Is Single Gloving Still Acceptable? Investigation and Evaluation of Damages on Sterile Latex Gloves in General Surgery.

Andreas Enz,Clemens Schafmayer,Emad Alwafai,Justus Groß,Imad Kamaleddine,Wolfram Mittelmeier,Larissa Sievers,Annett Klinder

doi:10.3390/jcm10173887

Abstract

(1) Background: The sterile latex surgical glove is an important part of protecting both the patient and the surgical team from infections. However, mechanical stress can damage the integrity of the glove material and thus may lead to infections. (2) Method: A total of 896 gloves from 448 surgeries were tested and evaluated by the water tightening test according to EN455 and ASTM D5151-19. (3) Results: From 448 surgeries, 18.8% of the interventions showed glove damage. In vascular surgery, gloves were damaged in 20.8%, in thoracic surgery 9.1%, in laparoscopic interventions 21.7%, in the subgroup hernia surgeries (TAPP) 17.6% and in open interventions 17.6%. A total of 101 damages were found on 896 gloves; one glove could have several damages. During vascular surgery, 60% of the damages were on the subordinated hand of the surgeon, and 73.3% of the damages had a size of 1 mm. In laparoscopic procedures, the subordinated hand was also more frequently affected (61.3%) than the dominant hand; 64.5% of the damages were 1 mm in size. In the hernia surgery subgroup (TAPP), no damage was larger than 1 mm; 66.7% were in the subordinated hand area. The duration of surgery had no influence on the lesion rate. (4) Conclusion: The damage rate in low impact procedures is high and represents an underestimated problem in soft tissue surgery. The use of single gloving can therefore lead to the risk of infection. EN455 and ASTM D5151-19 does not take into consideration the risk of intraoperative lesions. Double gloving and glove change algorithms should be established.

Highlights

Since the 1890s, surgical gloves have been worn to reduce or prevent wound infections in surgical interventions [1] and laid the basis for modern surgery [2]
In the hernia surgery subgroup (TAPP), no damage was larger than 1 mm; 66.7% were in the subordinated hand area
The production of gloves is subject to standards like the European committee of standardization (CEN) European norm (EN) 455 [9] or the American Society for Testing and Materials (ASTM) D3577-19 [10] and D5151-19 [11], which describe almost identical specifications

Summary

Introduction

Since the 1890s, surgical gloves have been worn to reduce or prevent wound infections in surgical interventions [1] and laid the basis for modern surgery [2]. The sterile latex surgical glove still plays an important role, as it protects both the patient and the surgical team from infections [3] This medical device made of thin latex is subject to mechanical stress [4], which damages the integrity of the glove and its protective function [5]. This could lead to sepsis or other infections, some of the most serious complications of surgery and can have both personal consequences for the patient and economic consequences for the health systems [6]. A total of 896 gloves from 448 surgeries were tested and evaluated by the water tightening test according to EN455 and ASTM D5151-19

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Methods

Results

Conclusion