Glove Change Research Articles

Effect of Changing Gloves Before Placental Extraction on Incidence of Postcesarean Endometritis

Objective: We sought to determine if changing the surgeon's gloves after delivery of the infant and prior to manual placental removal decreases the incidence of postcesarean endometritis. Methods: Laboring women undergoing cesarean delivery between September 1, 1994, and August 31, 1995, were prospectively randomized into either a change or no-change glove group. In the change-glove group, the surgeon's gloves were changed after delivery of the infant and before manual removal of the placenta. All patients enrolled received a single prophylactic dose of an IV antibiotic after clamping of the umbilical cord. Endometritis was diagnosed by an oral temperature of ≥38℃ on 2 occasions at least 6 h apart and >24 h after delivery, uterine tenderness, peripheral blood leukocytosis (≥15,000 cells/ml), and the exclusion of other foci of infection. In order to detect a reduction in endometritis from 14% to 2%, at P < 0.05 with 80% power, we needed 95 patients in each group. Results: Two hundred twenty-eight women were randomized to 2 groups: 113 were in the change group and 115 in the no-change group. No significant differences were noted between the groups with respect to demographics, duration of labor, length of ruptured membranes, number of vaginal examinations, duration of internal monitoring, length of surgery, blood loss, or infant weight. There was no decrease in the incidence of endometritis between the change group (17.7%) and the no-change group (15.7%) (relative risk 1.1, 95% confidence interval 0.75–1.47). Conclusions: In this study, the incidence of postcesarean endometritis was not decreased by changing the surgeon's gloves after delivery of the infant but before placental extraction.

A new glove puncture detection system

A new glove detection system has been developed for early and accurate detection of a hole in the glove. It consists of an inner glove colored by a green dye and outer glove. When a breach in the outer glove occurs, the inner glove develops a dark patch around the needle puncture hole, a visible indicator for immediate glove change. Using a computerized needle penetration system, the immediate and maximal penetration forces as well as the work required for needle penetration of this new double glove was significantly greater than those encountered with either the inner or outer glove tested separately. In addition to hole detection, this double glove provides increased protection against needle penetration.

The Key–Lock Theory and the Induced Fit Theory

As a glove changes shape when a hand slips into it, so an enzyme changes its conformation on binding a ligand. This theory of induced fit extends the lock‐and‐key principle that Emil Fischer proposed exactly 100 years ago. The new theory proposed by D. E. Koshland, Jr. in 1958 allows one to explain regulation and cooperative effects, and adds some new specificity principles as well.

Intraoperative glove change and spontaneous placental delivery reduces post-cesarean endometritis: [formula omitted], A Wren x, J Owen, JC Hauth. Dept. of OB/GYN, University of Alabama at Birmingham

Intraoperative glove change and spontaneous placental delivery reduces post-cesarean endometritis: [formula omitted], A Wren x, J Owen, JC Hauth. Dept. of OB/GYN, University of Alabama at Birmingham

Preparing Cytotoxic Agents in an Isolator

The design of an isolator and its use by an oncology satellite pharmacy for preparing cytotoxic drugs are described. The isolator (Iso Concept, Boulogne, France) is a totally enclosed ventilated biological-safety cabinet of class III polyvinyl chloride (PVC) with positive air pressure, a half-suit with a rotating seal, and attached neoprene gloves. There are three work-stations, one for the half-suit and two along one side of the isolator. The ventilation and air filtration system consists of one entry pipe with a full ventilation-filtration box fitted with one prefilter, one blower, one ball valve, one high-efficiency particulate air (HEPA) filter, one airtight nipple connected to an automatic sterilizer, alarms, and one exhaust pipe protected by a HEPA filter. The air lock consists of a rigid, transparent Plexiglas pass-through. The chamber is sterilized with heated compressed air mixed with 3.5% peracetic acid. Maintenance includes regular changing of gloves and HEPA filters; checking of the integrity of the PVC, half-suit, and gloves; and washing and decontamination procedures. Preparation of cytotoxics is planned in advance with prescription data and manufacturing sheets. In the half-suit, a pharmacy technician reads the label, supervises preparation of the sterile admixture, and writes a label. The operators on the side of the unit read the manufacturing sheet and prepare the dose identified by the label.(ABSTRACT TRUNCATED AT 250 WORDS)

Frequency of glove puncture in the post mortem room.

The post mortem room is a potential source of danger from contamination caused by glove punctures. The objective of this study was to assess the incidence of hand injury and hand contamination during post mortem examinations. A prospective study of injury and glove puncture rate was conducted during post mortem examinations performed in 1990 on adults in Northwick Park Hospital mortuary. Four pathologists and two assistants performed a total of 44 post mortem examinations on adults. All participants completed a questionnaire after each examination, recording the total number of gloves used and the number of hand injuries and glove perforations sustained. Just over 8.3% of gloves were punctured; 31.8% of these punctures went unnoticed. Evisceration was the procedure most likely to result in hand contamination. The study highlights a significant risk which could be reduced by more care, frequent glove changes, and hand washing during post mortem examinations. In particular, gloves should be changed and hand washed when evisceration has been completed.

Association of contaminated gloves with transmission of Acinetobacter calcoaceticus var. anitratus in an intensive care unit

purpose: Acinetobacter calcoaceticus var. anitratus is an important nosocomial pathogen that has been associated with environmental reservoirs. An increased isolation rate of A. anitratus in our intensive care units (ICUs), from 0.03% (two of 7,800) to 0.5% (seven of 1,300) (p <0.00003), prompted an investigation. patients, methods, and results: Ten patients were admitted to the surgical ICU and nine to the medical ICU during the outbreak period (late December 1987 to January 1988). Controls were all patients on the units who were not infected or colonized with the transmitted strain of A. anitratus. Three patients had A. anitratus pneumonia. A throat culture prevalence survey demonstrated three patients colonized with A. anitratus. Cases were placed in a cohort and symptomatic cases treated. An epidemiologic investigation was conducted to identify reservoirs and modes of transmission. Latex gloves were being used for universal precautions without routine changing of gloves between patients. Environmental sources culture-positive for A. anitratus included a small volume medication nebulizer and gloves in use for patient care. Plasmid typing showed that plasmid profiles of isolates from two symptomatic patients, two colonized patients, the nebulizer, and the gloves were identical. Other A. anitratus ICU isolates had distinct plasmid profiles. All patients with the transmitted strain had been in the surgical ICU. The need for changing gloves between patients and contaminated body sites was reinforced. conclusion: Gloves, used incorrectly for universal precautions, may potentially transmit A. anitratus.

Effects of dental medicaments on examination glove permeability

Dental care providers wear gloves for all clinical procedures. This study was designed to assess the intactness of examination gloves after exposure to commonly used agents. Finger portions from latex and vinyl examination gloves were sealed to syringe barrels and exposed to alcohol, eugenol, a surface disinfectant, cavity varnish, or commercial mouth wash. Tritiated water was introduced into the finger-tip portion, which was suspended in a vacuum flask containing distilled water. Aliquots of water were withdrawn from the flask at intervals of 5 minutes to 8 hours and analyzed for transfer of radioactivity through the glove tip. Treatment with agents such as eugenol and cavity varnish resulted in significant leakage after 5 to 15 minutes. Although some agents apparently quickly damaged the gloves, leaks developed in untreated gloves with time. Results suggest that visibly intact gloves may have developed microleaks and that changing gloves during long clinical procedures may be indicated.

Routine Preoperative Screening for HIV

<h3>To the Editor.—</h3> I wish to take issue with the SPECIAL COMMUNICATION entitled "Routine Preoperative Screening for HIV: Does the Risk to the Surgeon Outweigh the Risk to the Patient?"¹The authors, three nonsurgeons, make a number of assumptions, such as a "first-order approximation" of the rate of skin penetration from intraoperative injuries to the surgeon's hands of 2%. The reverse calculation of skin-puncture rate from seroconversion to hepatitis B virus among surgeons is farfetched and not particularly pertinent. More pertinent would be an attempt to estimate the highest possible risk. Such data are critical to those of us who are exposed. The skin-puncture rate could be assumed to be equal to the glove-puncture rate, since multiple punctures may occur during the same procedure and frequent glove changes are common. If the glove-puncture rate is 25% and the risk of human immunodeficiency virus (HIV) infection after skin puncture is

Limitations in Protection Afforded by Gloves in Laboratory Handling of Aflatoxins

The permeability of latex and vinyl laboratory gloves by aflatoxins in chloroform or dimethyl sulfoxide (DMSO) has been investigated. Latex gloves provide good protection against permeation by aflatoxins in DMSO, but aflatoxins in chloroform permeate all types of laboratory gloves. If gloves are contaminated when aflatoxins in chloroform are handled, an immediate change of gloves is recommended.

Radiation in the Operating Room

<i>To the Editor</i>.–I was pleased to see a discussion about the radiation hazard to operating-room personnel during performance of operative cholangiography by Linos et al (Archives1980;115:1431-1433). However, I disagree with their recommendation that personnel leave the operating room during roentgenographic filming or fluoroscopy. I do not believe that the scrub nurse or the surgical assistant should leave the operating room, enter an unsterile environment, then return to the operating room to continue the operation. Changing gown and gloves consumes time. Putting on lead aprons would also require gown and glove change. The article indicates that stepping back at least 75 cm from the source of radiation should offer sufficient protection under ordinary circumstances. This can be done in most operating rooms, without having to leave the room. Shouldn't surgical assistants and personnel be rotated through procedures in which x-rays or fluoroscopy are used, to give them added protection?

Effect of Local Irrigation with Proflavine Hemisulfate on Wounds Seeded with Tumor Cells An Experimental Study

ALTHOUGH the problem of the surgically seeded wound and its relation to tumor recurrence had been recognized as early as 1885 by Gerster,9 and again in 1907 by Ryall,25 means to prevent seeding have consisted primarily of gown, glove, drape and instrument change. Occasionally, various wound washes have been used but without prior experimental basis or follow-up clinical reports. Within the past decade articles by Goligher,11 Cole5 and Smith,20 have re-emphasized this problem and have stimulated other experimental6, 10, 12, 13, 18, 27, 30 and clinical studies14, 28, 30 in search of tumoricidal agents which could be applied locally within the operative area This report describes the local effectiveness of proflavine hemisulfate (3–6-Diamino-acridinc hemisulfate) in preventing tumor takes in wounds artificially seeded with cells from two animal tumors. It also demonstrates several factors that can influence the tumoricidal effectiveness of this drug

Effect of local irrigation with proflavine hemisulfate on wounds seeded with tumor cells. An experimental study.

ALTHOUGH the problem of the surgically seeded wound and its relation to tumor recurrence had been recognized as early as 1885 by Gerster,9 and again in 1907 by Ryall,25 means to prevent seeding have consisted primarily of gown, glove, drape and instrument change. Occasionally, various wound washes have been used but without prior experimental basis or follow-up clinical reports. Within the past decade articles by Goligher,11 Cole5 and Smith,20 have re-emphasized this problem and have stimulated other experimental6, 10, 12, 13, 18, 27, 30 and clinical studies14, 28, 30 in search of tumoricidal agents which could be applied locally within the operative area This report describes the local effectiveness of proflavine hemisulfate (3–6-Diamino-acridinc hemisulfate) in preventing tumor takes in wounds artificially seeded with cells from two animal tumors. It also demonstrates several factors that can influence the tumoricidal effectiveness of this drug

WOUND IRRIGATION IN CANCER SURGERY

The incidence of local recurrence of cancer following radical mastectomy for breast carcinoma and radical surgery for head and neck malignancy is higher than is generally realized. In most instances the cause of the recurrence appears to be implantation, or more descriptively, wound seeding. This is the most insidious type of cancer dissemination with which the surgeon is confronted. Mechanical flushing of the wound with physiologic saline or distilled water is not sufficient to prevent the occurrence of implantation. The possibility of wound implantation can be decreased somewhat by careful surgical technique including the frequent changing of gloves and instruments. However, these methods alone do not appear to be sufficient to protect the patient from being seeded with his own tumor. In the experimental laboratory we determined that a 2% solution of a form of monoxychlorosene (Clorpactin XCB) and a 2 mg. % mechlorethamine (nitrogen mustard) solution, properly diluted so that

Wound Irrigation in Cancer Surgery

The incidence of local recurrence of cancer following radical mastectomy for breast carcinoma and radical surgery for head and neck malignancy is higher than is generally realized. In most instances the cause of the recurrence appears to be implantation, or more descriptively, wound seeding. This is the most insidious type of cancer dissemination with which the surgeon is confronted. Mechanical flushing of the wound with physiologic saline or distilled water is not sufficient to prevent the occurrence of implantation. The possibility of wound implantation can be decreased somewhat by careful surgical technique including the frequent changing of gloves and instruments. However, these methods alone do not appear to be sufficient to protect the patient from being seeded with his own tumor. In the experimental laboratory we determined that a 2% solution of a form of monoxychlorosene (Clorpactin XCB) and a 2 mg. % mechlorethamine (nitrogen mustard) solution, properly diluted so that