Correlation between a Compliance of Using Double-Gloving Bundle during Endotracheal Intubation and the Surgical Site Infection

Abstract

Background: Surgical site infections (SSI) represent severe postoperative adverse events. Contamination of operating room (OR) environment with oral bacteria and bloodborne pathogens poses an additional risk of infection. Studies have demonstrated that anesthesia providers’ use of double-gloving care bundle reduce operating room contamination as intubator wears two sets of gloves, sheaths the laryngoscope blade after use with endotracheal tube packaging and removes the outer glove after intubation. Materials and Methods: The authors conducted a prospective, single-center quality improvement project to increase anesthesia provider compliance with a double-gloving care bundle between January and December 2019. The primary measure was the percentage of anesthesia providers’ compliance with the double-gloving care bundle as compared to baseline. The secondary measure was the correlation between compliance with the use of the double-gloving bundle and SSIs. Results: The authors assessed 307 surgeries with 280 that had adequate data for analyses. The initial compliance rate was 38% before the quality improvement initiative. There was no change in the median compliance rate following the initiative. There was no difference in demographic data between the compliance and the non-compliance providers. Three patients (1.07%) developed SSIs, one patient in compliance group and two patients in the non-compliance group. There was no correlation between double-glove care bundle compliance and SSIs. Conclusion: The present study quality improvement initiative study did not increase anesthesia providers’ compliance with the double-gloving care bundle. There was no correlation between compliance and SSIs due to small sample size. However, double-gloving and laryngoscope sheathing by anesthesia providers do improve the standard of care and reduce contamination in the operating room setting. We will continue efforts to increase compliance. Keywords: Double-gloving; Laryngoscope sheathing; Surgical site infection; Anesthesia provider; Operating room contamination