilaments. Urology 2002; 57:1145-50. [PMID: 11377329 DOI: 10.1016/s0090-4295(01)00964-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the use of pressure aesthesiometers (Semmes-Weinstein monofilaments) in the evaluation of female external genitalia. The pressure aesthesiometers are widely used to assess the pressure/touch perceptions of the hand, face, and breast dermatomes. METHODS Thirty-two consecutive neurologically intact women (mean age 48.7 +/- 13.8 years) and 5 neurologically impaired women referred for a routine gynecologic examination were prospectively enrolled. The monofilaments were applied to the S2-S5 vulvar dermatomes using specific anatomic landmarks. Test-retest reliability studies were performed at the same clinical session. A comparison was made between premenopausal (n = 17) and postmenopausal (n = 15) women; hypoestrogenic (n = 9) and normoestrogenic (n = 23) women; postmenopausal women with (n = 6) and without (n = 9) estrogen replacement therapy; women with normal (n = 18) and abnormal (n = 14) sexual function; and neurologically impaired (n = 5) and neurologically intact (n = 5) women, matched by age, parity, and estrogen status. RESULTS A clear association was found between reduced vulvar sensitivity to pressure/touch and estrogen deficiency, sexual dysfunction, and neurologic impairment. Postmenopausal women had significantly reduced sensitivity to pressure/touch compared with premenopausal women. Similar decreased sensitivity was found in hypoestrogenic compared with normoestrogenic women, with significantly reduced sensitivity in postmenopausal women not using estrogen replacement therapy. Women with sexual dysfunction and those with neurologic impairment had significantly reduced vulvar sensitivity to pressure/touch. No correlation was found between the sensitivity to pressure/touch and either levator ani muscle bulk or the levator contraction score, but significant differences were found between women with and without vulvovaginal atrophy at the time of the examination. Test-retest analysis confirmed the reliability of the monofilaments in testing vulvar sensation. CONCLUSIONS The Semmes-Weinstein monofilaments may be used as a valid and reliable diagnostic tool in the evaluation of vulvar sensitivity to pressure/touch. Additional studies with larger series are needed to establish the role of this clinical tool in the evaluation of various treatment outcomes.
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Affiliation(s)
- L J Romanzi
- Department of Obstetrics and Gynecology, Weill Medical College, Cornell University, New York, New York, USA
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28
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Abstract
BACKGROUND The invasive nature of surgery, with its increased exposure to blood, means that during surgery there is a high risk of transfer of pathogens. Pathogens can be transferred through contact between surgical patients and the surgical team, resulting in post-operative or blood borne infections in patients or blood borne infections in the surgical team. Both patients and the surgical team need to be protected from this risk. This risk can be reduced by implementing protective barriers such as wearing surgical gloves. Wearing two pairs of surgical gloves, as opposed to one pair, is considered to provide an additional barrier and further reduce the risk of contamination. OBJECTIVES The primary objective of this review was to determine if double gloving (wearing two pairs of gloves), rather than single gloving, reduces the number of post-operative or blood borne infections in surgical patients or blood borne infections in the surgical team. The secondary objective of this review was to determine if double gloving, rather than single gloving, reduces the number of perforations to the innermost pair of surgical gloves. The innermost gloves (next to skin) compared with the outermost gloves are considered to be the last barrier between the patient and the surgical team. SEARCH STRATEGY The reviewers searched the Cochrane Wounds Group Specialised Trials Register, MEDLINE, CINAHL, EMBASE and the Cochrane Controlled Trials Register. Glove manufacturing companies and professional organisations were also contacted. SELECTION CRITERIA Randomised controlled trials involving: single gloving, double gloving, glove liners or coloured puncture indicator systems. DATA COLLECTION AND ANALYSIS Both reviewers independently assessed the relevance and quality of each trial. Trials to be included were cross checked and authenticated by both reviewers. Data was extracted by one reviewer and cross checked for accuracy by the second reviewer. MAIN RESULTS Two trials were found which addressed the primary outcome. A total of 18 randomised controlled trials which measured glove perforations were identified and included in the review. DOUBLE GLOVING (wearing two pairs of latex gloves). Nine trials compared single latex gloves versus double latex gloves. These found no difference in the number of perforations between the single latex gloves and the outermost pair of the double latex gloves, but the number of perforations to the double latex-innermost glove was significantly reduced when two pairs of latex gloves were worn. ORTHOPAEDIC GLOVES (thicker than standard latex gloves). One trial compared single latex orthopaedic gloves with double latex gloves. This showed there was no difference in the number of perforations to the innermost gloves when wearing double latex gloves compared with a single pair of latex orthopaedic gloves. INDICATOR GLOVES (coloured latex gloves worn underneath latex gloves). Three trials compared double latex gloves versus double latex indicator gloves. These trials showed similar numbers of perforations to both the innermost and the outermost gloves for both gloving groups. Perforations to the outermost gloves were detected more easily when double latex indicator gloves were worn. Wearing double latex indicator gloves did not increase the detection of perforations to the innermost gloves. GLOVE LINERS (an insert worn between two pairs of latex gloves). Two trials compared double latex gloves versus double latex gloves with liners. These trials showed a significant reduction in the number of perforations to the innermost glove when a glove liner was worn between two pairs of latex gloves. CLOTH GLOVES (cloth gloves worn on top of latex gloves). Two trials compared double latex gloves versus latex inner with cloth outer gloves. These trials showed that wearing a cloth outer glove significantly reduced the number of perforations to the innermost latex glove. STEEL WEAVE GLOVES (steel weave gloves worn on top of latex gloves). One trial compared double latex gloves versus latex inner with steel weave outer gloves. This trial showed no reduction in the number of perforations to the innermost glove when wearing a steel weave outer glove. REVIEWER'S CONCLUSIONS Wearing two pairs of latex gloves significantly reduces the number of perforations to the innermost glove. This evidence comes from trials undertaken in 'low risk' surgical specialties, that is specialties which did not include orthopaedic joint surgery. Wearing two pairs of latex gloves does not cause the glove wearer to sustain more perforations to their outermost glove. Wearing double latex indicator gloves enables the glove wearer to detect perforations to the outermost glove more easily than when wearing double latex gloves. However wearing a double latex indicator system will not assist with the detection of perforations to the innermost glove, nor reduce the number of perforations to either the outermost or the innermost glove. Wearing a glove liner between two pairs of latex gloves to undertake joint replacement surgery significantly reduces the number of perforations to the innermost glove compared with double latex gloves only. Wearing cloth outer gloves to undertake joint replacement surgery significantly reduces the number of perforations to the innermost glove compared with wearing double latex gloves. Wearing steel weave outer gloves to undertake joint replacement surgery does not reduce the number of perforations to innermost gloves compared with double latex gloves.
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Affiliation(s)
- J Tanner
- Health Care Studies, University of Leeds, Beckett Street, Leeds, UK, LS9 7TF
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Hentz VR, Stephanides M, Boraldi A, Tessari R, Isani R, Cadossi R, Biscione R, Massari L, Traina GC. Surgeon-patient barrier efficiency monitored with an electronic device in three surgical settings. World J Surg 2001; 25:1101-8. [PMID: 11571942 DOI: 10.1007/bf03215854] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Blood-borne viral pathogens are an occupational threat to health care workers (HCWs), particularly those in the operating room. A major risk is posed by accidental penetrating injury, but skin contamination with body fluids from an infected patient, with prolonged intimate cutaneous contact, is a frequent occurrence during surgery, carrying further risk of transdermal infection. We have monitored barrier failure in three surgical settings (microsurgery, orthopedic surgery, general surgery) by means of an electronic surveillance device. A total of 111 surgical procedures were monitored: 67 microsurgeries, 22 orthopedic surgeries, and 22 general surgeries. Of the 278 electronic alarms signaling barrier failure, 44 (15.8%) were associated with glove perforation, 39 of which (88.6%) were not perceived by the operator. In 16 of those, the skin was visibly stained with the patient's blood. Altogether, 76 of the alarms (27.3%) were consequent to contacts caused by soaked gowns/sleeves, and 121 (43.5%) were attributed to hydration of latex porosities; 37 alarms (13.4%) were unexplained false positives. On only one occasion did a surgeon observe blood stains on his hands without a previous alarm; this event was classified as a device failure due to incorrect wiring. Double-gloving offered satisfactory protection against skin contamination during microsurgery but not during orthopedic surgery. The data presented here indicate that electronic monitoring of the surgical barrier enables prompt detection of barrier failure, especially at the level of the gloves, thereby limiting skin contamination with patients' body fluids during surgery.
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Affiliation(s)
- V R Hentz
- Department of Surgery, Division of Hand Surgery, Stanford University Medical Center, 300 Pasteur Drive, M121, Stanford, California 94305-5119, USA
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Fisher MD, Reddy VR, Williams FM, Lin KY, Thacker JG, Edlich RF. Biomechanical performance of latex and non-latex double-glove systems. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 2000; 48:797-806. [PMID: 10556843 DOI: 10.1002/(sici)1097-4636(1999)48:6<797::aid-jbm6>3.0.co;2-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The purpose of this study was to evaluate ten commercially available latex, powder-free surgical gloves and four commercially available non-latex, powder-free surgical gloves using standardized, reproducible biomechanical parameters that included glove thickness, puncture resistance, and glove donning force. For all gloves tested, with one exception (Neolontrade mark PF), puncture resistance increased for double-gloves as compared to single-gloves. In addition, single-glove thickness was not a reliable determinant of puncture resistance for either latex or non-latex gloves. For the latex gloves, the Ultrafree double and single-gloves exhibited the highest puncture resistance. The glove donning forces for the Biogeltrade mark M and Biogel Sensortrade mark single-gloves were the lowest. In contrast, the Biogel Revealtrade mark and Encoretrade mark Ultra-Thick exhibited the lowest double-glove donning forces. On the basis of these performance tests of latex gloves, the surgeon should consider the Biogel Reveal as well as the Ultrafree gloves for their latex double-glove system. For the non-latex gloves, the Pure Advantage Nitriletrade mark glove had the highest puncture resistance for one layer and two layers of glove material. The thin Pure Advantage Nitrile glove was the most resistant to glove puncture. The Pure Advantage Nitrile glove had low glove donning forces for both single-glove donning configurations and double-glove donning configurations. Consequently, we recommend the Pure Advantage Nitrile glove as the powder-free, non-latex, double-glove system.
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Affiliation(s)
- M D Fisher
- Department of Plastic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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Affiliation(s)
- S L Jensen
- Orthopaedic Research Laboratory, University Hospital of Aarhus, Denmark
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