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Guanche Garcell H, Gonzalez Valdés A, Gonzalez Alvarez L, Fresneda Septiem G, Cardenás Goulet K, Matos Figueroa Y, Gutiérrez García F. Glove perforation in selected surgical procedures in a general hospital in La Habana, Cuba. Infect Prev Pract 2022; 4:100238. [PMID: 36052310 PMCID: PMC9424954 DOI: 10.1016/j.infpip.2022.100238] [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: 03/11/2022] [Accepted: 06/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Surgical glove perforation constitutes a risk for the maintenance of aseptic technique and the risk of surgical site infection and occupational exposure to blood borne infections for healthcare workers. Aim To identify the frequency of glove perforation in selected surgical procedures. Methods A cross-sectional descriptive observational study was carried out in the surgical unit of the Joaquin Albarrán Hospital (La Habana, Cuba) during the period September–December 2019. Gloves used by surgeons in major urgent or elective surgical procedures were collected and tested for perforations. Findings 757 gloves from 149 surgeons and 8 surgical specialties were tested and 95 (25.8%) had perforations. The highest frequencies of glove perforations were reported in vascular surgery (50.0%), proctology (37.9%), urology (28.0%) and general surgery (26.1%). The selected surgical procedures with the highest frequencies were open radical nephrectomy (87.5%), splenectomy (57.1%), open adenomectomy (55.6%), limb amputation (46.2%) and hysterectomy (41.7%). Glove perforation occurred more frequently in consultant surgeons (28.8%) than in residents (20.9%) (P = 0.021), in surgeons with more years of surgical experience (P = 0.003) and longer procedure duration (P = <0.001). Most glove perforations were identified in the left hand (64.1%), while 23.1% were in the right hand and 12.8% in both hands. 51.2% occurred in thumb and index finger. Differences in the patterns of glove perforation were observed among the different surgical procedures. Conclusions Our findings provide insights into the risk of glove perforation during selected surgical procedures and the need for prevention strategies to reduce adverse consequences of glove perforation in patients and healthcare workers.
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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.
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Affiliation(s)
- Seung Yeol Lee
- Department of Orthopaedic Surgery, Myongji Hospital, Hanyang University College of Medicine, Gyeonggi, Korea
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Polajnar P, Szanto Z, Gruborovic S, Willmitzer F, Medl N. Tibial plateau levelling osteotomy using a dome-shaped saw blade for canine cranial cruciate ligament insufficiency. Vet Rec 2021; 188:e241. [PMID: 33870528 DOI: 10.1002/vetr.241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/21/2020] [Accepted: 02/12/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Tibial plateau levelling osteotomy (TPLO) is commonly used to manage cranial cruciate ligament (CrCL) disease. The use of a spherical osteotomy blade (S-TPLO) enables correction of some tibial deformities with three rotational degrees of freedom. METHODS As a proof of concept, this retrospective study included 45 dogs with CrCL disease that were treated with an S-TPLO. The tibial plateau angle (TPA) was measured preoperatively, immediately after surgery (pTPA0 ) and on postoperative days 42 (pTPA42 ) and 56 (pTPA56 ). Lameness and osteotomy healing were assessed until 56 days postoperatively. RESULTS Thirty-one dogs had complete CrCL ruptures, and 14 dogs had partial ruptures. Thirty-one dogs had medial meniscal damage. The mean TPA, pTPA0 , pTPA42 and pTPA56 were 26.0°, 7.8°, 8.5° and 8.9°, respectively. The TPA from post-op to follow-up did not vary significantly (p > 1.365). Minor complications occurred in five dogs. The mean lameness score improved significantly from 3.2 preoperatively to 0.9 on day 56 (p < 0.0001). The mean healing score improved significantly from 1.6 on day 42 to 2.2 on day 56 (p < 0.001). CONCLUSION S-TPLO was successful in treating CrCL disease in stifle joints without tibial deformities, with results comparable to previously reported TPLO outcomes.
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Affiliation(s)
- Petar Polajnar
- AniCura Small Animal Referral Clinic, Babenhausen, Germany
| | - Zsigmond Szanto
- Twin Falls Veterinary Clinic and Hospital, Twin Falls, Idaho, USA
| | | | | | - Nikola Medl
- AniCura Small Animal Referral Clinic, Babenhausen, Germany
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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.
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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
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Head and neck surgical antibiotic prophylaxis in resource-constrained settings. Curr Opin Otolaryngol Head Neck Surg 2020; 28:188-193. [PMID: 32332205 DOI: 10.1097/moo.0000000000000626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Antimicrobial resistance represents a global threat and causes almost 700 000 deaths per year. The rapid dissemination of resistant bacteria is occurring globally, turning this into the primary threat to public health in the 21st century and forcing organizations around the globe to take urgent action. RECENT FINDINGS About risks related to surgical site infection (SSI) in head and neck surgery, surgical limitations in resource-constrained settings, comorbidities and the risk of SSI, evidence about surgical prophylaxis from low and middle-income countries, SSI gap between the developed and developing worlds and how to reduce resistance. SUMMARY Antibiotic protocols can be adjusted to local and regional bacterial resistance profiles, taking into account the availability of antibiotics and cost limitations on each country in order to decrease the SSI risk.
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Isaacson G, Doyle W, Summer D. Reducing Surgical Site Infections During Otolaryngology Surgical Missions. Laryngoscope 2019; 130:1388-1395. [PMID: 31755991 DOI: 10.1002/lary.28418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/21/2019] [Accepted: 10/24/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To determine what measures an otolaryngology-head and neck surgery team might adopt to decrease the incidence of surgical site infection (SSI) on a short-term surgical mission. Despite concerns about safety and efficacy, short-term surgical missions remain the predominant structure for humanitarian surgical care in low- and middle-income countries (LMIC). Hospitals in high-income countries strive to improve surgical outcomes through implementation of World Health Organization (WHO) safe surgery guidelines. Reduction of SSI risk is a key part of this effort. METHODS Literature review and practical experience. RESULTS WHO recommendations for reducing SSI are based largely on research done in the North America and Europe. LMIC populations are younger; comorbidities are fewer; infectious disease and trauma are prevalent; and delays in access to care are common. SSI are much more frequent in resource-limited settings. Recommendations regarding preoperative assessment, operating room environment, instrument sterilization, surgical antibiotic prophylaxis, surgical site preparation, gloving, draping, and postsurgical care are reviewed in the context of a surgical mission at a typical LMIC government hospital. CONCLUSION Many of the WHO guidelines on reduction of SSI are logical and applicable to the short-term surgical missions; others may need to be modified. Careful prospective data collection and clinical trials are needed to learn which interventions are valid and which should be changed. LEVEL OF EVIDENCE 5 Laryngoscope, 130:1388-1395, 2020.
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Affiliation(s)
- Glenn Isaacson
- Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
| | - Winifred Doyle
- Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
| | - Deborah Summer
- Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
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Sayın S, Yılmaz E, Baydur H. Rate of Glove Perforation in Open Abdominal Surgery and the Associated Risk Factors. Surg Infect (Larchmt) 2019; 20:286-291. [PMID: 30735109 DOI: 10.1089/sur.2018.229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Glove perforation is common during surgery. Surgical gloves are used as personal protective equipment to reduce infection risks from bloodborne pathogens for both the surgical team and patients. This research was conducted to determine the perforation rates of gloves worn in open abdominal surgery performed in a general surgery department and the risk factors affecting perforation. Methods: This research was designed as an observational prospective cohort study including 70 open abdominal operations. There were four members of the surgical team (surgeon, first assistant, second assistant, and scrub nurse). A total of 280 (70 × 4) pairs of gloves in 70 consecutive open abdominal procedures were included in this study. A total of 140 unused gloves were tested as control group to assess perforations and pre-existing leaks. After the operation, all gloves were checked for water impermeability using the EN455-1 method and the presence or absence of a puncture hole was recorded. Results: Glove perforation was detected in 54.3% of operations. The rate of perforation in all gloves was 10.7%, of which 78% unnoticed by the surgical team during surgical procedure. It was determined that the puncture in the gloves was mostly on the non-dominant hand (left). For the left-hand glove, the highest number of holes was observed on the index finger (21.1%) and palm/dorsum of the hand (21.1%). The risk of glove perforation was 5.8 times greater for surgeons compared with the other team members, and operation time of 61 minutes or longer increased the risk of perforation by 12.77 times. Conclusions: Glove perforation rates are high in open abdominal surgery. The highest number of perforations occurred in the non-dominant hand (left) has a high rate of perforation in surgeons and long operations. It may be beneficial for surgical team members to change gloves at certain intervals during surgery or use indicator glove systems.
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Affiliation(s)
- Selma Sayın
- 1 Institute of Health Science, Department of Surgical Nursing, Manisa Celal Bayar University, Manisa, Turkey
| | - Emel Yılmaz
- 2 Faculty of Health Science, Department of Surgical Nursing, Manisa Celal Bayar University, Manisa, Turkey
| | - Hakan Baydur
- 3 Faculty of Health Science, Department of Social Work, Manisa Celal Bayar University, Manisa, Turkey
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Haque M, McKimm J, Godman B, Abu Bakar M, Sartelli M. Initiatives to reduce postoperative surgical site infections of the head and neck cancer surgery with a special emphasis on developing countries. Expert Rev Anticancer Ther 2018; 19:81-92. [DOI: 10.1080/14737140.2019.1544497] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Mainul Haque
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Judy McKimm
- Swansea University School of Medicine, Grove Building, Swansea University, Swansea, Wales, UK
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sasako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Muhamad Abu Bakar
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Massimo Sartelli
- Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100 Macerata, Italy
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Tlili MA, Belgacem A, Sridi H, Akouri M, Aouicha W, Soussi S, Dabbebi F, Ben Dhiab M. Evaluation of surgical glove integrity and factors associated with glove defect. Am J Infect Control 2018; 46:30-33. [PMID: 28893444 DOI: 10.1016/j.ajic.2017.07.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 07/20/2017] [Accepted: 07/20/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surgical glove perforation may expose both patients and staff members to severe complications. This study aimed to determine surgical glove perforation rate and the factors associated with glove defect. MATERIAL AND METHODS This descriptive cross-sectional study was conducted between January and March 2017 at a Tunisian university hospital center in 3 different surgical departments: urology, maxillofacial, and general and digestive. The gloves were collected and tested to detect perforations using the water-leak test as described in European Norm NF EN 455-1. For percentage comparisons, the χ2 test was used with a significance threshold of 5%. RESULTS A total of 284 gloves were collected. Of these, 47 were found to be perforated, a rate of 16.5%. All perforations were unnoticed by the surgical team members. The majority of perforated gloves (61.7%) were collected after urology procedures (P = .00005), 77% of perforated gloves were detected when the duration of the procedure exceeded 90 minutes (P = .001), and 96% were from brand A, which were the thicker gloves (P = .015). CONCLUSIONS This study highlighted an important problem neglected by surgical teams. The findings reaffirm the importance of double-gloving and changing gloves in surgeries of more than 90 minutes' duration.
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Affiliation(s)
- Mohamed Ayoub Tlili
- Health Sciences Research, Higher School of Health Sciences and Techniques of Sousse, University of Sousse, Tunisia.
| | - Amina Belgacem
- Health Sciences Research, Higher School of Health Sciences and Techniques of Sousse, University of Sousse, Tunisia
| | - Haifa Sridi
- Higher School of Health Sciences and Techniques of Sousse, University of Sousse, Tunisia
| | - Maha Akouri
- Higher School of Health Sciences and Techniques of Sousse, University of Sousse, Tunisia
| | - Wiem Aouicha
- Health Sciences Research, Higher School of Health Sciences and Techniques of Sousse, University of Sousse, Tunisia
| | - Sonia Soussi
- Health Sciences Research, Higher School of Health Sciences and Techniques of Tunis, University of Tunis El Manar, Tunisia
| | - Faten Dabbebi
- Department of Occupational Medicine, University Hospital Center of Sahloul, Tunisia
| | - Mohamed Ben Dhiab
- Health Sciences Research, Higher School of Health Sciences and Techniques of Sousse, University of Sousse, Tunisia
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