Colored Indicator Undergloves Increase the Detection of Glove Perforations by Surgeons During Small Animal Orthopedic Surgery: A Randomized Controlled Trial

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.

Evaluation of Surgical Gown Cuff Contamination During Orthopaedic Surgery in a Veterinary Teaching Hospital

OBJECTIVE

 The objective of this study was to determine the frequency of positive cultures of the surgical gown cuffs among scrubbed personnel prior to and immediately after orthopaedic surgical procedures performed on client-owned dogs.

STUDY DESIGN

 In this cross-sectional study, the left and right surgical gown cuffs of three scrubbed persons in 10 orthopaedic surgical procedures were individually sampled using a sterile wipe prior to and immediately after surgery in order to determine the frequency of and risk factors associated with positive bacterial cultures.

RESULTS

 Fifty of 120 (41.6%) cultures were positive with an even distribution before and after surgery. The three most common genera were Staphylococcus, Corynebacterium and Streptococcus. Using multivariable logistic regression models, humidity in the operating room (odds ratio: 1.04, 95% confidence interval: 1.00-1.08; p = 0.038) and the number of individuals scrubbed into surgery (odds ratio: 0.59, 95% confidence interval: 0.39-0.91; p = 0.016) had a significant effect on the likelihood of positive culture after surgery. Of the nine patients available for follow-up, one dog developed osteomyelitis.

CONCLUSIONS

 Maintaining the humidity in the operating room to the lowest comfortable level may reduce contamination of the surgical gown cuffs. Confirmation of bacterial contamination of surgical gown cuffs warrants adherence to operative guidelines to minimize the risk of surgical gown cuffs' contact with sterile attire, equipment and the surgical field during surgical procedures.

Comparative antimicrobial efficacy of 4 surgical hand-preparation procedures prior to application of an alcohol-based hand rub in veterinary students

OBJECTIVE

To determine the influence of skin preparations before application of an alcohol-based hand rub (ABHR) on bacterial counts before and after elective surgery.

STUDY DESIGN

Clinical prospective study.

SAMPLE POPULATION

Veterinary students (n = 103) performing ovariohysterectomies on 140 dogs.

METHODS

Participants were randomly assigned to 1 initial surgical preparation on the day of surgery: A - hand preparation with medicated solution (4% w/v chlorhexidine bigluconate followed by an ABHR; B - application of a medication solution (benzalkonium chloride 0.1%-1% and polymeric biguanide hydrochloride 0.01%-0.1%) followed by an ABHR; C - nonmedicated pH-neutral soap hand wash followed by ABHR, and D - direct application of an ABHR. Samples were taken by pressing the distal finger tips to an agar plate before the hand preparation, after the hand preparation (n = 3), after ABHR application, and 120 minutes later. Colony-forming units (CFUs) for samples were determined. Total log CFU and CFU log10 reduction were calculated and used for comparison with P < .05.

RESULTS

Two hours after surgery commenced, the participants of groups that performed a hand preparation had lower total CFUs than those that did not perform a hand preparation (P = .001). In particular, the number of CFUs was lower when ABHR was performed after application of pHN compared to direct ABHR (P = .001).

CONCLUSION

In this population, performing a hand preparation with pHN prior to applying an ABHR had better antimicrobial effect for the duration of surgery than not performing a hand preparation.

CLINICAL SIGNIFICANCE

Surgeons should wash their hands prior to ABHR before starting their first surgery of the day, even when hands appear clean.

Perforations of tri-layer nitrile-latex and natural rubber latex gloves during ex-vivo equine intestinal anastomoses

OBJECTIVE

To compare perforation rates between tri-layer nitrile-latex and natural rubber latex surgical gloves after single-layer end-to-end jejunojejunal anastomoses in equine cadavers.

STUDY DESIGN

Prospective randomized ex-vivo study.

SAMPLE POPULATION

Pairs of surgical gloves (n = 46) worn during jejunojejunal anastomoses.

METHODS

Tri-layer nitrile-latex and rubber latex pairs of gloves were equally but randomly allocated to a right-handed surgeon performing 46 single-layer end-to-end jejunojejunal anastomoses on cadaveric material. Number and location of perforations were determined with the water leak test after each procedure. Ten unused pairs of both glove types were tested as controls.

RESULTS

At least one perforation occurred in 41% (19/46) of the pairs of gloves. Glove perforations were present in 22% (5/23; 95% CI: 9-42) of tri-layer glove pairs and 61% (14/23; 95% CI: 41-78) of the rubber glove pairs. The odds of glove perforation were 5.6 times (p = .009, 95% CI: 1.5-20.5) lower when tri-layer rather than rubber gloves were used. The duration of procedure did not affect the risk of glove perforation (p = .679). No perforations were observed in the unused gloves.

CONCLUSION

Perforations were less common when the surgeon wore tri-layer nitrile-latex gloves rather than to the natural rubber latex gloves tested in this study.

CLINICAL RELEVANCE

Tri-layer nitrile-latex gloves were more resistant to perforations in experimental settings; further studies may confirm that they are also superior in a clinical setting.

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.

Surgical hand preparation in an equine hospital: Comparison of general practice with a standardised protocol and characterisation of the methicillin-resistant Staphylococcus aureus recovered

Presurgical hand asepsis is part of the daily routine in veterinary medicine. Nevertheless, basic knowledge seems to be low, even among specialised veterinary surgeons. The major objectives of our study were to assess current habits for presurgical hand preparation (phase 1) among personnel in a veterinary hospital and their effectiveness in reducing bacteria from hands in comparison to a standardised protocol (phase 2). Assessment of individual habits focused on time for hand washing and disinfection, the amount of disinfectant used, and the usage of brushes. The standardised protocol defined hand washing for 1 min with liquid neutral soap without brushing and disinfection for 3 min. All participants (2 surgeons, 8 clinic members, 32 students) used Sterillium®. Total bacterial counts were determined before and after hand washing, after disinfection, and after surgery. Hands were immersed in 100 ml sterile sampling fluid for 1 min and samples were inoculated onto Columbia sheep blood agar using the spread-plate method. Bacterial colonies were manually counted. Glove perforation test was carried out at the end of the surgical procedure. Differences in the reduction of relative bacterial numbers between current habits and the standardised protocol were investigated using Mann-Whitney-Test. The relative increase in bacterial numbers as a function of operation time (≤60 min, >60 min) and glove perforation as well as the interaction of both was investigated by using ANOVA. Forty-six and 41 preparations were carried out during phase 1 and phase 2, respectively. Individual habits differed distinctly with regard to time (up to 8 min) and amount of disinfectant (up to 48 ml) used both between participants and between various applications of a respective participant. Comparison of current habits and the standardised protocol revealed that the duration of hand washing had no significant effect on reducing bacteria. Contrary, the reduction in bacterial numbers after disinfection by the standardised protocol was significantly higher (p<0.001) compared to routine every-day practice. With regard to disinfection efficacy, the standardised protocol completely eliminated individual effects. The mean reduction in phase 1 was 90.72% (LR = 3.23; right hand) and 89.97% (LR = 3.28; left hand) compared to 98.85% (LR = 3.29; right hand) and 98.92% (LR = 3.47; left hand) in phase 2. Eight participants (19%) carried MRSA (spa type t011, CC398) which is well established as a nosocomial pathogen in veterinary clinics. The isolates could further be assigned to a subpopulation which is particularly associated with equine clinics (mainly t011, ST398, gentamicin-resistant). Glove perforation occurred in 54% (surgeons) and 17% (assistants) of gloves, respectively, with a higher number in long-term invasive procedures. Overall, bacterial numbers on hands mainly increased over time, especially when glove perforation occurred. This was most distinct for glove perforations on the left hand and with longer operating times. Our results demonstrate that standardised protocols highly improve the efficacy of hand asepsis measures. Hence, guiding standardised protocols should be prerequisite to ensure state-of-the-art techniques which is essential for a successful infection control intervention.

Incidence and risk factors for surgical glove perforation in small animal ophthalmic surgery

OBJECTIVE

To determine the incidence of perforation of surgical gloves and identify associated risk factors that contribute to glove perforation in small animal ophthalmic surgery.

STUDY DESIGN

Observational cohort study.

SAMPLE POPULATION

Surgical gloves (n = 2000) collected following 765 small animal ophthalmic procedures.

METHODS

All the gloves were tested for perforation at the end of the procedure using a water leak test. The potential risk factors for glove perforation were recorded, and associations between these risk factors and perforation were explored using univariable (Fisher's exact test) and mixed effect logistic regression analysis. Results were considered significant if P < .05.

RESULTS

Glove perforation was detected in 6% of procedures. Glove perforation was 1.97 (95% CI: 0.98-4.22) times more likely in extraocular than in intraocular surgeries (7.3% vs 3.9%; P = .0462). The incidence of perforations was not statistically different between main and assistant surgeon (P = .86). No significant association was found between the risk of glove perforation and duration of the procedure (P = .13). Perforation of the nondominant hand was 2.6 (95% CI: 1.38-4.98) times more likely than the dominant hand (74% vs 26%; P = .0028). Only 22% of the perforations were detected intraoperatively. Multivariable analysis identified only extraocular surgery as a risk factor for perforations.

CONCLUSIONS

There is a low incidence of glove perforation in small animal ophthalmic surgery, but extra care of the nondominant hand is required, especially during extraocular procedures.

Perforation rates in double latex gloves and protective effects of outer work gloves in a postmortem examination room: A STROBE-compliant study

Medical staff face the risk of exposure to blood-borne infectious agents during postmortem examinations. This study investigated the effectiveness of non-slip work gloves worn over 2 layers of surgical latex gloves (outer and inner gloves) as a means of reducing hand and finger injuries. Complete sets of outer and inner gloves worn during postmortem examinations were collected from participating forensic staff. Latex gloves were categorized into 2 groups based on the users' actions during the examination: the wearing group if the wearer wore their work gloves continuously without interruption, and the taking-off group if the wearer removed them at least once. Perforation rates, locations, and shapes were compared between these groups. Outer-glove perforation occurred significantly more often in the taking-off group (n = 102 pairs) than in the wearing group (n = 91 pairs) (30.4% vs 3.8%, P < .001). Inner-glove perforation occurred at rates of 2.0% and 0.5% (P = .38), respectively. The wearers did not incur hand or finger injuries. Perforation rates were similar between the dominant and non-dominant hands (P = .18). Regarding location, gloves were punctured most frequently at the thumb, followed by the index finger. Most examiners (85.6%) did not notice the perforation when the damage occurred. Therefore, we could not confirm that a specific operation within a set of plural operations affected the rate of perforation. Additionally, we could not prove a relationship between glove perforation and each operation performed with/without work gloves. The perforation appearances varied greatly in shape and size, suggesting multiple causes of perforation. The continuous (i.e., uninterrupted) wear of work gloves during postmortem examinations reduced the incidence of perforations in both latex glove layers and thus reduced the risk of hand and finger injury.

Influence of orthopedic reinforced gloves versus double standard gloves on contamination events during small animal orthopedic surgery

OBJECTIVE

To determine the influence of orthopedic reinforced gloves on contamination events during small animal orthopedic surgery.

STUDY DESIGN

Prospective randomized controlled trial SAMPLE POPULATION: Two hundred and thirty-seven pairs of orthopedic gloves (474 gloves) and 203 pairs of double standard gloves (812 gloves) worn during 193 orthopedic procedures.

METHODS

Primary and assistant surgeons were randomized to wear either orthopedic reinforced gloves or double gloves. Gloves were leak tested to identify perforations at the end of procedures. Perforations detected intraoperatively or postoperatively were recorded. A contamination event was defined as at least one perforation on either hand for orthopedic reinforced gloves, or a perforation of both the inner and outer glove on the same hand for double gloves.

RESULTS

Baseline characteristics between the 2 intervention groups were similar. There was no difference in contamination events between the double-gloved and orthopedic gloved groups (OR = 0.95, 95% CI = 0.49-1.87, P = .89). The same percentage of contamination events (8% glove pairs used) occurred in the double gloved group (17 contamination events) and in the orthopedic gloved group (19 contamination events). The odds of a contamination event increased by 1.02 (95% CI 1.01-1.03, P < .001) with each additional minute of surgery.

CONCLUSION

Orthopedic reinforced gloves and double standard gloving were equally effective at preventing contamination events in small animal orthopedic procedures.

CLINICAL RELEVANCE

Surgeons reluctant to double glove due to perceptions of decreased dexterity and discomfort may safely opt for wearing orthopedic gloves, which may improve their compliance.

Incidence and patterns of surgical glove perforations: experience from Addis Ababa, Ethiopia

Background

Surgical glove perforation is a common event. The operating staff is not aware of the perforation until the procedure is complete, sometimes in as high as 70% of the incidences. Data from Ethiopia indicates that the surgical workforce suffers from a very surgery related accidents, however there is paucity of data regarding surgical glove perforation.

The main objective is to describe the incidence and patterns of surgical glove perforation during surgical procedures and to compare the rates between emergency and elective surgeries at one of the main hospitals in Addis Ababa Ethiopia.

Methods

This is a prospective study, performed at the Minilik II referral hospital, Addis Ababa. All surgical gloves worn during all major surgical procedures (Emergency and Elective) from June 1-July 20, 2016 were collected and used for the study. Standardised visual and hydro insufflation techniques were used to test the gloves for perforations. Parameters recorded included type of procedure performed, number of perforations, localisation of perforation and the roles of the surgical team.

Results

A total of 2634 gloves were tested, 1588 from elective and 1026 from emergency procedures. The total rate of perforation in emergency procedures was 41.4%, while perforation in elective surgeries was 30.0%. A statistically significant difference (P < 0.05) was found in between emergency and elective surgeries.

There were a very high rate of perforations of gloves among first surgeons 40.6% and scrub nurses 38.8% during elective procedures and among first surgeons (60.14%), and second assistants (53.0%) during emergency surgeries.

Only 0.4% of inner gloves were perforated. The left hand, the left index finger and thumb were the most commonly perforated parts of the glove. Glove perforation rate was low among consultant surgeons than residents.

Conclusions

Our reported perforation rate is higher than most publications, and this shows that the surgical workforce in Ethiopia is under a clear and present threat. Measures such as double gloving seems to have effectively prevented cutaneous blood exposure and thus should become a routine for all surgical procedures. Manufacturing related defects and faults in glove quality may also be contributing factors.