Removing Outer Gloves as a Method to Reduce Spinal Surgery Infection

Abstract

A retrospective cohort study was performed to analyze the effect of a specifically timed glove change on infection rates in lumbar spinal fusion. Postoperative infection is a frequent and taxing complication following posterior lumbar spine fusion with instrumentation. This procedure is associated with infection rates up to 9%. The most common organism responsible for infection is Staphylococcus aureus which, along with many of the other common causative organisms, is often part human skin flora. This implicates the surgeon's gloves as the mode of transfer for these organisms from the patient's skin to the wound. The authors conducted a retrospective study to determine if a simple glove change before handling instrumentation could significantly reduce the rate of postoperative infection for this procedure. A total of 389 patients requiring lumbar spine fusion were enrolled retrospectively and divided into 2 groups: a control group of 179 patients treated with standard protocol for the procedure (group A) and a treatment group of 210 patients in whom, after initially double gloving, the outer pair of gloves was removed before handling the instrumentation. Infection rates were compared up to 1 year postoperatively. There was a statistically significant reduction of infection rate from 3.35% in group A (control) to 0.48% in group B (P=0.0369). This study shows that the removal of an outer pair of gloves before handling instrumentation may be a simple, cost-effective, and practical way to reduce the burden of postoperative infection following lumbar spinal fusion.