The global incidence and associated factors of surgical gloves perforation: A systematic review and meta-analysis

BACKGROUND

Surgeon's hands are exposed to a range of chemical and physical stressors that influence the integrity of gloves. Thus, glove perforation facilitates pathogen transmission through the holes. Numerous studies have shown that glove perforation is of great importance, but there is still no complete consensus.

OBJECTIVE

This study aimed to investigate the safety conditions of surgical gloves based on the incidence of glove perforation among surgical teams.

METHODS

A literature review was conducted by searching PubMed, Embase, Scopus, ISI, and ProQuest databases. The incidence of glove perforation was reviewed in eight categories. A total of 580 articles were found in the initial search.

RESULTS

109 articles containing 130 datasets were analyzed. The overall incidence of glove perforation was 14.44 %. Surgeons had the highest incidence of glove perforation (23.09 %). An increase in the duration of surgery increased the odds of perforation. It was found that 68.58% of the glove perforations were not identified by practitioners.

CONCLUSION

Despite major advances in the design of surgical gloves, the issue of safety and integrity of gloves has not improved. Due to the high incidence of surgical glove perforations, most of which had not been identified, it is imperative to consider strategies to minimize the incidence of perforation. The results of the present study can be used to integrate information related to the rate of perforation of surgical gloves in different surgeries.

Making Glove Decision Less of a White Knuckling Experience: A Systematic Review and Inventory of Glove Accelerator Contents

Background

Accelerators in medical gloves are a common cause of allergic contact dermatitis among healthcare workers.

Objective

A systematic review of medical and nursing literature, patch testing reports, and chemical analyses of gloves was conducted to assess accelerator contents reported in the literature and to identify accelerator-free gloves.

Methods

A systematic literature search was performed in OVID Medline and OVID EMBASE. Hand-searching of reference lists of articles in the field and author input generated the remainder of articles assessed.

Results

We present an inventory of accelerator contents of gloves and accelerator-free glove options as reported in the literature as a clinical reference tool to assist allergen-free glove selection for individuals suffering from allergic contact dermatitis due to rubber accelerators.

Limitations

Pertinent limitations of our review include lack of predefined study exclusion criteria and screening of the studies identified in the search by 1 review author only.

Conclusion

The glove inventory we provide summarizes the available literature regarding medical and surgical glove accelerator content, describing gloves both by brand and manufacturer as well as by accelerators.

'Hand inside glove': Useful method of burn dressing in children

The use of sterile surgical gloves in wound dressing is not new. It has been used previously in dressing of fresh wounds and in adjunct to the negative pressure wound management. Herein we describe an interesting case of burn wound dressing of hand in a child. Low cost, easy availability, better patient compliance and lesser chances of wound infection are special attributes of glove dressing.

Using double gloves in surgical procedures: a literature review

This article will present a critical review of the literature relating to the use of double gloves during surgery in order to identify best practice by using available resources and to improve health care. During surgery there is an increased risk of exposure to blood and, as a result, pathogens can be transferred through contact between the patient and surgical team. Health professionals working in the operating room are prone to frequent exposure to patients' blood and body fluids (Davanzo et al, 2008 ; Au et al, 2008 ; Myers et al, 2008). Several researchers have also demonstrated that the highest incidence of blood and body fluid exposure is in the operating room during surgical procedures (Ganczak et al, 2006 ; Myers et al, 2008 ; Naghavi and Sanati, 2009).

Evaluation of surgical glove integrity during surgery in a Brazilian teaching hospital

BACKGROUND

A cross-sectional study was conducted in a large university hospital in Belo Horizonte, Minas Gerais, Brazil to evaluate surgical glove integrity after use during surgery.

METHODS

This 6-month study was conducted by a gastroenterological, cardiovascular, and pediatric surgical team consisting of surgeons (main surgeon and first and second assistants), medical students, and scrub nurses. The gloves used during surgery were examined postsurgery for microperforations using the watertight test as described in European Norm EN 455-1.

RESULTS

A total of 116 medical professionals conducted the 100 surgeries monitored. Of the 1090 gloves analyzed, 131 (12%) had a perforation detected postsurgery, 39 of which (37.5%) were recognized by users at the time of occurrence. The highest incidence of perforations occurred among surgeons (P = .033) in the index finger, followed by the thumb of the nondominant hand; in outer gloves (76.9%) when double-gloving was used (P = .014); in open surgery (P = .019); and in surgeries lasting ≥ 150 minutes (P < .05).

CONCLUSION

These findings reaffirm the importance of double-gloving, using a perforation indicator system, and changing gloves in surgeries of ≥ 150 minutes duration, especially in procedures involving open incisions.

Suppression of surgeons' bacterial hand flora during surgical procedures with a new antimicrobial surgical glove

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.

Latex medical gloves: time for a reappraisal

Many hospitals have implemented policies to restrict or ban the use of devices made of natural rubber latex (NRL) in healthcare as precautionary measures against the perceived risk of NRL allergy. Changes in glove technology, progress in measuring the specific allergenic potential of gloves and a dramatic decrease in the prevalence of NRL allergies after interventions and education prompted us to revisit the basis for justifiable glove selection policies. The published Anglophone literature from 1990 to 2010 was reviewed for original articles and reviews dealing with the barrier and performance properties of NRL and synthetic gloves and the role of glove powder. The review shows that NRL medical gloves, when compared with synthetic gloves, tend to be stronger, more flexible and better accepted by clinicians. The introduction of powder-free gloves has been associated with reductions in protein content and associated allergies. Recently, new methods to quantify clinically relevant NRL allergens have enabled the identification of gloves with low allergenic potential. The use of low-protein, low-allergenic, powder-free gloves is associated with a significant decrease in the prevalence of type I allergic reactions to NRL among healthcare workers. Given the excellent barrier properties and operating characteristics, dramatically reduced incidences of allergic reactions, availability of specific tests for selection of low-allergen gloves, competitive costs and low environmental impact, the use of NRL gloves within the hospital environment warrants reappraisal.

The Comparison of Double Gloving to Single Gloving in the Theatre Environment

The role of surgical gloving is to minimise the risk of surgical site infection (SSI) and to protect the surgical team from cross infection. However, different practitioners have different views as to when double gloving is appropriate, with many factors like speciality and procedure dictating their use. This review will look at best practice through the evidence available and provide recommendations for practice.

Surgical gowning and gloving

Surgical gowning and gloving is an essential element of perioperative practice and is undertaken by the members of the anaesthetic and surgical teams involved in a perioperative intervention or procedure. Gowning and gloving will take place immediately after surgical hand antisepsis and the whole process is often referred to as scrubbing, gowning and gloving. Surgical hand antisepsis is defined as 'an extension of hand washing' (AfPP 2007), and 'the antiseptic surgical scrub or antiseptic hand rubs performed before donning sterile attire preoperatively' (AORN 2008). The aim of these processes is to improve the perioperative outcome of interventions and procedures by enhancing and further promoting aseptic techniques (ACORN 2006, AfPP 2007).