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Baker NF, Brown O, Hart AM, Danko D, Stewart CM, Thompson PW. Preventing Infection in Implant-based Breast Reconstruction: Evaluating the Evidence for Common Practices and Standardized Protocols. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4208. [PMID: 35350150 PMCID: PMC8939924 DOI: 10.1097/gox.0000000000004208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/22/2022] [Accepted: 01/25/2022] [Indexed: 12/14/2022]
Abstract
Infection following implant-based breast reconstruction (IBBR) results in increased rates of hospital readmission, reoperation, patient and hospital expenses, and reconstructive failure. IBBR is a complex, multistep procedure, and there is a relative lack of high-quality plastic surgery evidence regarding "best practices" in the prevention of implant infections. In the absence of strong data, standardizing procedures based on available evidence can reduce error and improve efficacy and outcomes. Methods We performed a focused literature review of the available evidence supporting specific interventions for infection prevention in the preoperative, intraoperative, and postoperative phases of care that are applicable to IBBR. In addition, we examined previously published standardized perioperative protocols for implant reconstruction. Results Preoperative, intraoperative, and postoperative planning and organization is crucial in IBBR. Preoperative planning involves skin decolonization in advance of surgery with either chlorhexidine gluconate or mupirocin. Intraoperative methods that have shown potential benefit include double-gloving, breast pocket irrigation, separate closing instruments, and the utilization of "no-touch" techniques. In the postoperative period, the duration of drain removal and postoperative antibiotic administration play an important role in the prevention of surgical site infection. Conclusions There is a crucial need to establish an evidence-based set of "best practices" for IBBR, and there exists a paucity of evidence in the breast literature. These data can be utilized to develop a standardized protocol as part of a rigorous quality improvement methodology.
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Affiliation(s)
| | - Owen Brown
- Emory Department of Surgery, Division of Plastic Surgery, Atlanta, Ga
| | - Alexandra M. Hart
- Emory Department of Surgery, Division of Plastic Surgery, Atlanta, Ga
| | - Dora Danko
- From the Emory University School of Medicine, Atlanta, Ga
| | | | - Peter W. Thompson
- Emory Department of Surgery, Division of Plastic Surgery, Atlanta, Ga
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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.
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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)
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Abstract
BACKGROUND Blood-borne pathogen infections (BPIs), caused by the human immunodeficiency virus, hepatitis C and hepatitis B viruses pose an occupational hazard to healthcare workers. Facial trauma reconstruction surgeons may be at elevated risk because of routine use of sharps, and a higher than average incidence of BPIs in the trauma patient population. METHODS The authors retrospectively reviewed health records of patients admitted to a level 1 trauma center with a facial fracture between January 2010 and December 2015. Patient demographics, medical history, mechanism of injury, type of fracture, and procedures performed were documented. The authors detemined the frequency of human immunodeficiency virus, hepatitis B, and hepatitis C diagnosis and utilized univariable/multivariable analyses to identify risk factors associated with infection in this population. RESULTS In total, 4608 consecutive patients were included. Infections were found in 4.8% (n = 219) of patients (human immunodeficiency virus 1.6%, hepatitis C 3.3%, hepatitis B 0.8%). 76.3% of BPI patients in this cohort were identified by medical history, while 23.7% were diagnosed by serology following initiation of care. 39.0% of all patients received surgical treatment during initial hospitalization, of whom 4.3% had a diagnosed BPI. History of intravenous drug use (odds ratio [OR] 6.79, P < 0.001), assault-related injury (OR 1.61, P = 0.003), positive toxicology screen (OR 1.56, P = 0.004), and male gender (OR 1.53, P = 0.037) were significantly associated with a BPI diagnosis. CONCLUSION Patients presenting with facial fractures commonly harbor a BPI. The benefit of early diagnosis and risk to surgical staff may justify routine screening for BPI in high risk facial trauma patients (male, assault-related injury, and history of intravenous drug use).
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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
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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.
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Affiliation(s)
- S A Al-Ani
- Department of Plastic Surgery, Castle Hill Hospital, Cottingham, UK.
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Shirol S, Cooduvalli P, Prabhu M. Glove Puncture During Liposuction: A Report of Two Cases. J Cutan Aesthet Surg 2016; 9:48-50. [PMID: 27081254 PMCID: PMC4812893 DOI: 10.4103/0974-2077.178560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Shidlingappa Shirol
- Department of Plastic Surgery, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | | | - Mahesh Prabhu
- Department of Plastic Surgery, KLE University, Belgaum, Karnataka, India
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Lee SW, Cho MR, Lee HH, Choi WK, Lee JH. Perforation of Surgical Gloves during Lower Extremity Fracture Surgery and Hip Joint Replacement Surgery. Hip Pelvis 2015; 27:17-22. [PMID: 27536597 PMCID: PMC4972615 DOI: 10.5371/hp.2015.27.1.17] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 03/07/2015] [Accepted: 03/09/2015] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess the frequencies and sites of surgical glove perforations in lower extremity fracture surgery and hip joint replacement (HJR) surgery. Additionally, we also studied the usefulness of an indicator system glove. Materials and Methods We assessed surgical glove perforations in 30 cases of lower extremity fracture surgery and 18 cases of HJR surgery conducted by one right handed 1st operator from April 2013 to July 2013. We assessed frequencies and sites of perforation in 152 gloves; 95 used in lower extremity fracture surgery and 57 used in HJR surgery. We studied the perforation rates and sites according to participants and operation types. Using the Biogel indicator system glove, which is well known as a fast indicator of glove perforation, we were also able to assess the time difference between operative participant detection of perforation and inspector nurse detection while observing in the operative field. Results There were 18 of 30 cases in lower extremity fracture surgeries and 12 of 18 cases in HJR surgeries which had more than one surgical glove perforation event. Of all 152 gloves used, perforation occurred in 15 of 57 gloves (26.3%) in HJR surgery and 23 of 95 gloves (24.2%) in lower extremity fracture surgery. Perforation occurred more frequently in operators than assistant doctors or scrub nurses. The most frequent perforation site was the second digit of the left hand. On average, the time difference between operative participant notice of perforation and inspector nurse notice of perforation was 20.6 seconds. Conclusion The perforation of surgical gloves happened in approximately one out of every four persons. Importantly, we noted a 37.0% prevalence of glove perforation in 1st operators. Considering that glove perforation is a critical factor responsible for intra-operative infection, surgeons must be conscious of the risk of surgical glove perforation and use double gloving regularly. Furthermore, indicator double gloving is recommended for fast detection of outer glove perforation.
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Affiliation(s)
- Sang Wook Lee
- Department of Orthopedic Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Myung-Rae Cho
- Department of Orthopedic Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Ho-Hyoung Lee
- Department of Orthopedic Surgery, Seogwipo Medical Center, Seoqwipo, Korea
| | - Won-Kee Choi
- Department of Orthopedic Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Joo-Hwan Lee
- Department of Orthopedic Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
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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]
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Perforación de los guantes e infección de la herida de esternotomía en cirugía cardíaca con circulación extracorpórea. CIRUGIA CARDIOVASCULAR 2015. [DOI: 10.1016/j.circv.2014.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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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.
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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
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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]
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Olson LK, Morse DJ, Duley C, Savell BK. Prospective, randomized in vivo comparison of a dual-active waterless antiseptic versus two alcohol-only waterless antiseptics for surgical hand antisepsis. Am J Infect Control 2012; 40:155-9. [PMID: 22381223 DOI: 10.1016/j.ajic.2011.10.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 10/12/2011] [Accepted: 10/12/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND This study aimed to demonstrate the value of adding an active level of a persistent antimicrobial agent, such as chlorhexidine gluconate (CHG), to an alcohol-based surgical hand antiseptic. METHODS The persistence of 3 waterless, brushless alcohol-based surgical hand antiseptics, including one product containing CHG, was compared. The test products were applied a total of 12 times over 5 days. Samples of aerobic bacteria were collected on days 1 and 5, on both days immediately after drying and 6 hours later, using the glove juice technique. Relative suppression of regrowth was compared using t tests. RESULTS Using an equivalence margin of 20%, the alcohol plus CHG product showed noninferiority to the alcohol-only products at all sampling points and, based on significantly lower bacterial regrowth (P = .026), superior persistence to the alcohol-only products after 6 hours of glove wear. CONCLUSIONS Given the primary objective of surgical hand antisepsis of reducing resident skin flora for the duration of the surgical procedure, using an alcohol-based hand antiseptic containing CHG appears to be the most appropriate choice for maintaining microbial levels as low as possible for as long as possible.
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Griffin MF, Hindocha S. The attitudes of British surgical trainees about the treatment of HIV-infected patients. Surg Today 2011; 42:1066-70. [DOI: 10.1007/s00595-011-0096-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 08/21/2011] [Indexed: 10/14/2022]
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Fry DE, Harris WE, Kohnke EN, Twomey CL. Influence of Double-Gloving on Manual Dexterity and Tactile Sensation of Surgeons. J Am Coll Surg 2010; 210:325-30. [DOI: 10.1016/j.jamcollsurg.2009.11.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 11/01/2009] [Indexed: 11/25/2022]
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de Castro-Peraza M, Garzón-Rodríguez E, Rodríguez-Pérez V, Sosa-Alvarez I, Gutierrez-Hernández J, Asiain-Ugarte C. Incidencia de la perforación de los guantes en cirugía y efecto protector del doble guante. ENFERMERIA CLINICA 2010; 20:73-9. [DOI: 10.1016/j.enfcli.2009.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 10/29/2009] [Accepted: 10/31/2009] [Indexed: 10/19/2022]
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Harnoß JC, Partecke LI, Heidecke CD, Hübner NO, Kramer A, Assadian O. Concentration of bacteria passing through puncture holes in surgical gloves. Am J Infect Control 2010; 38:154-8. [PMID: 19822380 DOI: 10.1016/j.ajic.2009.06.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2009] [Revised: 06/11/2009] [Accepted: 06/17/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The reasons for gloving-up for surgery are to protect the surgical field from microorganisms on the surgeon's hands and protect the surgeon from the patient's microorganisms. This study measured the concentration of bacteria passing through glove punctures under surgical conditions. METHODS Double-layered surgical gloves were worn during visceral surgeries over a 4-month period. The study included 128 outer gloves and 122 inner gloves from 20 septic laparotomies. To measure bacterial passage though punctures, intraoperative swabs were made, yielding microorganisms that were compared with microorganisms retrieved from the inner glove layer using a modified Gaschen bag method. RESULTS Depending on the duration of glove wear, the microperforation rate of the outer layer averaged 15%. Approximately 82% of the perforations went unnoticed by the surgical team. Some 86% of perforations occurred in the nondominant hand, with the index finger being the most frequently punctured location (36%). Bacterial passage from the surgical site through punctures was detected in 4.7% of the investigated gloves. CONCLUSION Depending on the duration of wear, surgical gloves develop microperforations not immediately recognized by staff. During surgery, such perforations allow passage of bacteria from the surgical site through the punctures. Possible strategies for preventing passage of bacteria include strengthening of glove areas prone to punctures and strict glove changing every 90 minutes.
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de Castro-Peraza ME. ¿Es realmente necesario el uso del doble guante? ENFERMERIA CLINICA 2009; 19:354-5. [DOI: 10.1016/j.enfcli.2009.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Accepted: 08/31/2009] [Indexed: 12/01/2022]
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Partecke LI, Goerdt AM, Langner I, Jaeger B, Assadian O, Heidecke CD, Kramer A, Huebner NO. Incidence of microperforation for surgical gloves depends on duration of wear. Infect Control Hosp Epidemiol 2009; 30:409-14. [PMID: 19335225 DOI: 10.1086/597062] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The use of sterile gloves is part of general aseptic procedure, which aims to prevent surgical team members from transmitting infectious agents to patients during procedures performed in an operating room. In addition, surgical gloves also protect team members against patient-transmitted infectious agents. Adequate protection, however, requires that the glove material remain intact. The risk of perforations in surgical gloves is thought to correlate with the duration of wear, yet very few prospective studies have addressed this issue. METHODS We prospectively collected 898 consecutive pairs of used surgical gloves over a 9-month period in a single institution. After surgical team members wore the gloves during surgical procedures, the gloves were examined for microperforations using the watertight test described in European Norm 455, part 1. The gloves were analyzed as a pair; if 1 glove had a perforation, the pair was considered to be perforated. In addition, we evaluated the use of a hand cream that contained a suspension of cornstarch and ethanol to determine its potential influence on the rate of microperforation. RESULTS Wearing gloves for 90 minutes or less resulted in microperforations in 46 (15.4%) of 299 pairs of gloves, whereas wearing gloves for 91-150 minutes resulted in perforation of 54 (18.1%) of 299 pairs, and 71 of (23.7%) of 300 pairs were perforated when the duration of wear was longer than 150 minutes (P = .05). Subgroup analysis revealed no significant difference in the rates of microperforation for surgeons (56 [23.0%] of 244 pairs of gloves perforated), first assistants (43 [19.0%] of 226 pairs perforated), and surgical nurses (53 [20.5%] of 259 pairs perforated). Of 171 microperforations, 114 (66.7%) were found on the left hand glove (ie, the glove on subjects' nondominant hand), predominantly on the left index finger (55 [32.3%]). The use of the hand cream had no influence on the rate of microperforation. CONCLUSION Because of the increase in the rate of microperforation over time, it is recommended that surgeons, first assistants, and surgical nurses directly assisting in the operating field change gloves after 90 minutes of surgery.
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Affiliation(s)
- Lars Ivo Partecke
- Clinic of General, Visceral, Vascular, and Thoracic Surgery, Department of Surgery, Ernst-Moritz-Arndt University, Greifswald, Germany
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Chan MF, Ho A, Day MC. Investigating the knowledge, attitudes and practice patterns of operating room staff towards standard and transmission-based precautions: results of a cluster analysis. J Clin Nurs 2008; 17:1051-62. [DOI: 10.1111/j.1365-2702.2007.01998.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Knowledge, attitude, and practice of Iranian surgeons about blood-borne diseases. J Surg Res 2008; 151:80-4. [PMID: 18599085 DOI: 10.1016/j.jss.2007.12.803] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Revised: 12/10/2007] [Accepted: 12/26/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND Perhaps more than any other healthcare worker, it is the surgeons who are at an increased risk of exposure to hepatitis B (HB) virus, hepatitis C virus, and human immunodeficiency virus. The aim of this study was to evaluate surgeons' concerns regarding risk awareness and behavioral methods of protection against blood-borne pathogen transmission during surgery. MATERIALS AND METHODS A 31-item questionnaire with a reliability coefficient of 0.73 was used. Of 575 surgeons invited to participate from three universities and one national annual surgical society between May and July 2007, 430 (75%) returned completed forms. RESULTS Concern about being infected with blood-borne diseases was more than 70 (from a total score of 100). Only 12.9% of surgeons always used double gloves. Complete vaccination against HB was done in about 76% of surgeons and only 56.8% had checked their HB surface antibody (anti-HBs) level. Older surgeons never used double gloves (P = 0.001). CONCLUSION Iranian surgeons are not aware of the correct percentage of infected patients with and seroconversion rate of blood-borne diseases, do not use double gloves adequately, do not report their needlestick injuries, vaccinate against HB, and check anti-HBs after vaccination. Educational meetings, pamphlets, and facilities must be provided to health care workers, informing them of hazards, prevention, and postexposure prophylaxis to needlestick injuries, vaccination efficacy, and wearing double gloves.
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Blaich A, Babikir R, Daschner F, Schweins M, Lambert J, Ingenhoven E, Gastmeier P, Dettenkofer M. Qualitätssicherung und Hygiene beim ambulanten Operieren. Chirurg 2007; 78:630-6. [PMID: 17356830 DOI: 10.1007/s00104-006-1301-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND According to the German Law on Infectious Diseases (Infektionsschutzgesetz or IfSG) German outpatient centres must provide evidence of maintaining certain standards of hygiene and record their nosocomial infection rates. To fulfill their legal obligations, the Commission for Hospital Hygiene and the Prevention of Infection recommends surveillance modules such as that known as AMBU-KISS. MATERIALS AND METHODS The AMBU-KISS project centre implemented a survey to evaluate all procedures relevant to hygiene, surveillance of surgical site infections, and facilities available at centres participating in the AMBU-KISS surveillance programme. The questionnaire was returned by 99 of 110 participants. RESULTS AND DISCUSSION All the centres possess cleaning and disinfection schemes, and practically all of them use written instructions on the processing of instruments and surgical hand disinfection procedure. Many of the participants spend too much time on surgical hand disinfection and presurgical skin disinfection. CONCLUSION The survey demonstrates that hygienic conditions at centres participating in AMBU-KISS are largely satisfactory. However, there is nevertheless a need to optimise infection control measures.
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Affiliation(s)
- A Blaich
- Institut für Umweltmedizin und Krankenhaushygiene, Universitätsklinikum, Freiburg, Deutschland.
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Abstract
Surgical gloves are worn to protect both the patient and the surgical team from transferred infections. Wearing two pairs of gloves, perforation indicator systems, glove liners, knitted gloves and triple gloving are said to offer additional protection. This paper presents the main findings from a Cochrane systematic review of 30 trials examining surgical gloving practice.
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Affiliation(s)
- Judith Tanner
- De Montfort University and University Hospitals Leicester
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Abstract
BACKGROUND The invasive nature of surgery, with its increased exposure to blood, means that during surgery there is a high risk of transfer of pathogens. Pathogens can be transferred through contact between surgical patients and the surgical team, resulting in post-operative or blood borne infections in patients or blood borne infections in the surgical team. Both patients and the surgical team need to be protected from this risk. This risk can be reduced by implementing protective barriers such as wearing surgical gloves. Wearing two pairs of surgical gloves, triple gloves, glove liners or cloth outer gloves, as opposed to one pair, is considered to provide an additional barrier and further reduce the risk of contamination. OBJECTIVES The primary objective of this review was to determine if additional glove protection reduces the number of surgical site or blood borne infections in patients or the surgical team. The secondary objective was to determine if additional glove protection reduces the number of perforations to the innermost pair of surgical gloves. The innermost gloves (next to skin) compared with the outermost gloves are considered to be the last barrier between the patient and the surgical team. SEARCH STRATEGY We searched the Cochrane Wounds Group Specialised Register (January 2006), and the Cochrane Central Register of Controlled Trials (CENTRAL)(The Cochrane Library Issue 4, 2005). We also contacted glove manufacturing companies and professional organisations. SELECTION CRITERIA Randomised controlled trials involving: single gloving, double gloving, triple gloving, glove liners, knitted outer gloves, steel weave outer gloves and perforation indicator systems. DATA COLLECTION AND ANALYSIS Both authors independently assessed the relevance and quality of each trial. Data was extracted by one author and cross checked for accuracy by the second author. MAIN RESULTS Two trials were found which addressed the primary outcome, namely, surgical site infections in patients. Both trials reported no infections. Thirty one randomised controlled trials measuring glove perforations were identified and included in the review. Fourteen trials of double gloving (wearing two pairs of surgical latex gloves) were pooled and showed that there were significantly more perforations to the single glove than the innermost of the double gloves (OR 4.10, 95% CI 3.30 to 5.09). Eight trials of indicator gloves (coloured latex gloves worn underneath latex gloves to more rapidly alert the team to perforations) showed that significantly fewer perforations were detected with single gloves compared with indicator gloves (OR 0.10, 95% CI 0.06 to 0.16) or with standard double glove compared with indicator gloves (OR 0.08, 95% CI 0.04 to 0.17). Two trials of glove liners (a glove knitted with cloth or polymers worn between two pairs of latex gloves)(OR 26.36, 95% CI 7.91 to 87.82), three trials of knitted gloves (knitted glove worn on top of latex surgical gloves)(OR 5.76, 95% CI 3.25 to 10.20) and one trial of triple gloving (three pairs of latex surgical gloves)(OR 69.41, 95% CI 3.89 to 1239.18) all compared with standard double gloves, showed there were significantly more perforations to the innermost glove of a standard double glove in all comparisons. AUTHORS' CONCLUSIONS There is no direct evidence that additional glove protection worn by the surgical team reduces surgical site infections in patients, however the review has insufficient power for this outcome. The addition of a second pair of surgical gloves significantly reduces perforations to innermost gloves. Triple gloving, knitted outer gloves and glove liners also significantly reduce perforations to the innermost glove. Perforation indicator systems results in significantly more innermost glove perforations being detected during surgery.
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Affiliation(s)
- J Tanner
- Derby Hospitals NHS FoundationTrust, Derby City General Hospital, Uttoxeter Road, Derby, Derbyshire, UK DE22 3NE.
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Florman S, Burgdorf M, Finigan K, Slakey D, Hewitt R, Nichols RL. Efficacy of double gloving with an intrinsic indicator system. Surg Infect (Larchmt) 2006; 6:385-95. [PMID: 16433603 DOI: 10.1089/sur.2005.6.385] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Blood-borne infection is an ever-present fear for medical professionals, especially surgeons and operating room personnel. Safety is paramount, and the reliability and efficacy of surgical gloves are crucial, as gloves are the most important barriers protecting hospital personnel and patients. Unfortunately, glove perforation rates are as high as 78% in high-risk procedures. As well as being efficacious, surgical gloves must be comfortable and easy to don, and when holes are present, it is imperative they be detected expeditiously. The purpose of this double-blind randomized study was to evaluate the ability of participants to locate 30-micron laser holes in surgical gloves while performing simulated surgery and to evaluate the Biogel Indicator Glove System, which reveals punctures. METHODS Twenty glove configurations (eight single, twelve double) were tested, half of which had laser-created holes. Each of the 25 participants tested and evaluated 20 configurations randomly. Simulated surgery terminated when a hole was identified by the participant or at the end of two minutes, whichever occurred first. Participants also rated their perceptions of each glove's features on questionnaires, all of which were returned, with 95.8% being complete. RESULTS Participants found 84% and 56% of the holes in the two indicator systems, latex and synthetic, in an average of 22 seconds and 42 seconds, respectively. In the worst-performing latex and synthetic glove configurations, participants found only 8% and 12% of the holes at an average of 47 seconds and 67 seconds, respectively. Indicator gloves were highly rated for comfort and ease of use. CONCLUSIONS Double gloving with an indicator system provides the best protection and allows the timeliest identification of perforations. Participants failed to identify most of the holes in the non-indicator gloves.
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Affiliation(s)
- Sander Florman
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana 70112, USA.
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Laine T, Kaipia A, Santavirta J, Aarnio P. Glove perforations in open and laparoscopic abdominal surgery: the feasibility of double gloving. Scand J Surg 2004; 93:73-6. [PMID: 15116826 DOI: 10.1177/145749690409300116] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS According to the traditional view, the glove protects the patient from the bacterial growth of the surgeons' hands and doing so prevents infections. Today, with growing incidences of HIV and Hepatitis B and C, surgical gloves are also important as protection for the surgeon. We compared the safety of double indicator gloves to standard single surgical gloves by investigating how often surgical gloves are punctured in laparoscopic and open gastrointestinal surgery. STUDY As study material we gathered all gloves that had been used in gastrointestinal surgery in Satakunta Central Hospital during two months. 814 gloves from 274 operations were tested by using standardized water filling test method. RESULTS In open surgery 67 gloves out of 694 had been punctured (9.6 percent). Puncture occurred in 22.5 percent of operations (53 out of 236). During open surgery 24 holes out of 35 were undetected with single gloves (69 percent). With double indicator gloves, only 3 out of 31 holes were unnoticed (10 percent). Long duration of operation increased the risk of puncture. In laparoscopic operations 4 gloves out of 120 had been perforated (3.3 percent). CONCLUSION Double surgical gloves give markedly better protection in surgery. This is important especially in high risk operations.
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Affiliation(s)
- T Laine
- Tampere University Hospital, Department of Surgery, Tampere, Finland.
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Patterson JMM, Novak CB, Mackinnon SE, Ellis RA. Needlestick injuries among medical students. Am J Infect Control 2003; 31:226-30. [PMID: 12806360 DOI: 10.1067/mic.2003.44] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Concern about occupational exposure to bloodborne pathogens exists, and medical students, who lack in experience in patient care and surgical technique, may be at an increased exposure risk. METHODS This prospective cohort study evaluated needlestick injuries and practices regarding the use of protective strategies against bloodborne pathogens in medical students. A questionnaire was developed and sent to 224 medical students. RESULTS Of 224 students, 146 students (64%) returned questionnaires. Forty-three students (30%) reported needlestick injuries that most commonly occurred in the operating room; 86% of students reported always using double gloves in the operating room; 90% reported always wearing eye protection, and all but one student had been vaccinated against hepatitis B. A concern about contracting a bloodborne pathogen through work was noted in 125 students, although they usually reported that this concern only slightly influenced their decision regarding a career subspecialty. CONCLUSION Medical students have a high risk for needlestick injuries, and attention should be directed to protection strategies against bloodborne pathogens.
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Affiliation(s)
- J Megan M Patterson
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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28
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Abstract
BACKGROUND The invasive nature of surgery, with its increased exposure to blood, means that during surgery there is a high risk of transfer of pathogens. Pathogens can be transferred through contact between surgical patients and the surgical team, resulting in post-operative or blood borne infections in patients or blood borne infections in the surgical team. Both patients and the surgical team need to be protected from this risk. This risk can be reduced by implementing protective barriers such as wearing surgical gloves. Wearing two pairs of surgical gloves, as opposed to one pair, is considered to provide an additional barrier and further reduce the risk of contamination. OBJECTIVES The primary objective of this review was to determine if double gloving (wearing two pairs of gloves), rather than single gloving, reduces the number of post-operative or blood borne infections in surgical patients or blood borne infections in the surgical team. The secondary objective of this review was to determine if double gloving, rather than single gloving, reduces the number of perforations to the innermost pair of surgical gloves. The innermost gloves (next to skin) compared with the outermost gloves are considered to be the last barrier between the patient and the surgical team. SEARCH STRATEGY The reviewers searched the Cochrane Wounds Group Specialised Trials Register, MEDLINE, CINAHL, EMBASE and the Cochrane Controlled Trials Register. Glove manufacturing companies and professional organisations were also contacted. SELECTION CRITERIA Randomised controlled trials involving: single gloving, double gloving, glove liners or coloured puncture indicator systems. DATA COLLECTION AND ANALYSIS Both reviewers independently assessed the relevance and quality of each trial. Trials to be included were cross checked and authenticated by both reviewers. Data was extracted by one reviewer and cross checked for accuracy by the second reviewer. MAIN RESULTS Two trials were found which addressed the primary outcome. A total of 18 randomised controlled trials which measured glove perforations were identified and included in the review. DOUBLE GLOVING (wearing two pairs of latex gloves). Nine trials compared single latex gloves versus double latex gloves. These found no difference in the number of perforations between the single latex gloves and the outermost pair of the double latex gloves, but the number of perforations to the double latex-innermost glove was significantly reduced when two pairs of latex gloves were worn. ORTHOPAEDIC GLOVES (thicker than standard latex gloves). One trial compared single latex orthopaedic gloves with double latex gloves. This showed there was no difference in the number of perforations to the innermost gloves when wearing double latex gloves compared with a single pair of latex orthopaedic gloves. INDICATOR GLOVES (coloured latex gloves worn underneath latex gloves). Three trials compared double latex gloves versus double latex indicator gloves. These trials showed similar numbers of perforations to both the innermost and the outermost gloves for both gloving groups. Perforations to the outermost gloves were detected more easily when double latex indicator gloves were worn. Wearing double latex indicator gloves did not increase the detection of perforations to the innermost gloves. GLOVE LINERS (an insert worn between two pairs of latex gloves). Two trials compared double latex gloves versus double latex gloves with liners. These trials showed a significant reduction in the number of perforations to the innermost glove when a glove liner was worn between two pairs of latex gloves. CLOTH GLOVES (cloth gloves worn on top of latex gloves). Two trials compared double latex gloves versus latex inner with cloth outer gloves. These trials showed that wearing a cloth outer glove significantly reduced the number of perforations to the innermost latex glove. STEEL WEAVE GLOVES (steel weave gloves worn on top of latex gloves). One trial compared double latex gloves versus latex inner with steel weave outer gloves. This trial showed no reduction in the number of perforations to the innermost glove when wearing a steel weave outer glove. REVIEWER'S CONCLUSIONS Wearing two pairs of latex gloves significantly reduces the number of perforations to the innermost glove. This evidence comes from trials undertaken in 'low risk' surgical specialties, that is specialties which did not include orthopaedic joint surgery. Wearing two pairs of latex gloves does not cause the glove wearer to sustain more perforations to their outermost glove. Wearing double latex indicator gloves enables the glove wearer to detect perforations to the outermost glove more easily than when wearing double latex gloves. However wearing a double latex indicator system will not assist with the detection of perforations to the innermost glove, nor reduce the number of perforations to either the outermost or the innermost glove. Wearing a glove liner between two pairs of latex gloves to undertake joint replacement surgery significantly reduces the number of perforations to the innermost glove compared with double latex gloves only. Wearing cloth outer gloves to undertake joint replacement surgery significantly reduces the number of perforations to the innermost glove compared with wearing double latex gloves. Wearing steel weave outer gloves to undertake joint replacement surgery does not reduce the number of perforations to innermost gloves compared with double latex gloves.
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Affiliation(s)
- J Tanner
- Health Care Studies, University of Leeds, Beckett Street, Leeds, UK, LS9 7TF
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Demir A, Uysal A, Güneren E. Has your finger ever been scratched by suture? Plast Reconstr Surg 2001; 108:265-6. [PMID: 11420543 DOI: 10.1097/00006534-200107000-00057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Laine T, Aarnio P. How often does glove perforation occur in surgery? Comparison between single gloves and a double-gloving system. Am J Surg 2001; 181:564-6. [PMID: 11513787 DOI: 10.1016/s0002-9610(01)00626-2] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In surgery, intact gloves protect the surgeon from bloodborne pathogens and the surgical wound from microorganisms on the skin of the surgeon. However, glove perforation is very common, and puncture rates as high as 61% are published in the literature. One objective of this study was to compare puncture rates between a unique double-gloving puncture indication system and single-use gloves, and another was to determine the extent to which glove perforations remain undetected during surgery. METHODS The study material comprised all gloves used in surgical operations at our hospital for a period of 2 months. The analysis was made by the glove type in a prospective and randomized manner. Gloves were tested immediately after the surgical procedure using the approved standardized water-leak method for 2 minutes to detect any holes. The gloves used in this study were either a double-gloving puncture indication system or the standard glove used at our hospital. RESULTS In 885 operations altogether, 2,462 gloves were tested; 1,020 single gloves, 1,148 double-glove systems, and 294 combination gloves were studied. The overall perforation rate was 192 out of 2,462 gloves (7.80%), and 162 out of 885 operations (18.3%). The detection of perforation during surgery was 28 out of 76 (36.84%) with single gloves, 77 out of 89 with the double-gloving system (86.52%), and 9 out of 27 with combination gloves (33.33%; P <0.001). The inner glove of the double-gloving system was punctured in 6 out of 88 outer glove perforations (6.82%). CONCLUSIONS In view of the critical importance of safety at work by having a sterile barrier between surgeon and patient, it is very important to use a double-gloving puncture indication system, at least in operations where there is a high risk of glove perforation.
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Affiliation(s)
- T Laine
- Department of Surgery, Satakunta Central Hospital, 28500, Pori, Finland
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Caillot JL, Côte C, Lemaire C, Fabry J. [Electronic detection of breaks in the surgeon-patient barrier. Evaluation of protective clothing in visceral surgery]. ANNALES DE CHIRURGIE 2000; 125:358-62. [PMID: 10900738 DOI: 10.1016/s0003-3944(00)00208-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
STUDY AIM Breakdown of the aseptic surgeon-patient barrier causing abnormal contact between skin and body fluids represents a risk for transmission of infectious disease. Such breakdowns are frequently not perceived by the surgical team over prolonged periods. The aim of this prospective randomized study was to evaluate the protection afforded by double gloving and reinforced gowns in visceral surgery. METHODS An electronic device detected breakdowns of the surgeon-patient barrier in a series of 80 surgical procedures, randomly assigned to double or single gloves, and normal or reinforced gowns. Fluid contacts due to glove perforation, glove porosity or gown wetting were recorded during 151 individual participations covering 238 hours. Surgical procedures were called deep for incisions of more than 10 cm. RESULTS Deep surgical procedures carried a sevenfold-increased risk of barrier breakdown, compared with superficial ones. Skin contacts through wet gowns were not prevented by the use of double thickness materials, but double gloving reduced the number of perforation and porosity alarms twofold in both superficial and deep surgery. CONCLUSION Without electronic detection, 96% of barrier breakdowns would remain undetected by the surgical team and lead to prolonged contact with potentially contaminating-fluids. The use of double gloving provides a real protection against contamination risk.
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Affiliation(s)
- J L Caillot
- Service d'urgence chirurgicale, centre hospitalier Lyon-Sud 69495 Pierre-Bénite, France
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Affiliation(s)
- S L Jensen
- Orthopaedic Research Laboratory, University Hospital of Aarhus, Denmark
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Abstract
BACKGROUND Breakdown of the surgeon-patient barrier represents a risk for transmission of infectious disease. Such breakdowns are frequently not recognized by the surgical team. The protection afforded by double gloving under normal operating conditions was evaluated. METHODS An electronic device detected breakdown of the surgeon-patient barrier in a series of 80 surgical procedures, randomly assigned to either double or single gloving. Fluid contact due to glove perforation, porosity or gown wetting was recorded during 151 individual surgeon episodes covering 238 operator-hours. Surgical procedures were called superficial for incisions of less than 10 cm. RESULTS Double gloving reduced the number of perforation and porosity alarms twofold in both superficial and deep surgical procedures. Deep procedures carried a sevenfold increased risk of barrier breakdown compared with superficial procedures, the risk being greatest for the principal operator. CONCLUSION Without electronic detection, a large majority of barrier breakdowns would remain undetected by the surgical team and lead to prolonged contact with potentially contaminating body fluids. The use of double gloving provides real protection against such contamination risks.
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Affiliation(s)
- J L Caillot
- Surgical Emergency Service, Centre hospitalier Lyon-Sud, Pierre Bénite, France
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Ong CS, Commens CA. The use of gloves in Australian dermatological practice. Australas J Dermatol 1999; 40:83-8. [PMID: 10333618 DOI: 10.1046/j.1440-0960.1999.00326.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Dermatologists use gloves as a major tool in universal precautions to prevent transmission of infections particularly human immunodeficiency virus (HIV) and hepatitis. We need to know how much protection is conferred by gloves and what problems are associated with glove use. This paper looks at these issues and reports the results of a survey on glove use by Australian dermatologists. The survey found a lack of awareness regarding gloves as a protective measure, suggesting the need to improve knowledge in this area so that realistic precautions can be adopted. Dermatologists have a high rate of glove use and reactions to gloves were noted by 13% of respondents. The authors recommend the use of non-powdered, low-allergen latex gloves. Handwashing prior to using non-powdered latex gloves needs further investigation. Handwashing after wearing latex gloves may decrease sensitization risk.
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Affiliation(s)
- C S Ong
- Department of Dermatology, Westmead Hospital, New South Wales, Australia.
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35
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Novak CB, Patterson JM, Mackinnon SE. Evaluation of hand sensibility with single and double latex gloves. Plast Reconstr Surg 1999; 103:128-31. [PMID: 9915172 DOI: 10.1097/00006534-199901000-00020] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to examine hand sensibility of surgeons wearing single and double latex gloves. Evaluation of hand sensibility, including cutaneous pressure thresholds, moving two-point discrimination, and static two-point discrimination, was performed on 25 surgeons (mean age 45 years). The dominant hand index finger was assessed with no glove, single glove, and double glove. The majority of surgeons had a moving and static two-point discrimination of 2 or 3 mm. The lowest cutaneous pressure thresholds were found when measured with no gloves and increased with single and double gloves. Statistically significant differences in cutaneous pressure thresholds using Semmes-Weinstein monofilaments were found for gloves versus no gloves (p < 0.0003) and single versus double gloves (p = 0.0003). Statistically significant differences in moving two-point discrimination were found for no gloves versus double gloves (p = 0.05) and single versus double gloves (p = 0.02). In conclusion, we found significant differences in hand sensation when measured with single and double gloves.
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Affiliation(s)
- C B Novak
- Division of Plastic and Reconstructive Surgery at the Washington University School of Medicine, St. Louis, MO, USA
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Patterson JM, Novak CB, Mackinnon SE, Patterson GA. Surgeons' concern and practices of protection against bloodborne pathogens. Ann Surg 1998; 228:266-72. [PMID: 9712573 PMCID: PMC1191469 DOI: 10.1097/00000658-199808000-00017] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate surgeons' concern regarding risk awareness and behavioral methods of protection against bloodborne pathogen transmission during surgery. METHODS A 29-item questionnaire was sent to 914 surgeons from two universities and two surgical societies. RESULTS The questionnaire was returned by 768 active surgeons. Slight or moderate concern about contracting human immunodeficiency virus (HIV) was reported by most surgeons; 8% reported extreme concern and 4% reported no concern. In total, 605 surgeons reported having been vaccinated against hepatitis B; surgeons in practice <7 years were most likely to be vaccinated. Most surgeons did not routinely use double gloves: 92 of 768 surgeons reported that they always use double gloves when performing surgery, and 83 reported that they usually use double gloves. There was a statistically significantly higher proportion of surgeons who always or usually use double gloves who also had hepatitis B vaccinations. Most surgeons incorrectly estimated the seroconversion rates with exposure to a patient with HIV (66% incorrect), hepatitis B (88% incorrect), or hepatitis C (84% incorrect). Most surgeons never or rarely report needle-stick injuries, and only 17% always report needle-stick injuries. CONCLUSIONS Most surgeons underestimate the risk of bloodborne pathogens and do not routinely use double gloves.
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Affiliation(s)
- J M Patterson
- Division of Plastic & Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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