1
|
Lee SY. What Role Does a Colored Under Glove Have in Detecting Glove Perforation in Foot and Ankle Procedures? Clin Orthop Relat Res 2022; 480:2327-2334. [PMID: 35695671 PMCID: PMC9653181 DOI: 10.1097/corr.0000000000002268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/16/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many orthopaedic surgical teams practice double gloving or use colored indicator gloving techniques to reduce contamination intraoperatively. Although the likelihood of glove perforation can be affected by the procedure type and surgeon habits, as well as the surgeon's technique, these factors have not been considered to determine the glove perforation rate, and the role of a colored under glove during operations seems less investigated. QUESTIONS/PURPOSES (1) What proportion of foot and ankle procedures result in perforation of outer gloves or under gloves? (2) What factors (such as the type or duration of operation) appear to be associated with the likelihood of glove perforation? (3) Does the use of a colored indicator under glove make it more likely that a surgeon would perceive the perforation of an outer glove intraoperatively? METHODS Between September 2020 and August 2021, the author performed 577 surgical foot or ankle procedures. Of those, patients who underwent subsequent operations under general or spinal anesthesia were considered as potentially eligible. Further, 16% (93) were excluded because the procedures were performed with the patient under local anesthesia, and another 1% (eight patients) were not analyzed (incomplete datasets for emergency operations performed at night). Finally, 82% (476 patients) were examined. To ensure statistical independence, gloves used in right-side operations in bilateral procedures and the most proximal surgery in unilateral procedures were included. Preoperatively, the surgeon was randomly assigned to use either a combination of two regular surgical gloves or a regular outer glove worn over a colored indicator under glove. Patient diagnosis, type of procedure, tourniquet time, and gloving type were recorded. There was no difference in potentially relevant confounding variables, such as the proportion of procedures performed on bone (78% [188 of 242] versus 83% [195 of 234]; p = 0.13), nor in tourniquet time (58 ± 30 minutes versus 62 ± 31 minutes; p = 0.45) between the regular glove and indicator glove groups. At the end of each procedure, the surgeon was asked whether he believed either the outer or under glove was perforated, and whether the use of a colored under glove increased the proportion of procedures in which the surgeon correctly ascertained that a perforation had occurred. To determine the proportion of gloves that were perforated, a standardized water-leak method was used, and the proportion of gloves with perforations based on several parameters of interest, including bone versus soft tissue operation and tourniquet time, was compared. RESULTS During 476 foot and ankle procedures, the overall glove perforation proportion was 19% (92 of 476 procedures). Under-glove perforation was observed in 4% (17 of 476 procedures) of the operations. There was no difference in glove perforation proportions between bone and soft tissue operations (76 of 383 versus 16 of 93; odds ratio [OR] = 0.84, 95% confidence interval [CI] 0.46 to 1.52; p = 0.56). As tourniquet time (operation time) increased, the glove perforation proportion also increased (Exp[B] = 1.02; 95% CI 1.01 to 1.03; p < 0.001). The use of indicator under gloves increased the surgeon's intraoperative detection of glove perforation (in 68% of procedures [32 of 47] versus 29% [13 of 45]; OR = 5.3; 95% CI 2.2 to 12.8; p < 0.001). CONCLUSION Surgical glove perforation occurred in approximately one of five foot and ankle procedures. Based on the results of this study, I recommend using colored indicator under gloves and replacing the under glove when replacing the outer glove after perforation is seen in order to detect contamination early and reduce any intraoperative contamination related to glove injury. LEVEL OF EVIDENCE Level I, therapeutic study.
Collapse
Affiliation(s)
- Seung Yeol Lee
- Department of Orthopaedic Surgery, Myongji Hospital, Hanyang University College of Medicine, Gyeonggi, Korea
| |
Collapse
|
2
|
Osodin TE, Akadiri OA, Akinmoladun VI. Evaluation of Surgical Glove Perforation and Sharps Injury in Oral and Maxillofacial Surgery. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:1-5. [PMID: 36590780 PMCID: PMC9802593 DOI: 10.4103/jwas.jwas_98_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/11/2022] [Indexed: 06/17/2023]
Abstract
Introduction The risk of exposure to infections during surgery is partly mitigated by gloving. However, perforation can reduce the effectiveness of gloving as a barrier to exposure. This study aimed at investigating the frequency of surgical glove perforation and factors predictive of these in our oral and maxillofacial surgical practice. Materials and Methods The study was carried out at the National Hospital and the University of Abuja Teaching Hospital, Abuja, Nigeria. Consenting patients requiring oral surgical interventions were consecutively recruited into the study. Similarly, surgeons and their assistants who consented to the study were also enlisted in the study. At the end of every surgical procedure, gloves used by the surgeons and the assistants were tested for perforation. Variables investigated included the rate of perforations, the influence of the type of gloving, single versus double gloving, type of anaesthesia, and duration of surgery on rates. Results At a minimum of three operators per procedure, a total of 154 participants were involved in the study and 895 gloves were used. The number of glove perforations was 117(13.1%) with 82 (70.1%) involving the surgeons. There were 58/117 (49.6%) cases of perforation involving the dominant hand. Forefinger glove perforation accounted for 62 (52.9%) cases. Wire-related perforations were 72 (61.5%). Overall, nine cases of percutaneous injury were recorded. Duration of operation and double gloving were the predictive factors for perforations. Conclusion Risk of sharps injury was relatively high due to the high incidence of glove perforation.
Collapse
Affiliation(s)
- Timothy E. Osodin
- Department of Oral and Maxillofacial Surgery, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Oladimeji A. Akadiri
- Department of Oral and Maxillofacial Surgery, College of Health Sciences, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
| | - Victor I. Akinmoladun
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| |
Collapse
|
3
|
Thomson I, Krysa N, McGuire A, Mann S. Recognition of intraoperative surgical glove perforation: a comparison by surgical role and level of training. Can J Surg 2022; 65:E82-E88. [PMID: 35135784 PMCID: PMC8834241 DOI: 10.1503/cjs.016720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 11/19/2022] Open
Abstract
Background: The aim of this study was to characterize the risk of glove perforation among surgical team members performing a typical set of trauma procedures, as well as to identify the rate at which these people recognize potential perforations. Methods: Gloves used in orthopedic trauma room procedures were collected from all participating team members over 2 weeks and were subsequently examined for perforations. Perforation rates based on glove position, type, wearer and procedure were assessed. Results: Perforations were found in 5.9% of gloves; 4.3% of the perforations were found in outer gloves and 1.6% in inner gloves. Among the outer gloves, 30.7% of the perforations were recognized by the wearer at the time of perforation; none of the inner glove perforations were recognized, even when they were associated with an accompanying outer glove perforation. Significantly more perforations were identified in the gloves of attending staff than in those of other team members. Attending staff experienced more perforations than other wearers, regardless of whether they were acting as the primary surgeon or as an assistant. Perforations were more common in open reduction internal fixation and amputation procedures. For open reduction internal fixation procedures, longer operative times were associated with more frequent glove perforations. Conclusion: The rates of glove perforation are high in orthopedic trauma surgeries, and often these perforations are not recognized by the wearer. Attending staff are at an elevated risk of glove perforation. It is recommended that all members of the surgical team change both pairs of gloves whenever an outer glove perforation is observed.
Collapse
Affiliation(s)
- Ian Thomson
- From the Division of Orthopaedic Surgery, Queen's University, Kingston, Ont. (Thomson, McGuire, Mann); and the Queen's School of Medicine, Kingston, Ont. (Krysa)
| | - Nicole Krysa
- From the Division of Orthopaedic Surgery, Queen's University, Kingston, Ont. (Thomson, McGuire, Mann); and the Queen's School of Medicine, Kingston, Ont. (Krysa)
| | - Andrew McGuire
- From the Division of Orthopaedic Surgery, Queen's University, Kingston, Ont. (Thomson, McGuire, Mann); and the Queen's School of Medicine, Kingston, Ont. (Krysa)
| | - Steve Mann
- From the Division of Orthopaedic Surgery, Queen's University, Kingston, Ont. (Thomson, McGuire, Mann); and the Queen's School of Medicine, Kingston, Ont. (Krysa)
| |
Collapse
|
4
|
Comparison of Unnoticed Glove Perforations during Minimally Invasive versus Open Surgeries: A Systematic Review and Meta-Analysis. CHILDREN 2022; 9:children9020179. [PMID: 35204901 PMCID: PMC8870279 DOI: 10.3390/children9020179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/19/2022] [Accepted: 01/29/2022] [Indexed: 11/17/2022]
Abstract
Objective: Various studies have depicted the incidence of glove perforations during open (OS) and minimally invasive surgeries (MIS). The aim of this meta-analysis was to compare the incidence of macroscopic and microscopic glove perforations during MIS and OS. Methods: The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Scientific databases (PubMed, Web of Science, Scopus, and EMBASE) were systematically searched for comparative studies depicting the glove perforation rates during MIS and OS. Risk ratios (RR) were calculated for both the outcomes (dichotomous) and the Mantel–Haenszel method was utilized for the estimation of pooled RR. The methodological quality assessment was performed by two independent investigators using the Downs and Black scale. The main outcomes of the study were the proportion of gloves with gross (macroscopic) perforations and the proportion of gloves with microscopic perforations. Results: Four comparative studies including a total of 1428 gloves (435 from the MIS group) were included. Pooling the data demonstrated no difference in the incidence of macroscopic glove perforations among the MIS and OS groups (RR 0.57, 95% CI 0.21 to 1.54, p = 0.27). On the other hand, the incidence of microscopic perforations was significantly higher in the OS group versus the MIS group (RR 0.72, 95% CI 0.55 to 0.95, p = 0.02). However, all the studies had a moderate risk of bias. Conclusions: When compared to OS, the macroscopic glove perforation rate during MIS showed no significant difference. The incidence of microscopic glove perforations was significantly higher during OS as compared to MIS. However, due to the moderate risk of bias of the available comparative studies, the level of evidence of these studies is limited.
Collapse
|
5
|
Matsuoka S, Kondo T, Seishima R, Okabayashi K, Tsuruta M, Shigeta K, Ishida T, Hasegawa H, Kitagawa Y. Surgical glove perforation during laparoscopic colorectal procedures. Surg Endosc 2021; 36:3489-3494. [PMID: 34382122 PMCID: PMC8356683 DOI: 10.1007/s00464-021-08670-0] [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: 11/18/2020] [Accepted: 07/29/2021] [Indexed: 11/18/2022]
Abstract
Background It has been reported that in conventional open surgery, approximately 10% of surgical gloves are perforated during surgery without being noticed. To protect both the patient and medical staff from harm, double gloving or changing gloves routinely at certain intervals during surgery is recommended. However, whether these protective measures are also necessary for laparoscopic colorectal surgery is unknown because the actual perforation rate during laparoscopic procedures is unclear. Methods Seventy-seven laparoscopic colorectal surgeries were evaluated, and a total of 616 surgical gloves used in the surgeries were collected for analysis. The presence of glove perforation was tested by the standard water-leak test method (EN455-1). Results Seven perforations were detected (1.1%). The duration of the laparoscopic procedure was not a statistically significant risk factor for glove perforation (p = 0.41). Postoperative surgical site infections (SSIs) were observed in 12 cases (15.6%), but there was no significant correlation between the presence of glove perforation and SSI (p = 0.92). According to the bacterial cultivation results, the majority of causative agents of SSI were enterobacteria, which belong to the major gut flora. Conclusion Although the perforation rate was considerably lower than that in open surgery, surgical glove perforation occurred during laparoscopic procedures. Double gloving in laparoscopic colorectal surgery is recommended not to prevent SSI but to protect medical workers from harmful infections after direct contact with the patient.
Collapse
Affiliation(s)
- Shinsei Matsuoka
- Department of Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takayuki Kondo
- Department of Surgery, Kawasaki Municipal Hospital, Kawasaki, Japan
| | - Ryo Seishima
- Department of Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Koji Okabayashi
- Department of Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Masashi Tsuruta
- Department of Surgery, Faculty of Medicine, International University of Health and Welfare, Narita, Japan
| | - Kohei Shigeta
- Department of Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takashi Ishida
- Department of Surgery, Faculty of Medicine, International University of Health and Welfare, Narita, Japan
| | - Hirotoshi Hasegawa
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| |
Collapse
|
6
|
Walczak D, Grajek M, Pawełczak D, Żółtaszek A, Szumniak R, Czarnecki M, Trzeciak P, Krakowczyk Ł, Maciejewski A, Pasieka Z. Do surgeons use double gloves during surgery? Results of a survey. POLISH JOURNAL OF SURGERY 2021; 93:9-14. [PMID: 33729171 DOI: 10.5604/01.3001.0014.4240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b>Introduction:</b> The perforation of gloves during surgical procedures is quite common. A cheap and quite effective method of reducing the risk of blood-borne infections is wearing two pairs of gloves. Unfortunately, some surgeons are reluctant to it, and they report decreased dexterity and sensation. The aim of the study was to evaluate surgeons' double-gloving practices to determine the factors related to compliance. <br><b>Material and methods:</b> An anonymous, 21-question survey in Polish was sent by post to 41 surgical departments. The questions concerned: demographic data, type of surgical gloves used, allergy to latex, number of surgeries performed, frequency of using double gloves and negative impressions from using them and finally, the frequency of needlestick injuries during surgical procedures. <br><b>Results:</b> We received 179 questionnaires back. More than 62% of the surgeons believe that double gloves provide better protection than a single pair, 24% do not believe in this, and 14% have no opinion. Only 0.6% of respondents always use double gloves during surgery, 19% double glove in at least 25% of cases and 68% do it occasionally. 13% of the surgeons declared that they had never worn double gloves. During high-risk procedures, 86% of respondents wear double gloves. About half of respondents (50.3%) report discomfort while wearing double gloves; 45% - decreased dexterity; about 30% complain of numbness and tingling; and 64% - decreased sensation. <br><b>Conclusion:</b> Due to the high number of surgical glove perforations and relatively high prevalence of needlestick injuries, it is necessary to use methods that reduce the risk of transmission of pathogens. The habit of using a double pair of gloves should be implemented especially among young surgeons starting to train in their specialities. Consequently, the period of initial discomfort will be combined with the acquisition of surgical skills, which will allow for gradual acclimatization.
Collapse
Affiliation(s)
- Dominik Walczak
- Department of Oncologic and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Maciej Grajek
- Department of Oncologic and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Dariusz Pawełczak
- Department of Experimental Surgery, Medical University of Lodz, Poland
| | | | - Ryszard Szumniak
- Department of Oncologic and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Marek Czarnecki
- Department of Oncologic and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Piotr Trzeciak
- Department of General Surgery, Mikołaj Kopernik Memorial Hospital in Piotrkow Trybunalski, Poland
| | - Łukasz Krakowczyk
- Department of Oncologic and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Adam Maciejewski
- Department of Oncologic and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Zbigniew Pasieka
- Department of Experimental Surgery, Medical University of Lodz, Poland
| |
Collapse
|
7
|
Zhang Z, Gao X, Ruan X, Zheng B. Effectiveness of double-gloving method on prevention of surgical glove perforations and blood contamination: A systematic review and meta-analysis. J Adv Nurs 2021; 77:3630-3643. [PMID: 33733484 DOI: 10.1111/jan.14824] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/06/2021] [Accepted: 02/28/2021] [Indexed: 11/29/2022]
Abstract
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.
Collapse
Affiliation(s)
- Zhihui Zhang
- Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xinghua Gao
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiangcai Ruan
- Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Bin Zheng
- Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| |
Collapse
|
8
|
Basak T, Sahin G, Demirtas A. Comparison of surgical gloves: perforation, satisfaction and manual dexterity. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2021; 28:1160-1166. [PMID: 33433290 DOI: 10.1080/10803548.2021.1875636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to assess the effectiveness of two different surgical gloves (powdered latex and powder and latex free) for glove perforation frequency, problems and satisfaction with glove usage and manual dexterity levels during surgical operations that include scrub nurses. Scrub nurses wore antiallergenic gloves (powder and latex free) gloves during three operations, double latex and powdered gloves during three operations and single latex and powdered gloves during three operations. The gloves were checked for punctures after each surgery with a water-inflation test. In our study, 19% of single gloves and 18.1 % of double gloves and 4.8% of powder and latex free worn by scrub nurses were punctured during surgery. None of the inner gloves in double gloves were punctured. Although wearing double gloves restricts manual dexterity, results in discomfort problems such as perspiration and fetor and results in a low satisfaction rate among scrub nurses, double gloves are protective against injuries and punctures.
Collapse
Affiliation(s)
- Tulay Basak
- University of Health Sciences Turkey, Gulhane Faculty of Nursing, Ankara, Turkey
| | - Gul Sahin
- University of Health Sciences Turkey, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Ayla Demirtas
- University of Health Sciences Turkey, Gulhane Faculty of Nursing, Ankara, Turkey
| |
Collapse
|
9
|
Ohge H, Mayumi T, Haji S, Kitagawa Y, Kobayashi M, Kobayashi M, Mizuguchi T, Mohri Y, Sakamoto F, Shimizu J, Suzuki K, Uchino M, Yamashita C, Yoshida M, Hirata K, Sumiyama Y, Kusachi S. The Japan Society for Surgical Infection: guidelines for the prevention, detection, and management of gastroenterological surgical site infection, 2018. Surg Today 2021; 51:1-31. [PMID: 33320283 PMCID: PMC7788056 DOI: 10.1007/s00595-020-02181-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The guidelines for the prevention, detection, and management of gastroenterological surgical site infections (SSIs) were published in Japanese by the Japan Society for Surgical Infection in 2018. This is a summary of these guidelines for medical professionals worldwide. METHODS We conducted a systematic review and comprehensive evaluation of the evidence for diagnosis and treatment of gastroenterological SSIs, based on the concepts of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The strength of recommendations was graded and voted using the Delphi method and the nominal group technique. Modifications were made to the guidelines in response to feedback from the general public and relevant medical societies. RESULTS There were 44 questions prepared in seven subject areas, for which 51 recommendations were made. The seven subject areas were: definition and etiology, diagnosis, preoperative management, prophylactic antibiotics, intraoperative management, perioperative management, and wound management. According to the GRADE system, we evaluated the body of evidence for each clinical question. Based on the results of the meta-analysis, recommendations were graded using the Delphi method to generate useful information. The final version of the recommendations was published in 2018, in Japanese. CONCLUSIONS The Japanese Guidelines for the prevention, detection, and management of gastroenterological SSI were published in 2018 to provide useful information for clinicians and improve the clinical outcome of patients.
Collapse
Affiliation(s)
- Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan.
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Seiji Haji
- Department of Surgery, Soseikai General Hospital, Kyoto, Japan
| | - Yuichi Kitagawa
- Department of Infection Control, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Masahiro Kobayashi
- Laboratory of Clinical Pharmacokinetics, School of Pharmacy, Kitasato University, Tokyo, Japan
| | - Motomu Kobayashi
- Perioperative Management Center, Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Toru Mizuguchi
- Division of Surgical Science, Department of Nursing, Sapporo Medical University, Sapporo, Japan
| | - Yasuhiko Mohri
- Department of Surgery, Mie Prefectural General Medical Center, Mie, Japan
| | - Fumie Sakamoto
- Infection Control Division, Quality Improvement Center, St. Luke's International Hospital, Tokyo, Japan
| | - Junzo Shimizu
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Katsunori Suzuki
- Division of Infection Control and Prevention, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Motoi Uchino
- Division of Inflammatory Bowel Disease Surgery, Department of Gastroenterological Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Chizuru Yamashita
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | | | | | - Shinya Kusachi
- Department of Surgery, Tohokamagaya Hospital, Chiba, Japan
| |
Collapse
|
10
|
Kobayashi M, Tsujimoto H, Takahata R, Einama T, Okamoto K, Kajiwara Y, Shinto E, Kishi Y, Hase K, Ueno H. Association Between the Frequency of Glove Change and the Risk of Blood and Body Fluid Exposure in Gastrointestinal Surgery. World J Surg 2020; 44:3695-3701. [PMID: 32661693 DOI: 10.1007/s00268-020-05681-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Surgical gloves are used to prevent the transmission of microorganisms from the surgeon's hands to the patient and vice versa. Little is known on the optimal frequency of glove changing. Therefore, we aimed to examine the optimal frequency of glove change during surgery by assessing the glove perforation rate in gastrointestinal surgery. METHODS In this observational prospective cohort study, we investigated the incidence of perforation of 5,267 gloves during gastrointestinal surgeries. RESULTS The overall glove perforation rate was 10.1%. There was no significant difference between single gloving (10.2%) and double gloving (10.0%; p = 0.8491). However, the perforation rate of the inner glove (5.7%) was found to be significantly lower than that of the outer glove (11.6%) (p < 0.0001). A significant difference in perforation rate was observed after wearing inner gloves for 240 min (< 240 min, 4.4%; ≤ 240 min, 7.2%; p = 0.0314), and outer gloves for 60 min (< 60 min, 7.1%; ≤ 60 min, 12.6%; p < 0.0001). We found cumulative perforation rate to rapidly increase until the wear time was 90 min. CONCLUSION The inner gloves and outer gloves have a higher perforation rate as the wear time increased. To reduce the risk of intraoperative blood and fluid exposure and prevent healthcare-associated infection, gloves should be changed for approximately every 60-90 min for outer gloves and approximately every 240 min for inner gloves.
Collapse
Affiliation(s)
- Minako Kobayashi
- Department of Medical Risk Management and Infection Control, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan.
| | - Hironori Tsujimoto
- Department of Medical Risk Management and Infection Control, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan
| | - Risa Takahata
- Department of Medical Risk Management and Infection Control, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan
| | - Takahiro Einama
- Department of Surgery, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan
| | - Koichi Okamoto
- Department of Surgery, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan
| | - Yoshiki Kajiwara
- Department of Surgery, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan
| | - Eiji Shinto
- Department of Surgery, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan
| | - Yoji Kishi
- Department of Surgery, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan
| | - Kazuo Hase
- Department of Surgery, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, Japan
| |
Collapse
|
11
|
Nthumba PM. Effective Hand Preparation for Surgical Procedures in Low- and Middle-Income Countries. Surg Infect (Larchmt) 2020; 21:495-500. [PMID: 32182163 DOI: 10.1089/sur.2020.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: The burden of healthcare-associated infections (HAIs) is greatest in low- and middle-income countries (LMICs); surgical site infections (SSIs) are the most common HAI in LMICs. Hand hygiene is the single most effective strategy for reducing HAIs and the transmission of antimicrobial drug-resistant pathogens. Similarly, effective surgical hand preparation is a critical step in the prevention of SSIs in the surgical patient. Methods: Surgical hand preparation (SHP) is a seemingly simple activity that is easily overlooked. Performed properly, however, along with other measures, it has the potential to reduce SSIs in LMICs. The article reviews the current state of surgical hand preparation in LMICs. Results: Alcohol-based handrubs (ABHRs) have received wide acceptance by healthcare workers for both hand hygiene and SHP; when mixed with emollients, ABHRs retain efficacy against microorganisms and gain skin tolerability and user acceptability. Healthcare institutions in many LMICs face difficulties obtaining the products needed to ensure effective SHP using ABHRs. Conclusion: The ABHRs are the most efficacious surgical hand preparation products available today. They are cost-effective and can safely be prepared locally in hospitals, even in LMICs. The challenge of access to ABHRs should be addressed by national and local governments, through advocacy by healthcare workers coupled with continued lobbying and campaigns by the World Health Organization. Effective surgical hand preparation, like hand hygiene, saves lives.
Collapse
Affiliation(s)
- Peter Muli Nthumba
- Department of Plastic and Reconstructive Surgery, AIC Kijabe Hospital, Kijabe, Kenya, and Department of Plastic and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
12
|
Idota N, Nakamura M, Akasaka Y, Tsuboi H, Bando R, Ikegaya H. Perforation rates in double latex gloves and protective effects of outer work gloves in a postmortem examination room: A STROBE-compliant study. Medicine (Baltimore) 2019; 98:e16348. [PMID: 31277191 PMCID: PMC6635159 DOI: 10.1097/md.0000000000016348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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.
Collapse
|
13
|
Incidence of sharps injuries in surgical units, a meta-analysis and meta-regression. Am J Infect Control 2019; 47:448-455. [PMID: 30502112 DOI: 10.1016/j.ajic.2018.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/05/2018] [Accepted: 10/05/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Sharps injuries occur often among surgical staff, but they vary considerably. METHODS We searched PubMed and Embase for studies assessing the incidence of sharps injuries. We combined the incidence rates of similar studies in a random effects meta-analysis and explored heterogeneity with meta-regression. RESULTS We located 45 studies of which 11 were randomized control trials, 15 were follow-up studies, and 19 were cross-sectional studies. We categorized injuries as self-reported, glove perforations, or administrative injuries. We calculated the population at risk as person-years and as person-operations (po). Meta-analysis of the incidence rate based on the best outcome measure resulted in 13.2 injuries per 100 time-units (95% confidence interval [CI], 4.7-37.1; I2 = 100%). Per 100 person-years, the injury rate was 88.2 (95% CI, 61.3-126.9; 21 studies) for self-reported injuries, 40.0 for perforations (95% CI, 19.2-83.5; 15 studies), and 5.8 for administrative injuries (95% CI, 2.7-12.2; 5 studies). Per 100 po, the respective figures were 2.1 (95% CI, 0.8-5.0; 4 studies), 11.1 (95% CI, 6.6-18.9, 15 studies), and 0.1 (95% CI, 0.05-0.21). I2 values were all above 90%. Meta-regression indicated lower incidence rates in studies that used perforations per po. CONCLUSIONS A surgeon will have a sharps injury in about 1 in 10 operations . Reporting of sharps injuries in surgical staff should be standardized per 100 po and be assessed in prospective follow-up studies.
Collapse
|
14
|
Yoon C, Gong HS, Park JS, Seok HS, Park JW, Baek GH. Two-Layer Wound Sealing before Surgical Hand Washing for Surgeons with a Minor Cut Injury on the Hand. Surg Infect (Larchmt) 2019; 20:390-394. [PMID: 30810481 DOI: 10.1089/sur.2018.271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: There is a lack of evidence-based recommendations for surgical hand washing when there is a minor cut on the hand. We sought to evaluate whether two-layer wound sealing functions as a barrier to prevent the spread of micro-organisms. Methods: We randomly categorized 20 surgeons into subjects with either a right- or left-hand injury. Each subject was assumed to have a minor injury on the assigned hand and the other hand was used as a control. Subjects applied a waterproof topical dressing as a first layer, then protected the injured area with a second layer using an antimicrobial drape, and finally performed surgical hand rubbing. Subjects stamped each hand onto an agar plate. The injured hands were checked by an investigator to confirm the wounded area remained properly sealed after hand rubbing. Colonies were counted and the micro-organisms were identified after 48 hours of incubation. Results: There was no leak found from two-layer wound sealing after hand washing. Mean number of the colonies was 0.2 on the injured hand and 0.25 on the uninjured hand (p = 0.772). The micro-organisms cultured from both the injured and uninjured hands were coagulase-negative staphylococci. Conclusions: Using a model for a minor cut injury on the hand this study demonstrated that two-layer wound sealing is an effective barrier not only to prevent the spread of micro-organisms but also to protect surgeons.
Collapse
Affiliation(s)
- Chan Yoon
- 1 Department of Orthopedic Surgery, Seoul Bumin Hospital, Seoul, Korea
| | - Hyun Sik Gong
- 2 Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Soo Park
- 3 Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun Sik Seok
- 2 Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Woo Park
- 2 Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Goo Hyun Baek
- 4 Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
15
|
Kim K, Zhu M, Munro JT, Young SW. Glove change to reduce the risk of surgical site infection or prosthetic joint infection in arthroplasty surgeries: a systematic review. ANZ J Surg 2018; 89:1009-1015. [DOI: 10.1111/ans.14936] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/01/2018] [Accepted: 10/04/2018] [Indexed: 01/11/2023]
Affiliation(s)
- Katy Kim
- Department of OrthopaedicsNorth Shore Hospital Auckland New Zealand
| | - Mark Zhu
- Department of OrthopaedicsAuckland Hospital Auckland New Zealand
| | - Jacob T. Munro
- Department of OrthopaedicsAuckland Hospital Auckland New Zealand
| | - Simon W. Young
- Department of OrthopaedicsNorth Shore Hospital Auckland New Zealand
| |
Collapse
|
16
|
Glove Perforation in Orthopaedics: Probability of Tearing Gloves During High-Risk Events in Trauma Surgery. J Orthop Trauma 2018; 32:474-479. [PMID: 29889823 DOI: 10.1097/bot.0000000000001233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the risk of glove perforation during common maneuvers or events in trauma-related orthopaedic surgical procedures. METHODS Four investigators executed 6 high-risk maneuvers in a simulated laboratory setting. Alternative techniques were also performed for most maneuvers. Glove integrity was examined by 2 standard methods of fluid leak testing. The rates of perforation were compared between techniques using χ and Fisher exact tests. RESULTS Investigators were only able to identify 14.3% of perforations. Cleaning drill bit flutes by hand had the highest overall tear rate (85%). Catching a glove along the guide wire when passing a cannulated drill bit resulted in a 50% perforation rate. Catching a glove around a rotating drill shaft had a tear rate of 40%. Palpating the end of a flexible nail cut with a wire cutter had a significantly higher perforation rate than a nail cut with a proprietary, nail-specific tool (35% vs. 5%, P = 0.022). Blind digital fracture reduction had a tear rate that was not statistically different than directly visualizing the reduction (20% vs. 15%, P = 0.5). Inserting screws while stabilizing the threads with one's fingers resulted in a perforation rate of 15%. CONCLUSIONS Orthopaedic surgeons should be aware that microperforation of surgical gloves often goes undetected and should consider modifying or using alternative techniques when performing certain surgical maneuvers. The results of this study can be used by orthopaedic and surgical first assist training programs to promote safe surgical practice.
Collapse
|
17
|
AlJehani R, Nassif M, Trabulsi N, Asiri A, AlGhofaily O. Factors Influencing Surgeons' Double-Gloving Practice. Surg Infect (Larchmt) 2018; 19:691-695. [PMID: 30142024 DOI: 10.1089/sur.2018.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We sought to evaluate the practice of double gloving among surgeons and to determine the factors that affect compliance with such practice at King Abdulaziz University Hospital (KAUH). METHODS A survey was conducted among surgeons in active training from all departments at KAUH through the use of a questionnaire from May through July 2017. RESULTS Of the 220 surgeons who worked at KAUH, 183 agreed to participate in the study for a response rate of 83.2%. Less than half of the respondents (44.3%) stated that they wear double gloves. The main reason for wearing them was "self-protection" (63%), whereas the main reason for not wearing them was that they "think it is required only for special cases" (62.7%). The association between wearing double gloves and the subspecialty was significant (p = 0.033), the highest rate being found among orthopedic surgeons. Among those who usually double glove 84% of needle-prick injuries occurred when they were not double gloved. Eighty percent of needle-prick injuries occurred while surgeons were wearing single gloves. CONCLUSIONS Less than half of the respondents practice double gloving, the main reason being self-protection. The most common reason for not wearing them was that they are required only for special cases. There was notable association between wearing double gloves and orthopedic surgery. Most needle-prick injuries occurred while wearing single gloves. We believe increasing awareness of the benefits of double gloving might change the practice.
Collapse
Affiliation(s)
- Reham AlJehani
- 1 Faculty of Medicine, King Abdulaziz University , Jeddah, Saudi Arabia
| | - Mohammed Nassif
- 2 Department of Surgery, Faculty of Medicine, King Abdulaziz University , Jeddah, Saudi Arabia
| | - Nora Trabulsi
- 2 Department of Surgery, Faculty of Medicine, King Abdulaziz University , Jeddah, Saudi Arabia
| | - Arub Asiri
- 1 Faculty of Medicine, King Abdulaziz University , Jeddah, Saudi Arabia
| | - Oyoon AlGhofaily
- 1 Faculty of Medicine, King Abdulaziz University , Jeddah, Saudi Arabia
| |
Collapse
|
18
|
Prävention postoperativer Wundinfektionen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:448-473. [PMID: 29589090 DOI: 10.1007/s00103-018-2706-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
19
|
Biermann NM, McClure JT, Sanchez J, Doyle AJ. Observational study on the occurrence of surgical glove perforation and associated risk factors in large animal surgery. Vet Surg 2017; 47:212-218. [DOI: 10.1111/vsu.12757] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 06/11/2017] [Accepted: 06/22/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Nora M. Biermann
- Department of Health Management; Atlantic Veterinary College, University of Prince Edward Island; Charlottetown Prince Edward Island Canada
| | - JT. McClure
- Department of Health Management; Atlantic Veterinary College, University of Prince Edward Island; Charlottetown Prince Edward Island Canada
| | - Javier Sanchez
- Department of Health Management; Atlantic Veterinary College, University of Prince Edward Island; Charlottetown Prince Edward Island Canada
| | - Aimie J. Doyle
- Department of Health Management; Atlantic Veterinary College, University of Prince Edward Island; Charlottetown Prince Edward Island Canada
| |
Collapse
|
20
|
Burn MB, Holtorf HL, Smith KM, Bernstein DT, Delgado DA, Prudhomme N, Deavers MT, McCulloch PC, Harris JD. Do Skin Lacerations Imply Tissue Transfer From Surgeon to Patient During Arthroscopic Knot Tying? Arthroscopy 2017; 33:2248-2254. [PMID: 29066268 DOI: 10.1016/j.arthro.2017.07.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 07/27/2017] [Accepted: 07/27/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To use simulated arthroscopic knot tying to assess (1) whether epithelial cells from the surgeon's hands were transmitted to the suture and (2) whether the number of knots tied or the presence of glove tears would correlate with the number of cells transmitted. METHODS Knots were tied in a simulated arthroscopic environment using a nonabsorbable No. 2 suture over a metal hook. The surgeon was double gloved for each knot tied. For each "anchor," a surgeon's knot was tied, followed by 3 reversed half-hitches on alternating posts. Multiple skin lacerations were sustained by the surgeon during each knot-tying session. Gloves were collected after tying 2, 4, or 6 anchors. Gloves were tested for perforation by (1) electroconductivity and (2) saline solution load testing. Cytopathologic ThinPrep analysis was applied and allowed for the number of epithelial cells found on each suture (within 10 high-powered fields) to be counted. Statistical analysis included analysis of variance and logistic regression. RESULTS There was no significant difference in the number of epithelial cells identified in any of the groups compared with the negative control groups (P > .05) or with each other (P > .05). Glove tears were present in 3.3% of gloves (50% in inner and 50% in outer gloves) and 1.7% of gloves (50% in inner and 50% in outer gloves) by electroconductivity and saline solution load testing, respectively. There was no significant association between glove tears and the number of epithelial cells found on the suture (P > .05). CONCLUSIONS Epithelial cells were transmitted to the suture during simulated arthroscopic knot tying. However, despite multiple skin lacerations produced during knot-tying sessions, the number of cells transmitted was not significantly different when compared with the negative controls. The number of cells transmitted did not correlate with the number of knots tied and/or the presence of glove tears. CLINICAL RELEVANCE Skin lacerations on the surgeon's fingers are often noted after arthroscopic knot tying. However, despite these skin lacerations, no skin tissue is transferred across the surgical gloves to the suture itself.
Collapse
Affiliation(s)
- Matthew B Burn
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Heidi L Holtorf
- Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Kevin M Smith
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Derek T Bernstein
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Domenica A Delgado
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Nickarr Prudhomme
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Michael T Deavers
- Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Patrick C McCulloch
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Joshua D Harris
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A..
| |
Collapse
|
21
|
Lutsky KF, Jones C, Abboudi J, Kirkpatrick W, Liss F, Leinberry C, Ilyas A, Martin D, Beredjiklian PK. Incidence of Glove Perforation During Hand Surgical Procedures. J Hand Surg Am 2017; 42:840.e1-840.e5. [PMID: 28802536 DOI: 10.1016/j.jhsa.2017.06.103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 06/14/2017] [Accepted: 06/28/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the rate of glove perforation during hand surgery. METHODS We prospectively examined the rate of glove perforations among 10 fellowship-trained hand surgeons at our institution during a 6 week period. Gloves were tested for perforation using a water-fill technique at the conclusion of each surgical procedure. Surgeons recorded the presence of any glove perforations. RESULTS Eleven perforations were identified in 10 gloves among 600 surgical procedures during the study period. The perforation rate per case was 1.5% (95% confidence interval, 0.78% to 2.8%). Forty percent of perforations (n = 4) occurred during fracture surgery. Other holes occurred during isolated carpal tunnel release (n = 3) or combined carpal tunnel and trigger finger release (n = 3). The perforation was noticed intraoperatively in only 2 gloves. The difference in perforation rate between single- and double-gloved procedures was not significant. There were no perforations in the inner glove of surgeons who double gloved. A total of 73% of holes (8 of 11) occurred on surgeons' index finger; 75% of these were on the dominant hand. The dominant thumb, non-dominant ring and nondominant little fingers each had a single perforation. CONCLUSIONS The rate of glove perforation during hand surgery is low. Holes can occur even during soft tissue procedures of short duration. The dominant index finger appears to be at greatest risk for perforation. When they do occur, most often holes are not noticed by the operating surgeon. The baseline glove perforation rate is unknown. CLINICAL RELEVANCE A high level of vigilance is required to maintain sterile technique.
Collapse
Affiliation(s)
- Kevin F Lutsky
- Hand and Upper Extremity Surgery, The Rothman Institute, 925 Chestnut Street, Philadelphia, PA.
| | - Christopher Jones
- Hand and Upper Extremity Surgery, The Rothman Institute, 925 Chestnut Street, Philadelphia, PA
| | - Jack Abboudi
- Hand and Upper Extremity Surgery, The Rothman Institute, 925 Chestnut Street, Philadelphia, PA
| | - William Kirkpatrick
- Hand and Upper Extremity Surgery, The Rothman Institute, 925 Chestnut Street, Philadelphia, PA
| | - Fred Liss
- Hand and Upper Extremity Surgery, The Rothman Institute, 925 Chestnut Street, Philadelphia, PA
| | - Charles Leinberry
- Hand and Upper Extremity Surgery, The Rothman Institute, 925 Chestnut Street, Philadelphia, PA
| | - Asif Ilyas
- Hand and Upper Extremity Surgery, The Rothman Institute, 925 Chestnut Street, Philadelphia, PA
| | - Dennis Martin
- Hand and Upper Extremity Surgery, The Rothman Institute, 925 Chestnut Street, Philadelphia, PA
| | - Pedro K Beredjiklian
- Hand and Upper Extremity Surgery, The Rothman Institute, 925 Chestnut Street, Philadelphia, PA
| |
Collapse
|
22
|
Bekele A, Makonnen N, Tesfaye L, Taye M. Incidence and patterns of surgical glove perforations: experience from Addis Ababa, Ethiopia. BMC Surg 2017; 17:26. [PMID: 28320370 PMCID: PMC5359816 DOI: 10.1186/s12893-017-0228-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 03/16/2017] [Indexed: 11/17/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Abebe Bekele
- School of Medicine, Addis Ababa University, PO BOX 3560, Addis Ababa, Ethiopia.
| | | | - Lidya Tesfaye
- School of Medicine, Addis Ababa University, PO BOX 3560, Addis Ababa, Ethiopia
| | - Mulat Taye
- School of Medicine, Addis Ababa University, PO BOX 3560, Addis Ababa, Ethiopia
| |
Collapse
|
23
|
Egeler K, Stephenson N, Stanke N. Glove perforation rate with orthopedic gloving versus double gloving technique in tibial plateau leveling osteotomy: A randomized trial. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2016; 57:1156-1160. [PMID: 27807378 PMCID: PMC5081145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In this randomized, prospective study, perforation rates, glove change rates, and cost between orthopedic gloves (n = 227) and double gloving with standard latex surgical gloves (n = 178) worn in tibial plateau leveling osteotomy procedures were compared. Gloves were collected from the surgeon and surgical resident after procedures and were tested for perforations with a standardized water leak test, as described by the American Society for Testing and Materials International. No statistically significant difference was found between the perforation rate using orthopedic gloving and double gloving techniques (P = 0.629) or the rate at which gloves were changed (P = 0.146). Orthopedic gloving was 2.1 times more costly than double gloving but they may be preferred by surgeons for dexterity and comfort.
Collapse
|
24
|
Al-Ani SA, Mohan D, Platt AJ. Hand Surgery on Patients Who Are “High Risk” For Blood-Borne Viruses. ACTA ACUST UNITED AC 2016; 31:426-31. [PMID: 16725242 DOI: 10.1016/j.jhsb.2006.03.172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2005] [Revised: 11/08/2005] [Accepted: 03/29/2006] [Indexed: 11/28/2022]
Abstract
There is a risk of transmission of blood-borne viruses (BBV) to health-care workers when performing hand surgery on intravenous drug abusers and other patients known to have BBV. This review summarises methods and procedures that may be employed to help reduce this risk to a minimum. High-risk patients should be identified early and a non-invasive procedure considered. Only experienced staff should scrub and appropriate clothing should be worn. Sharp instrument use should be kept to a minimum and only instrument retraction and suturing should be employed. When possible, wounds should be closed with staples, glue or absorbable sutures. Appropriate steps must be taken to reduce the risk of injuries from sharp bone ends, K-wires and splash exposure during irrigation.
Collapse
Affiliation(s)
- S A Al-Ani
- Department of Plastic Surgery, Castle Hill Hospital, Cottingham, UK.
| | | | | |
Collapse
|
25
|
Makama JG, Okeme IM, Makama EJ, Ameh EA. Glove Perforation Rate in Surgery: A Randomized, Controlled Study To Evaluate the Efficacy of Double Gloving. Surg Infect (Larchmt) 2016; 17:436-42. [DOI: 10.1089/sur.2015.165] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jerry Godfrey Makama
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria
| | - Ibrahim Mohammed Okeme
- School of Post Basic Nursing Program, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria
| | - Elizabeth Jerry Makama
- Department of Nursing Services, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria
| | - Emmanuel Adoyi Ameh
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria
| |
Collapse
|
26
|
Infektionsschutz und spezielle Hygienemaßnahmen in klinischen Disziplinen. KRANKENHAUS- UND PRAXISHYGIENE 2016. [PMCID: PMC7152143 DOI: 10.1016/b978-3-437-22312-9.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
27
|
Trindade JPDA, Serra JRD, Tipple AFV. INDEX OF PERFORATION OF PROCEDURE/SURGICAL GLOVES USED BY WORKERS IN THE PURGING OF A MATERIAL AND STERILIZATION CENTER. TEXTO & CONTEXTO ENFERMAGEM 2016. [DOI: 10.1590/0104-07072016001410015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT The objectives of this study were to identify the types of gloves the nursing team uses for the manual cleaning of health products and to identify the perforation rates in procedure/surgical gloves used for this purpose. Cross-sectional and descriptive, descriptive study with quantitative approach was developed at a large hospital in Goiânia, Goiás, Brazil. In total, 300 procedure/surgical gloves (Group A), 100 procedure and 100 new surgical gloves (Group B), and six nitrile gloves (Group C) were analyzed. Among the gloves in Group A, 135 (45.0%) were perforated. Superposition of gloves did not prevent perforations and, the longer they were used, the higher the index of perforation (p<0.05). No perforations were identified in Group B, whereas there were four perforations in 48 hours of use in Group C. This study reinforces the idea that procedure/surgical gloves are inappropriate for cleaning health products, representing an ineffective barrier for the safety of workers.
Collapse
|
28
|
|
29
|
Provenzano DA, Deer T, Luginbuhl Phelps A, Drennen ZC, Thomson S, Hayek SM, Narouze S, Rana MV, Watson TW, Buvanendran A. An International Survey to Understand Infection Control Practices for Spinal Cord Stimulation. Neuromodulation 2015; 19:71-84. [DOI: 10.1111/ner.12356] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/08/2015] [Accepted: 09/01/2015] [Indexed: 11/28/2022]
Affiliation(s)
| | - Timothy Deer
- The Center for Pain Relief, Inc.; Charleston WV USA
| | - Amy Luginbuhl Phelps
- Economic and Finance Department at the AJ Palumbo Donahue School of Business; Duquesne University; Pittsburgh PA USA
| | | | - Simon Thomson
- Basildon and Thurrock University Hospitals; Grays Essex UK
| | - Salim M. Hayek
- University Hospitals Case Medical Center; Cleveland OH USA
| | - Samer Narouze
- Center for Pain Medicine at Western Reserve Hospital; Cuyahoga Falls OH USA
| | - Maunak V. Rana
- Advocate Illinois Masonic Medical Center; Chicago IL USA
| | | | | |
Collapse
|
30
|
Laurikainen E, Rintala E, Kaarto AM, Routamaa M. Adherence to surgical hand rubbing directives in a hospital district of Southwest Finland. Infect Dis (Lond) 2015; 48:116-21. [PMID: 26416015 DOI: 10.3109/23744235.2015.1089591] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The primary objective was to measure the compliance with alcohol-based surgical hand rubbing (SHR) among operation room personnel. The secondary objective was to evaluate the effect of feedback sessions on compliance. METHODS This was a prospective observational before-after intervention study. Between October 2010 and June 2012 the hygiene nurses observed SHR among operation room personnel in the hospital district of Southwest Finland. After feedback sessions a second observation round was conducted in the main operation room of Turku University Hospital. The first observation round comprised 477 observations: 259 (54%) were doctors, 190 (40%) nurses and 28 (5%) other personnel. In the second observation round a total of 210 observations were made. RESULTS During the first round in 42% of observations the 3 min SHR time recommended by WHO was used. Median times for SHR were 1 min 50 s (range 0 min to 5 min 44 s) for doctors and 3 min 25 s (range 1 min 1 s to 8 min 15 s) for nurses, respectively (p < 0.0001). In 40% of observations hands were not properly dried after a wash before applying SHR and in 45% hands were not allowed to dry properly after SHR before donning surgical gloves. After feedback, time for SHR did not significantly improve but technique did. CONCLUSIONS SHR was performed incorrectly in most observations even after feedback. The results stress the importance of more effective education, helping techniques and positive role models for operation room personnel to promote SHR.
Collapse
Affiliation(s)
| | - Esa Rintala
- b Department of Hospital Hygiene and Infection Control , Turku University Central Hospital , Turku , Finland
| | - Anne-Mari Kaarto
- b Department of Hospital Hygiene and Infection Control , Turku University Central Hospital , Turku , Finland
| | - Marianne Routamaa
- b Department of Hospital Hygiene and Infection Control , Turku University Central Hospital , Turku , Finland
| |
Collapse
|
31
|
Kim YG, Jeong IS, Park SM. Sharps injury prevention guidance among health care professionals: A comparison between self-reported and observed compliance. Am J Infect Control 2015; 43:977-82. [PMID: 26072716 DOI: 10.1016/j.ajic.2015.04.210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study was performed to compare self-report and observation methods for measuring compliance with double gloving (DG) and the hands-free technique (HFT). METHODS The participants were 81 health care professionals (29 nurses, 52 doctors) working in 22 operating rooms in a tertiary hospital in Busan (South Korea). All participants were asked to complete a self-report questionnaire. Additionally, compliance with DG and the HFT was observed from March-May 2014. Data were analyzed using descriptive statistics, χ(2) test, and κ statistic using SPSS version 18.0 (SPSS, Chicago, IL). RESULTS The participants who always complied with DG and the HFT were 30.9% and 7.7% according to the self-report method, respectively, and 30.9% and 0.0% according to direct observation, respectively. The κ value comparing the self-report and observation methods was 0.557 for all study participants, 0.259 for nurses, and 0.668 for doctors for DG. The κ value was 0.027 for all participants, 0.131 for nurses, and 0.020 for doctors for the HFT. CONCLUSION DG compliance and HFT compliance showed moderate and low levels of agreement between the 2 methods, respectively. Doctors showed higher agreement than nurses between the 2 methods for DG compliance but similar to nurses for HFT compliance. Therefore, the levels of compliance with DG may be measured by either the self-report or observation methods for doctors.
Collapse
|
32
|
Gorj M, Revol M. Les rituels en chirurgie : quels fondements scientifiques ? ANN CHIR PLAST ESTH 2015; 60:3-11. [DOI: 10.1016/j.anplas.2014.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022]
|
33
|
Verwilghen D, Singh A. Fighting surgical site infections in small animals: are we getting anywhere? Vet Clin North Am Small Anim Pract 2014; 45:243-76, v. [PMID: 25542615 DOI: 10.1016/j.cvsm.2014.11.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A diverse array of pathogen-related, patient-related, and caretaker-related issues influence risk and prevention of surgical site infections (SSIs). The entire surgical team involved in health care settings in which surgical procedures are performed play a pivotal role in the prevention of SSIs. In this article, current knowledge of SSI risk factors and prevention methods is reviewed. Although new avenues that can be explored in the prevention of SSIs in veterinary medicine are described, the main conclusion drawn is that the best method for prevention of SSI is to adhere to what we already know.
Collapse
Affiliation(s)
- Denis Verwilghen
- Department of Large Animal Sciences, University of Copenhagen, Hojbakkegaerd Allé 5, Taatsrup 2630, Denmark.
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada
| |
Collapse
|
34
|
Ford DA. Implementing AORN recommended practices for sharps safety. AORN J 2014; 99:106-20. [PMID: 24369976 DOI: 10.1016/j.aorn.2013.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/04/2013] [Accepted: 11/18/2013] [Indexed: 11/25/2022]
Abstract
Prevention of percutaneous sharps injuries in perioperative settings remains a challenge. Occupational transmission of bloodborne pathogens, not only from patients to health care providers but also from health care providers to patients, is a significant concern. Legislation and position statements geared toward ensuring the safety of patients and health care workers have not resulted in significantly reduced sharps injuries in perioperative settings. Awareness and understanding of the types of percutaneous injuries that occur in perioperative settings is fundamental to developing an effective sharps injury prevention program. The AORN "Recommended practices for sharps safety" clearly delineates evidence-based recommendations for sharps injury prevention. Perioperative RNs can lead efforts to change practice for the safety of patients and perioperative team members by promoting the elimination of sharps hazards; the use of engineering, work practice, and administrative controls; and the proper use of personal protective equipment, including double gloving.
Collapse
|
35
|
Giordano V, Koch HA, de Sousa Prado J, de Morais LS, de Araújo Hara R, de Souza FS, do Amaral NP. Is the surgical knot tying technique associated with a risk for unnoticed glove perforation? An experimental study. Patient Saf Surg 2014; 8:26. [PMID: 24991234 PMCID: PMC4078929 DOI: 10.1186/1754-9493-8-26] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 06/13/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The issue of safety in the surgical procedure has recently been widely and openly discussed at the World Health Organization. The use of latex gloves is the current standard of protection during surgery, as they remain intact throughout the procedure. The present study was designed to evaluate the rate of glove perforation during a two-hand technique using polyester sutures in a controlled experimental study. METHODS Hypothesis was that the gloves used during a two-hand technique using polyester suture suffer punctures. We used 150 pairs of gloves during the experiment. Each investigator performed 30 tests always using double gloving. They made five surgical knots on each test over a custom-made table specifically developed for the experiment. Ten tests were done at a time with a week- interval. The Control Group (CG) has 30 pairs of intact surgical gloves. The gloves were tested to impermeability by water filling and leaking was observed at three different times. Statistics relating to the perforation rate were analyzed using the chi-square test. A P value less than 0.05 was considered statistically significant. RESULTS During the experiment there was no loss of gloves by drilling or inadvertent error in performing the impermeability test. No perforations were detected at any time during the impermeability test with the gloves used for sutures. Also, the CG presented no leakage of the liquid used for the test. There was no statistical difference between the groups underwent suture nor between them and the GC. CONCLUSION Under the studied conditions, the authors' hypotheses could not be proved. There was no damage to the surgical gloves during the entire experiment. The authors believe that the skin abrasions observed in the ulnar side of the little finger, constant throughout the experiment, must be caused by friction. We feel there is no risk of perforation of surgical gloves during a two-hand technique using polyester suture.
Collapse
Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, R. Carlos Góis 375/203 Leblon, 22440-040 Rio de Janeiro, RJ, Brazil
| | - Hilton Augusto Koch
- Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-590, RJ, Brazil
| | - Juliano de Sousa Prado
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, R. Carlos Góis 375/203 Leblon, 22440-040 Rio de Janeiro, RJ, Brazil
| | - Leonardo Schiavo de Morais
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, R. Carlos Góis 375/203 Leblon, 22440-040 Rio de Janeiro, RJ, Brazil
| | - Rafael de Araújo Hara
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, R. Carlos Góis 375/203 Leblon, 22440-040 Rio de Janeiro, RJ, Brazil
| | - Felipe Serrão de Souza
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, R. Carlos Góis 375/203 Leblon, 22440-040 Rio de Janeiro, RJ, Brazil
| | - Ney Pecegueiro do Amaral
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, R. Carlos Góis 375/203 Leblon, 22440-040 Rio de Janeiro, RJ, Brazil
| |
Collapse
|
36
|
Mischke C, Verbeek JH, Saarto A, Lavoie M, Pahwa M, Ijaz S. Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel. Cochrane Database Syst Rev 2014; 2014:CD009573. [PMID: 24610769 PMCID: PMC10766138 DOI: 10.1002/14651858.cd009573.pub2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Healthcare workers are at risk of acquiring viral diseases such as hepatitis B, hepatitis C and HIV through exposure to contaminated blood and body fluids at work. Most often infection occurs when a healthcare worker inadvertently punctures the skin of their hand with a sharp implement that has been used in the treatment of an infected patient, thus bringing the patient's blood into contact with their own. Such occurrences are commonly known as percutaneous exposure incidents. OBJECTIVES To determine the benefits and harms of extra gloves for preventing percutaneous exposure incidents among healthcare workers versus no intervention or alternative interventions. SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE, NHSEED, Science Citation Index Expanded, CINAHL, NIOSHTIC, CISDOC, PsycINFO and LILACS until 26 June 2013. SELECTION CRITERIA Randomised controlled trials (RCTs) with healthcare workers as the majority of participants, extra gloves or special types of gloves as the intervention, and exposure to blood or bodily fluids as the outcome. DATA COLLECTION AND ANALYSIS Two authors independently assessed study eligibility and risk of bias, and extracted data. We performed meta-analyses for seven different comparisons. MAIN RESULTS We found 34 RCTs that included 6890 person-operations as participating units and reported on 46 intervention-control group comparisons. We grouped interventions as follows: increased layers of standard gloves, gloves manufactured with special protective materials or thicker gloves, and gloves with puncture indicator systems. Indicator gloves show a coloured spot when they are perforated. Participants were surgeons in all studies and they used at least one pair of standard gloves as the control intervention. Twenty-seven studies also included other surgical staff (e.g. nurses). All but one study used perforations in gloves as an indication of exposure. The median control group rate was 18.5 perforations per 100 person-operations. Seven studies reported blood stains on the skin and two studies reported self reported needlestick injuries. Six studies reported dexterity as visual analogue scale scores for the comparison double versus single gloves, 13 studies reported outer glove perforations. We judged the included studies to have a moderate to high risk of bias.We found moderate-quality evidence that double gloves compared to single gloves reduce the risk of glove perforation (rate ratio (RR) 0.29, 95% confidence interval (CI) 0.23 to 0.37) and the risk of blood stains on the skin (RR 0.35, 95% CI 0.17 to 0.70). Two studies with a high risk of bias also reported the effect of double compared to single gloves on needlestick injuries (RR 0.58, 95% CI 0.21 to 1.62).We found low-quality evidence in one small study that the use of three gloves compared to two gloves reduces the risk of perforation further (RR 0.03, 95% CI 0.00 to 0.52). There was similar low-quality evidence that the use of one fabric glove over one normal glove reduces perforations compared to two normal gloves (RR 0.24, 95% CI 0.06 to 0.93). There was moderate-quality evidence that this effect was similar for the use of one special material glove between two normal material gloves. Thicker gloves did not perform better than thinner gloves.There was moderate to low-quality evidence in two studies that an indicator system does not reduce the total number of perforations during an operation even though it reduces the number of perforations per glove used.There was moderate-quality evidence that double gloves have a similar number of outer glove perforations as single gloves, indicating that there is no loss of dexterity with double gloves (RR 1.10, 95% CI 0.93 to 1.31). AUTHORS' CONCLUSIONS There is moderate-quality evidence that double gloving compared to single gloving during surgery reduces perforations and blood stains on the skin, indicating a decrease in percutaneous exposure incidents. There is low-quality evidence that triple gloving and the use of special gloves can further reduce the risk of glove perforations compared to double gloving with normal material gloves. The preventive effect of double gloves on percutaneous exposure incidents in surgery does not need further research. Further studies are needed to evaluate the effectiveness and cost-effectiveness of special material gloves and triple gloves, and of gloves in other occupational groups.
Collapse
Affiliation(s)
| | - Jos H Verbeek
- Finnish Institute of Occupational HealthCochrane Occupational Safety and Health Review GroupPO Box 310KuopioFinland70101
| | - Annika Saarto
- Finnish Institute of Occupational HealthLemminkäisenkatu 14‐18 BTurkuFinland20520
| | - Marie‐Claude Lavoie
- University of Maryland Baltimore110 South Paca StreetRm 4‐S‐100BaltimoreMarylandUSA21201
| | - Manisha Pahwa
- University of TorontoDalla Lana School of Public Health155 College Street, 6th floorTorontoOntarioCanadaM5T 3M7
| | - Sharea Ijaz
- Finnish Institute of Occupational HealthCochrane Occupational Safety and Health Review GroupPO Box 310KuopioFinland70101
| | | |
Collapse
|
37
|
Assadian O, Kramer A, Ouriel K, Suchomel M, McLaws ML, Rottman M, Leaper D, Assadian A. Suppression of surgeons' bacterial hand flora during surgical procedures with a new antimicrobial surgical glove. Surg Infect (Larchmt) 2013; 15:43-9. [PMID: 24116857 DOI: 10.1089/sur.2012.230] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Perforations of surgical gloves are common and increase with the duration of glove wear. Skin flora, re-grown after pre-operative disinfection of the hands, may contaminate a surgical site. An antimicrobial surgical glove with chlorhexidine on its inner surface has been developed. We hypothesized that by suppressing the re-growth of skin flora during the complete course of a surgical procedure, antimicrobial gloves may reduce the risk of surgical site contamination in the event of an intra-operative glove breach. METHODS We conducted a randomized, double-blind, single-center trial, to measure any differences in the bacterial skin populations of surgeons' hands during surgical procedures done with antimicrobial and non-antimicrobial surgical gloves [ISRCTN71391952]. In this study, 25 pairs of gloves were retrieved from 14 surgeons who donned them randomly on their dominant or non-dominant hand. The number of bacteria retrieved from glove fluid was measured and expressed as colony forming units (CFU)/mL. RESULTS The median cfu/mL of antimicrobial gloves was 0.00 (LQ: 0.00 CFU/mL; UQ: 0.00 cfu/mL), with a mean log10 cfu/mL=0.02 (range: 0.00-0.30). The median CFU/mL of non-antimicrobial gloves was 54.00 (LQ: 3.00 cfu/mL; UQ: 100.00 cfu/mL) with a mean log10 CFU/mL=1.32 (range: 0.00-2.39). After a mean operating time of 112 min, the difference in the log10 CFU/mL was 1.30 (p<0.001). CONCLUSIONS A new antimicrobial surgical glove suppressed surgeons' hand flora during operative procedures. In the event of a glove breach, the use of such a glove may have the potential to prevent bacterial contamination of a sterile surgical site, thereby decreasing the risk of surgical site infection (SSI) and increasing patient safety. Further clinical studies are needed to confirm this concept.
Collapse
Affiliation(s)
- Ojan Assadian
- 1 Clinical Department for Hospital Hygiene, Medical University of Vienna , Vienna, Austria
| | | | | | | | | | | | | | | |
Collapse
|
38
|
|
39
|
Joint Practice Guideline for Sterile Technique during Vascular and Interventional Radiology Procedures: From the Society of Interventional Radiology, Association of periOperative Registered Nurses, and Association for Radiologic and Imaging Nursing, for the Society of Interventional Radiology (Wael Saad, MD, Chair), Standards of Practice Committee, and Endorsed by the Cardiovascular Interventional Radiological Society of Europe and the Canadian Interventional Radiology Association. J Vasc Interv Radiol 2012. [DOI: 10.1016/j.jvir.2012.07.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
|
40
|
Guo YP, Wong PM, Li Y, Or PPL. Is double-gloving really protective? A comparison between the glove perforation rate among perioperative nurses with single and double gloves during surgery. Am J Surg 2012; 204:210-5. [DOI: 10.1016/j.amjsurg.2011.08.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 08/05/2011] [Accepted: 08/05/2011] [Indexed: 11/29/2022]
|
41
|
Swenne CL, Alexandrén K. Surgical team members’ compliance with and knowledge of basic hand hygiene guidelines and intraoperative hygiene. J Infect Prev 2012. [DOI: 10.1177/1757177412448407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of the present study was to observe surgical team members’ compliance with basic hand hygiene and intraoperative hygiene guidelines during the anaesthetic and surgical procedure. A secondary aim was to investigate the team members’ knowledge and attitudes toward these guidelines. A structured observation schedule was designed to capture observational data on compliance with hygiene guidelines. A questionnaire was also designed to elicit written responses on attitudes, beliefs and knowledge about hygiene routines. The results showed that the clinical procedures for basic hand hygiene and intraoperative hygiene were flawed in three areas. Hand disinfection before and after direct patient contact was incomplete. Secondly, the team members used gloves in an incorrect way. Thirdly, the scrub nurse did not always change sterile gloves after intraoperative skin disinfection before handling sterile instruments. The quantity of 0.5% chlorhexidine with 70% ethanol used varied and the mechanical performance of skin disinfection varied. Knowledge of hand hygiene routines and intraoperative hygiene routines among surgical team members is incomplete and adherence needs to improve. Regular routine observations and continuous feedback to all staff may be necessary to improve compliance and avoid deterioration of practice.
Collapse
Affiliation(s)
- CL Swenne
- Department of Public Health and Caring Sciences, Box 564, 751 22, Uppsala, Sweden
- Department of Cardiothoracic Surgery, Uppsala University Hospital, Uppsala, Sweden
| | | |
Collapse
|
42
|
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]
|
43
|
Yang L, Mullan B. Reducing needle stick injuries in healthcare occupations: an integrative review of the literature. ISRN NURSING 2011; 2011:315432. [PMID: 22007320 PMCID: PMC3169876 DOI: 10.5402/2011/315432] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 03/14/2011] [Indexed: 11/23/2022]
Abstract
Needlestick injuries frequently occur among healthcare workers, introducing high risk of bloodborne pathogen infection for surgeons, assistants, and nurses. This systematic review aims to explore the impact of both educational training and safeguard interventions to reduce needlestick injuries. Several databases were searched including MEDLINE, PsycINFO, SCOPUS, CINAHL and Sciencedirect. Studies were selected if the intervention contained a study group and a control group and were published between 2000 and 2010. Of the fourteen studies reviewed, nine evaluated a double-gloving method, one evaluated the effectiveness of blunt needle, and one evaluated a bloodborne pathogen educational training program. Ten studies reported an overall reduction in glove perforations for the intervention group. In conclusion, this review suggests that both safeguard interventions and educational training programs are effective in reducing the risk of having needlestick injuries. However, more studies using a combination of both safeguards and educational interventions in surgical and nonsurgical settings are needed.
Collapse
Affiliation(s)
- Lin Yang
- School of Psychology, University of Sydney, Brennan McCallum Building A18, NSW 2006, Australia
| | | |
Collapse
|
44
|
Daeschlein G, Kramer A, Arnold A, Ladwig A, Seabrook GR, Edmiston CE. Evaluation of an innovative antimicrobial surgical glove technology to reduce the risk of microbial passage following intraoperative perforation. Am J Infect Control 2011; 39:98-103. [PMID: 20864217 DOI: 10.1016/j.ajic.2010.05.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 05/10/2010] [Accepted: 05/12/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND Surgical gloves provide a protective barrier for patients and members of the surgical team. Although glove integrity is important in an era of blood-borne pathogens, little data exist on bacterial passage after glove perforation. This study evaluated the impact of antimicrobial surgical gloves in reducing microbial passage after glove puncture in a model of wound contamination. METHODS Staphylococcus aureus (ATCC 6538) and Brevundimonas diminuta (DSM 1639) were used to prepare a standardized suspension for testing bacterial passage after glove puncture in volunteers wearing single-layer gloves (group A), double-layer gloves (group B), or antimicrobial trilayer gloves (group C). After exposure periods of 5, 10, 30 and 45 minutes, the outer test gloves were removed and microbial passage was measured on the inner surface of the base gloves. Multiple repetitions (5 or 6) were performed at each sampling time. RESULTS Microbial passage at 5-, 10-, 30-, and 45-minute exposures were analyzed both separately and combined (5 and 10 minutes and 30 and 45 minutes). No difference was observed in microbial passage between group A and group B at the 10-, 30-, and 45-minute exposures for S aureus, whereas a significant reduction in microbial passage was observed in group C compared with group A (P ≤ .05 to < .005) at the 5-, 30-, and 45-minute exposures for both S aureus and B diminuta. When timed groups were combined (5 and 10 minutes and 30 and 45 minutes), a significant reduction (P ≤ .01 to ≤ .005) in microbial passage of S aureus and B diminuta was observed in group C compared with both group A and group B. CONCLUSION These findings represent the first evidence that microbial passage across surgical gloves can be reduced significantly using an innovative antimicrobial glove technology.
Collapse
Affiliation(s)
- Georg Daeschlein
- Department of Dermatology, Ernst Moritz Arndt University, Greifswald, Germany
| | | | | | | | | | | |
Collapse
|
45
|
Abstract
Surgical site infections (SSI) in the postoperative period represent the sword of Damocles in surgery. In spite of the medical progress in recent years these infections cannot always be avoided and occur in 25% of all nosocomial infections in Germany. They also generate up to 50% of the required costs in this context. The consequences vary from extended duration of hospitalization to elevated mortality. The degree of contamination of surgical wounds is of great importance as well as the patient's immune status and comorbidities. Prevention of infected surgical wounds is essential and important measures should begin even prior to the surgical procedure. In addition, during and following the surgical procedure several standards have to be followed. Rapid confirmation of diagnosis and correct management of surgical site infections are essential for the course of the disease. This study provides information on development, prevention and therapy of surgically infected wounds.
Collapse
|
46
|
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).
Collapse
Affiliation(s)
- Sammy Al-Benna
- St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE.
| |
Collapse
|
47
|
Demircay E, Unay K, Bilgili MG, Alataca G. Glove perforation in hip and knee arthroplasty. J Orthop Sci 2010; 15:790-4. [PMID: 21116897 DOI: 10.1007/s00776-010-1547-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 08/16/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND The transmission of blood-borne pathogens during surgery is a major concern. Surgical gloves are the primary barrier between the surgeon and the patient. Surgical procedures that need manual handling of bony surfaces or sharp instruments have the highest risk of glove perforations. The frequencies and the sites of surgical glove perforations in arthroplasty procedures were assessed. METHODS We assessed the surgical glove perforations in total hip and knee arthroplasty procedures. Double standard latex gloves were used. A total of 983 outer and 511 inner gloves were tested. The gloves of all the surgical team members were tested for perforations during the first and second hours of surgery. RESULTS There were 18.4% outer and 8.4% inner glove perforations. The most frequent site of perforation was the second digit of the nondominant hand (25.5%). We found that hip and knee arthroplasty had significantly more glove perforation risk for the surgeon in the first half of the operation rather than the second half, and 57.8% of the perforations were at the index finger and the thumb. CONCLUSIONS Arthroplasty procedures still have high glove perforation rates despite the use of double gloving with frequent changes. Extra augmentation of the gloves in selected areas of the hand, in addition to double gloving, may be safer and more cost-effective than double gloving alone.
Collapse
Affiliation(s)
- Emre Demircay
- Department of Orthopedic Surgery, Baskent University School of Medicine, Uskudar, Istanbul, Turkey
| | | | | | | |
Collapse
|
48
|
Uçkay I, Harbarth S, Peter R, Lew D, Hoffmeyer P, Pittet D. Preventing surgical site infections. Expert Rev Anti Infect Ther 2010; 8:657-70. [PMID: 20521894 DOI: 10.1586/eri.10.41] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The risk of surgical site infection (SSI) is approximately 1-3% for elective clean surgery. Apart from patient endogenous factors, the role of external risk factors in the pathogenesis of SSI is well recognized. However, among the many measures to prevent SSI, only some are based on strong evidence, for example, adequate perioperative administration of prophylactic antibiotics, and there is insufficient evidence to show whether one method is superior to any other. This highlights the need for a multimodal approach involving active post-discharge surveillance, as well as measures at every step of the care process, ranging from the operating theater to postoperative care. Multicenter or supranational intervention programs based on evidence-based guidelines, 'bundles' or safety checklists are likely to be beneficial on a global scale. Although theoretically reducible to zero, the maximal realistic extent by which SSI can be decreased remains unknown.
Collapse
Affiliation(s)
- Ilker Uçkay
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland
| | | | | | | | | | | |
Collapse
|
49
|
Todd ECD, Michaels BS, Greig JD, Smith D, Bartleson CA. Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 8. Gloves as barriers to prevent contamination of food by workers. J Food Prot 2010; 73:1762-73. [PMID: 20828485 DOI: 10.4315/0362-028x-73.9.1762] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The role played by food workers and other individuals in the contamination of food has been identified as an important contributing factor leading to foodborne outbreaks. To prevent direct bare hand contact with food and food surfaces, many jurisdictions have made glove use compulsory for food production and preparation. When properly used, gloves can substantially reduce opportunities for food contamination. However, gloves have limitations and may become a source of contamination if they are punctured or improperly used. Experiments conducted in clinical and dental settings have revealed pinhole leaks in gloves. Although such loss of glove integrity can lead to contamination of foods and surfaces, in the food industry improper use of gloves is more likely than leakage to lead to food contamination and outbreaks. Wearing jewelry (e.g., rings) and artificial nails is discouraged because these items can puncture gloves and allow accumulation of microbial populations under them. Occlusion of the skin during long-term glove use in food operations creates the warm, moist conditions necessary for microbial proliferation and can increase pathogen transfer onto foods through leaks or exposed skin or during glove removal. The most important issue is that glove use can create a false sense of security, resulting in more high-risk behaviors that can lead to cross-contamination when employees are not adequately trained.
Collapse
Affiliation(s)
- Ewen C D Todd
- Department of Advertising Public Relations and Retailing, Michigan State University, East Lansing, Michigan 48824, USA.
| | | | | | | | | |
Collapse
|
50
|
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.
Collapse
Affiliation(s)
- Andreas Wittmann
- Department of Safety Engineering, University of Wuppertal, D-42119 Wuppertal, Germany.
| | | | | | | | | | | |
Collapse
|