Observational study on the occurrence of surgical glove perforation and associated risk factors in large animal surgery

Influence of closed glove exchange on bacterial contamination of the hands of the surgical team

OBJECTIVE

To determine if closed glove exchange (CGE) increases hand contamination.

STUDY DESIGN

Prospective experimental study.

SAMPLE POPULATION

Surgical teams participating in 65 individual surgical procedures were included, resulting in 200 individual enrollments.

METHODS

At the completion of surgery, gloves were removed and hands were swabbed. The inside of the gown cuff was swabbed. Each participant regloved, using a closed gloving technique. The new gloves were removed, and hands were swabbed for culture a second time. Swabs underwent standard bacterial culture.

RESULTS

Before glove exchange, or baseline, contamination was found on 17/200 dominant hands and 13/200 nondominant hands. After performing CGE, contamination was found on 14/200 and 15/200 dominant and nondominant hands, respectively. No difference was detected between the number of CFUs cultured from a surgeon's hands before CGE and the number of CFUs cultured from a surgeon's hands post-CGE (one sided sign test, p = .61). Twelve (12) different bacterial species were identified, the most common were Staphylococcus spp. (97/154; 63%).

CONCLUSION

Closed glove exchange did not increase bacterial hand contamination over baseline levels.

CLINICAL SIGNIFICANCE

We found no evidence to support discontinuing CGE.

Pre-surgical hand preparation in veterinary practice

The objective of this paper is to review the evidence for different methods of surgical hand preparation applicable to veterinary practice. Surgical hand preparation is an essential step in performing surgery as a veterinarian. Recommended protocols and products for surgical hand preparation have varied since its inception in the late 1800s. Many factors must be considered when assessing the efficacy, safety, and users' compliance with any available product. Traditional scrub methods employing chlorhexidine gluconate or povidone-iodine have been compared to alcohol-based rub protocols with respect to immediate and prolonged efficacy, safety, compliance, requirements for theatre furniture, cost and water usage. Although much of the comparative data has been generated in human medical facilities, extrapolation of the data to veterinary surgery is appropriate. Considerations for veterinary practice are specifically discussed. Overall, the benefits of alcohol-based rubs indicate that this should be the preferred method of pre-surgical hand preparation for veterinarians in all types of practice.

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.

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.