Glove Perforation Rate Research Articles

EFFECTIVENESS OF DOUBLE-GLOVING METHOD ON PREVENTION OF SURGICAL GLOVE PERFORATIONS AND BLOOD CONTAMINATION: A PROSPECTIVE STUDY

Objectives: To evaluate efficacy of double gloving to provide mechanical barrier against communicable diseases and also to evaluate different parameters affecting glove perforation rate. Methods: This prospective study was performed in department of General Surgery at tertiary care teaching hospital of Gujarat. This study involved a group of surgeons and operation theatre nursing staff. Randomization of the participants was done with the closed envelope method in two groups: single gloving and double gloving. Glove perforation rate and hand contamination rate was calculated and compared between both the groups. Participants of double gloving groups were also asked for discomfort using double gloves and compromised tactile sensations. Results: There was no statistically significant difference in the glove perforation rate between single gloves and double outer gloves. (p=0.55) But, the glove perforation rate was significantly low in double inner gloves than single gloves. (p=0.004) The hand contamination rate was significantly lower amongst perforated double gloves than perforated single gloves. (p=0.00001) Awareness of glove perforation was absent in majority of the participants in both the groups. All the participants in the double gloving group were comfortable with using double gloves and their tactile sensations were not compromised. Conclusion: This study concluded that double gloving efficiently prevented hand contaminations during a surgery. There was no significant difference noted in glove perforation rates in both single and double gloving groups. Double gloving is recommended for the surgeons and nursing staff to protect them from blood borne infections and eliminate the chances of surgical site infections in the patients.

Comparison between screw retained arch bars and conventional Erich’s arch bar in maxillofacial fractures

: Establishing a stable occlusion and Maxillomandibular fixation (MMF) is a cornerstone for rigid fixation. Conventional Erich’s arch bar poses a risk of wire stick injury, and extrusion of teeth, and is unsuitable for patients with periodontally compromised teeth or edentulous dentition. There is a dearth of literature comparing modified Screw retained arch bars to the Conventional Erich’s arch bar. Hence, a study was conducted to evaluate the same.: The study compared 30 patients requiring MMF. Group A patients received modified SRAB and group B patients received CEAB. The primary predictor variable was the use of conventional Erich arch bars versus modified screw-retained arch bars. The parameters considered were time taken to place the arch bar, perforation in the gloves, patient compliance, stability, oral hygiene, mouth opening, and post-op occlusion.: The mean time taken for placement of the modified SRAB was lower (27.87 mins) as compared to the CEAB (90.20 mins). The rate of glove perforation was higher in the CEAB group. All patients were compliant in the modified SRAB group as compared to the control group (30%). There was no significant difference in the mouth opening between the two groups.: Based on the study results, we can conclude that modified SRAB is a superior alternative compared to CEAB in maxillomandibular fractures. The usage of modified SRAB does not affect the functional outcome of fracture management.

What Role Does a Colored Under Glove Have in Detecting Glove Perforation in Foot and Ankle Procedures?

Many orthopaedic surgical teams practice double gloving or use colored indicator gloving techniques to reduce contamination intraoperatively. Although the likelihood of glove perforation can be affected by the procedure type and surgeon habits, as well as the surgeon's technique, these factors have not been considered to determine the glove perforation rate, and the role of a colored under glove during operations seems less investigated. (1) What proportion of foot and ankle procedures result in perforation of outer gloves or under gloves? (2) What factors (such as the type or duration of operation) appear to be associated with the likelihood of glove perforation? (3) Does the use of a colored indicator under glove make it more likely that a surgeon would perceive the perforation of an outer glove intraoperatively? Between September 2020 and August 2021, the author performed 577 surgical foot or ankle procedures. Of those, patients who underwent subsequent operations under general or spinal anesthesia were considered as potentially eligible. Further, 16% (93) were excluded because the procedures were performed with the patient under local anesthesia, and another 1% (eight patients) were not analyzed (incomplete datasets for emergency operations performed at night). Finally, 82% (476 patients) were examined. To ensure statistical independence, gloves used in right-side operations in bilateral procedures and the most proximal surgery in unilateral procedures were included. Preoperatively, the surgeon was randomly assigned to use either a combination of two regular surgical gloves or a regular outer glove worn over a colored indicator under glove. Patient diagnosis, type of procedure, tourniquet time, and gloving type were recorded. There was no difference in potentially relevant confounding variables, such as the proportion of procedures performed on bone (78% [188 of 242] versus 83% [195 of 234]; p = 0.13), nor in tourniquet time (58 ± 30 minutes versus 62 ± 31 minutes; p = 0.45) between the regular glove and indicator glove groups. At the end of each procedure, the surgeon was asked whether he believed either the outer or under glove was perforated, and whether the use of a colored under glove increased the proportion of procedures in which the surgeon correctly ascertained that a perforation had occurred. To determine the proportion of gloves that were perforated, a standardized water-leak method was used, and the proportion of gloves with perforations based on several parameters of interest, including bone versus soft tissue operation and tourniquet time, was compared. During 476 foot and ankle procedures, the overall glove perforation proportion was 19% (92 of 476 procedures). Under-glove perforation was observed in 4% (17 of 476 procedures) of the operations. There was no difference in glove perforation proportions between bone and soft tissue operations (76 of 383 versus 16 of 93; odds ratio [OR] = 0.84, 95% confidence interval [CI] 0.46 to 1.52; p = 0.56). As tourniquet time (operation time) increased, the glove perforation proportion also increased (Exp[B] = 1.02; 95% CI 1.01 to 1.03; p < 0.001). The use of indicator under gloves increased the surgeon's intraoperative detection of glove perforation (in 68% of procedures [32 of 47] versus 29% [13 of 45]; OR = 5.3; 95% CI 2.2 to 12.8; p < 0.001). Surgical glove perforation occurred in approximately one of five foot and ankle procedures. Based on the results of this study, I recommend using colored indicator under gloves and replacing the under glove when replacing the outer glove after perforation is seen in order to detect contamination early and reduce any intraoperative contamination related to glove injury. Level I, therapeutic study.

A randomized controlled trial on cross infection control in maxillofacial trauma surgery a comparison of intermaxillary fixation techniques

Aim: The purpose of the present research was to evaluate the intermaxillary fixation techniques in maxillofacial trauma surgery in terms of cross infection control. Methodology: A randomized controlled trial which included 120 patients with fractures of the mandible requiring open reduction and fixation. The participants were allocated either to the study group and treated with intraoperative Rapid IMF or to the control group and managed with intraoperative eyelet wire ties. Results: Rapid IMF group had significantly fewer glove perforations than the traditional method (0.67 per operation compared with 1.5), (P &lt; 0.0001). The incidence of skin-penetrating injuries was the same in both groups (rate 0.02/ procedure). The application of Rapid IMF was significantly faster than wiring (P &lt; 0.0001). Minor intraoperative complications were noted in both groups, but more in the Rapid IMF group. Most concerned loosening or fracture of the anchorage ties but the surgical outcome was not affected. Conclusion: Rapid IMF is a safer alternative to wiring methods with significant reduction in glove perforation rates and is quicker to apply than conventional wiring techniques.

Comparison of Unnoticed Glove Perforations during Minimally Invasive versus Open Surgeries: A Systematic Review and Meta-Analysis.

Objective: Various studies have depicted the incidence of glove perforations during open (OS) and minimally invasive surgeries (MIS). The aim of this meta-analysis was to compare the incidence of macroscopic and microscopic glove perforations during MIS and OS. Methods: The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Scientific databases (PubMed, Web of Science, Scopus, and EMBASE) were systematically searched for comparative studies depicting the glove perforation rates during MIS and OS. Risk ratios (RR) were calculated for both the outcomes (dichotomous) and the Mantel–Haenszel method was utilized for the estimation of pooled RR. The methodological quality assessment was performed by two independent investigators using the Downs and Black scale. The main outcomes of the study were the proportion of gloves with gross (macroscopic) perforations and the proportion of gloves with microscopic perforations. Results: Four comparative studies including a total of 1428 gloves (435 from the MIS group) were included. Pooling the data demonstrated no difference in the incidence of macroscopic glove perforations among the MIS and OS groups (RR 0.57, 95% CI 0.21 to 1.54, p = 0.27). On the other hand, the incidence of microscopic perforations was significantly higher in the OS group versus the MIS group (RR 0.72, 95% CI 0.55 to 0.95, p = 0.02). However, all the studies had a moderate risk of bias. Conclusions: When compared to OS, the macroscopic glove perforation rate during MIS showed no significant difference. The incidence of microscopic glove perforations was significantly higher during OS as compared to MIS. However, due to the moderate risk of bias of the available comparative studies, the level of evidence of these studies is limited.

Does Size Affect the Rate of Perforation? A Cross-sectional Study of Medical Gloves.

Healthcare workers often have unnoticed minor abrasions on their hands, putting them at risk of contracting infectious diseases from patients, if the integrity of the medical gloves is compromised. This study aimed to compare the rate and location of glove perforation between well-fitted and ill-fitted gloves. The participants of this cross-sectional study were 45 midwives in the maternity ward of a hospital in Shiraz city, Iran. A total of nine pairs of medical gloves including three pairs of fit size, three pairs of gloves with one size smaller (tight), and three pairs of gloves with one size larger (loose) were given to subjects, and asked them to use the gloves during episiotomy repair operations. After completing the task, all gloves were collected safely and gloves perforation was investigated based on water test (NF EN 455-1). The perforation rate of the fit, tight, and loose medical gloves was 20, 37.78, and 34.81%, respectively. The results showed a significant difference between glove perforation of different glove sizes (P < 0.05). In general, there was a significant difference between the perforation rate of the fit glove and ill-fitted gloves (P = 0.013). Wearing the wrong size gloves may increase the glove perforation rate. Providing a wide range of glove sizes by the hospital management, and choosing the best glove size can be very effective in reducing the glove perforation and increasing safety for healthcare workers and patients.

Effectiveness of double-gloving method on prevention of surgical glove perforations and blood contamination: A systematic review and meta-analysis.

To determine the effectiveness of the double-gloving method on preventing surgical glove perforation and blood contamination compared with single gloving. Systematic review. Seven electronic databases were searched including: Embase, CINAHL, OVID, Medline, Pubmed, Web of Science, and Foreign Medical Literature Retrieval Service in March 2020. Our systematic review and meta-analysis was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guideline. Risk of bias of Cochrane Handbook (Version 5.1.0) was applied to evaluate the study quality. Revman 5.3 was used to calculate the effect size of odds ratio (OR) with 95% confidence interval (CI). Meta-analysis with forest plot and funnel plot was performed to compare the rate of surgical glove perforation and to determine the published bias, respectively. This review has been registered with ID: CRD42020189694 on the web site of PROSPERO. Seven randomized controlled trials regarding the efficacy of double gloving on reducing surgical glove perforation were identified and a total of 7090 gloves were tested. After analyzing the pooled data, we identified that the rate of surgical glove perforation in the double-gloving group was lower than that of single gloving with statistical significance (OR=0.75, 95% CI: 0.64-0.89, p<.05). It was statistically significant that surgical glove perforation was lower in the double-inner gloves as well as matched outer-inner perforated gloves compared with that of single glove (OR=0.05, 95% CI: 0.03-0.07, p<.05). Findings of this systematic review demonstrate that double gloving could reduce the rate of surgical-glove perforation. Meanwhile, the risk of being contaminated by a blood-borne pathogen during surgery could be reduced by wearing double gloves. We strongly suggest that surgical team members when operating should wear double gloves to protect themselves and reduce the risk of occupational blood exposure. The necessity of double gloving for preventing blood contamination was demonstrated. The rate of surgical glove perforation is statistically significant in double-gloving group compared to single gloving. Double gloving could reduce the risk of being contaminated during surgery by blood-borne pathogen. Evidence is provided for surgical team and decision makers that double gloving could reduce occupational exposure.

Epidemology of glove perforation in orthopaedic surgeries

Introduction: Surgical glove perforation is one of cause for percutaneous transfer of disease. Among many HIV HBV & HCV are deadliest diseases. Among the other surgical specialities, orthopaedics has the highest rate of glove perforation. Hence this study was conducted to study the incidence of glove perforation & their pattern in our institute. Materials and Methods: all the gloves (1444) collected from 286 operations which occurred during 3months period were tested, out of which 172 were major procedures and 114 were minor procedures. During the procedure, if any perforation was detected to naked eye examination then they were labelled as perforated. And rest the gloves were tested as per American society for testing and material standard (ASTM d5151 - 06) guidelines for any perforations. Results: In our prospective study, perforation occurred in 74(26%) surgeries. Total of 173(12%) gloves were perforated, 51(17.83%) from major & 23(8.04%) from minor procedures, the primary surgeon was most commonly involved (68%). Only 53(30.6%) glove perforation was detected during the procedure. Among the double glove users, inner glove perforation was seen in only 5% of cases. The most common fingers involved was left index (38%), then right index finger (28%) followed by left thumb (20%) and right thumb was (14%).the primary surgeon was most commonly involved (68%). The mean duration of the surgery in which perforation was noticed was 76+6minutes. Conclusion: Double glove practice is better than the use of the single glove. Gloves have to be changed regularly in prolonged procedures. Keywords: Glove perforation, Orthopaedic surgeries, Double glove.

Association Between the Frequency of Glove Change and the Risk of Blood and Body Fluid Exposure in Gastrointestinal Surgery.

Surgical gloves are used to prevent the transmission of microorganisms from the surgeon's hands to the patient and vice versa. Little is known on the optimal frequency of glove changing. Therefore, we aimed to examine the optimal frequency of glove change during surgery by assessing the glove perforation rate in gastrointestinal surgery. In this observational prospective cohort study, we investigated the incidence of perforation of 5,267 gloves during gastrointestinal surgeries. The overall glove perforation rate was 10.1%. There was no significant difference between single gloving (10.2%) and double gloving (10.0%; p = 0.8491). However, the perforation rate of the inner glove (5.7%) was found to be significantly lower than that of the outer glove (11.6%) (p < 0.0001). A significant difference in perforation rate was observed after wearing inner gloves for 240min (< 240min, 4.4%; ≤ 240min, 7.2%; p = 0.0314), and outer gloves for 60min (< 60min, 7.1%; ≤ 60min, 12.6%; p < 0.0001). We found cumulative perforation rate to rapidly increase until the wear time was 90min. The inner gloves and outer gloves have a higher perforation rate as the wear time increased. To reduce the risk of intraoperative blood and fluid exposure and prevent healthcare-associated infection, gloves should be changed for approximately every 60-90min for outer gloves and approximately every 240min for inner gloves.

Glove perforation in orthopaedic surgery: Pattern and predictors

Background: Intact surgical gloves prevent transmission of pathogens between the surgeon and the patient. However, gloves may be breached during surgical operations with risk of cross-transmission of pathogens between the surgeon and the patient. This study aimed to determine the incidence, nature and predictors of glove perforations in orthopaedic surgery. Methods: Gloves worn by the surgeon, their assistants and the scrub nurse were tested. Number, position and nature of perforations were recorded and analysed. Binary logistic regression was used to assess the impact of six possible predictors on the likelihood of glove perforation. Results: The operative glove perforation rate was 72.2%. Perforations occurred more on the nondominant hand (62.4%) and on outer gloves (85.8%). They were more common among surgeons and their assistants than scrub nurses and in trauma and implant operations than other surgeries. Only 27.1% of glove perforations were detected intraoperatively. The status of operative personnel and duration of surgery were predictive of glove perforation. Conclusions: Glove perforation is common in orthopaedic operations and was predicted by status of the surgeon and the duration of surgery. Double gloving provides a better barrier to contamination of surgeon's skin by patients' body fluids than single gloving; however, sometimes, the barrier can still fail. We recommend that double-gloving be routinely used in orthopaedic surgery, especially where complex instrumentations are employed.

Rate of Glove Perforation in Open Abdominal Surgery and the Associated Risk Factors.

Background: Glove perforation is common during surgery. Surgical gloves are used as personal protective equipment to reduce infection risks from bloodborne pathogens for both the surgical team and patients. This research was conducted to determine the perforation rates of gloves worn in open abdominal surgery performed in a general surgery department and the risk factors affecting perforation. Methods: This research was designed as an observational prospective cohort study including 70 open abdominal operations. There were four members of the surgical team (surgeon, first assistant, second assistant, and scrub nurse). A total of 280 (70 × 4) pairs of gloves in 70 consecutive open abdominal procedures were included in this study. A total of 140 unused gloves were tested as control group to assess perforations and pre-existing leaks. After the operation, all gloves were checked for water impermeability using the EN455-1 method and the presence or absence of a puncture hole was recorded. Results: Glove perforation was detected in 54.3% of operations. The rate of perforation in all gloves was 10.7%, of which 78% unnoticed by the surgical team during surgical procedure. It was determined that the puncture in the gloves was mostly on the non-dominant hand (left). For the left-hand glove, the highest number of holes was observed on the index finger (21.1%) and palm/dorsum of the hand (21.1%). The risk of glove perforation was 5.8 times greater for surgeons compared with the other team members, and operation time of 61 minutes or longer increased the risk of perforation by 12.77 times. Conclusions: Glove perforation rates are high in open abdominal surgery. The highest number of perforations occurred in the non-dominant hand (left) has a high rate of perforation in surgeons and long operations. It may be beneficial for surgical team members to change gloves at certain intervals during surgery or use indicator glove systems.

Glove change to reduce the risk of surgical site infection or prosthetic joint infection in arthroplasty surgeries: a systematic review.

Microbiological contamination of surgical gloves occurs during surgery, which may warrant glove change during orthopaedic surgeries. However, no systematic review of this topic has previously been published. Therefore, this review evaluated whether changing gloves during arthroplasty surgeries reduces the risk of surgical site infection/prosthetic joint infection (SSI/PJI) and the optimal frequency of glove change. Search terms such as surgical gloves, surgical site infections, prosthesis-related infections, arthroplasty were used, including Medical Subject Headings terms. Of the 89 articles screened, 12 articles were included for qualitative synthesis. No studies measured the direct effect of glove change on PJI rate. Therefore, microbiological contamination and perforation rate of gloves were used as surrogate outcomes. Eight studies evaluated microbiological contamination of surgical gloves, with rates ranging from 3.4 to 30%. Five contamination studies recommended changing gloves after draping and before handling implants. One randomized controlled trial also recommended changing gloves at least once an hour regardless of surgical stages. Five studies recommended changing gloves to prevent perforation, with recommendations ranging from 20 to 90 min. Furthermore, one study advised change of gloves after resection of bone and before implantation. As microbiological contamination rates of gloves increase with duration of surgery, glove changes are recommended at least once per hour. Furthermore, gloves should be changed after draping, before handling implants and if visible perforation is seen to reduce contamination. Due to the lack of studies with SSI/PJI as primary outcomes, we cannot draw a definitive conclusion regarding the effectiveness of changing gloves in reducing the risk of SSI/PJI in arthroplasty.

A cross-sectional study of surgical glove perforation during the posterior lumbar interbody spinal fusion surgery: Its frequency, location, and risk factors.

Lumbar fusion surgery was known to pose a greater risk of surgical glove perforation. However, there has been no study on the glove perforation that can transmit the blood-borne disease to the patient and surgical staff members in the posterior lumbar interbody fusion surgery (PLIFs).We performed a cross-sectional study to investigate the glove perforation during the PLIFs. The study included 37 consecutive patients (10 males and 27 females). All used gloves of surgical staff members, which included the surgeon, assistant surgeons, bone trimmer (who performed local bone trimming and interbody cage preparation), and scrub nurse were collected and were performed to the pinhole water infusion test. The characteristics (i.e., frequency and location of perforated glove) and relative risk of glove perforation were investigated for each participant. The independent risk factors influencing glove perforation were analyzed by multiple logistic regression analysis.The overall operative perforation rate which is a percentage of detected more than one glove perforated event in all cases was 51.4%. The overall glove perforation rate which is the percentage of perforated gloves in all gloves used for surgery was 3.8%. The relative risk of glove perforation by each participant was 2.38 in the surgeon (P = .002), 1.36 in the bone trimmer (P = .04), 1.36 in the scrub nurse (P = .04), and 1.19 in assistant surgeons (P = .13). And, the volume of trimmed local bone was analyzed as an independent risk factor for glove perforation (ORs = 1.310, P = .02).The overall operative perforation rate in PLIFs is higher than 50%. The surgeon, scrub nurse and bone trimmer were observed as a significant risk factor for glove perforation. And, the volume of trimmed local bone was analyzed as independent risk factor. Since the preparation of the interbody cage is essential for successful lumbar fusion surgery, the bone trimmer must pay attention to the glove perforation during this procedure.

Glove Perforation Rate Survey of Perioperative Nurse

본 연구는 수술실 간호사의 한 겹 혹은 이중 장갑 착용이 수술 부위 감염을 최소화하기 위한 보호도구로써 효과가 있는지 파악하기 위해 시도된 조사연구로서 일개 3차 대학병원 수술실 간호사 중 연구에 참여를 동의한 79명 간호사의 총 243건의 장갑을 대상으로 하였다. 수집된 자료를 SPSS/Win Ver. 21.0을 이용한 통계분석결과는 한 겹 장갑은 28.7%, 이중 장갑은 35.5%의 천공률을 보였으나, 한 겹 장갑과 이중 장갑의 착용별 천공발생률의 통계적 유의한 차이는 없었다(=1.307, p=.274). 부위별 장갑 천공률은 한 겹, 이중 장갑 모두 왼손 검지에서 각각 31.4%, 25.6%로 가장 많은 천공이 일어났다. 장갑 착용 유형에 따른 대상자의 일반적 특성, 수술 관련 특성, 수술 장갑 관련 특성별 장갑 천공률 비교에서 한 겹 장갑군에서 장갑 착용 시간에서만 통계적으로 유의한 차이가 있었다(chi^2=.10.645, p=0.14). 장갑 천공률에 영향을 미치는 요인을 파악하기 위한 코크란-멘텔-헨젤 검정(Cochran-Mantel-Haenszel test)에서는 진료과에 따라서 한 겹 장갑 착용 시간에 따른 장갑 천공률은 서로 연관성이 존재하였다(chi^2=5.197, p<.05). 오즈비 2.578로 진료과에 상관없이 한 겹 장갑의 착용 시간이 3시간 미만에 비하여 3시간 이상일 때 장갑 천공이 나타나지 않는 경우에 비하여 천공이 나타날 확률이 2.578배 높다는 것을 알 수 있었다.The purpose of this study was to compare the perforation frequency of single and double-layered gloves in perioperative nurses and to investigate whether double-layered gloves are effective as a protective tool to minimize surgical site infection. A total of 243 gloves of 79 nurses who agreed to participate in this study were included in the study room nurses of a tertiary university hospital. Data were analyzed using descriptive statistics, chi-square test and Cochran-Mantel-Haenszel test. As a result, the perforation rates of single gloves and double gloves were 28.7% and 35.5%, respectively, but there was no statistically significant difference between the two groups (chi^2=1.307, p=.274). There was a statistically significant difference in glove perforation rates according to the type of wearing gloves (=.10.645, p=0.14). In the Cochran-Mantel-Haenszel test to determine the factors affecting the perforation rate of single gloves, there was a correlation between the glove perforation rates according to the time of wearing the gloves (chi^2=5.197, p<.05). The odds ratio was 2.578, which means that the probability of puncture was 2.578 times higher than that of glove perforation when the wearing time of a glove was 3 hours or more than 3 hours, regardless of the department.

Study the Incidence of Surgical Glove Perforation during Surgery and Evaluation for the Risk of Perforation and Risk of Surgical Site Infection

In a surgical setting there is always a possibility of cross infection between patient and surgeon and surgical gloves act as an important barrier to prevent this infection. Use of double gloves provides more effective barrier for transfer of pathogens from surgical team to patient and vice versa. This study compares the benefit of using double gloves versus single gloves in various departments and its role in preventing Surgical Site Infection (SSI). This study was conducted at Army Hospital (R&R) where surgical gloves used by the operating surgeon were checked for any perforation in outer and inner gloves. In case of perforation was detected, culture of both gloves and surgical part were taken and examined for any cross infection. This study reveals that simultaneous perforation rate of both outer and inner gloves was very less and hence chances of cross infection between patient and surgeon was less when compared to single glove use. Also, the rate of perforation was less in laparoscopic surgery compared to open surgery however this is controversial as various studies which shows more perforation in laparoscopic surgery. The departments where surgeries were complex and were of longer duration had more perforation rate of gloves and consequently SSI. This study concludes that the use of double surgical gloves has got low chances of cross infection between patient and surgeon and hence low rate of Surgical Site Infection and hence should be encouraged.

Comparison of Efficacy of Transalveolar Screws and Conventional Dental Wiring Using Erich Arch Bar for Maxillomandibular Fixation in Mandibular Fractures.

Maxillomandibular fixation is required in nearly all cases of facial fractures which can be achieved by conventional dental wiring techniques or newer methods using transalveolar screws. A prospective randomized clinical study divided into two groups with thirty adult patients each with mandibular fractures was undertaken comparing the Maxillomandibular fixation technique using transalveolar screws and Erichs arch bar. Total time taken, rate of glove perforation, intraoperative and postoperative complications were noted in both the groups. The time taken for maxillomandibular fixation in minutes and rate of glove perforation was found to be statistically significantly less for transalveolar group compared to arch bar group (p<0.05). However, there was no significant difference found in the oral hygiene and gingival status using the Glass index and Gingival index. The rate of screw breakage (04.67%), wire breakage (05.12%), non-vitality due to iatrogenic dental damage (01.66%), soft tissue injury and tooth loss were some of the noted complications during the study. We found that transalveolar group offered advantages like less time taken with a definite decreased risk of percutaneous injury, while the iatrogenic complications like dental damage can be reduced by taking adequate precautions.

Evaluation of surgical glove integrity and factors associated with glove defect

Surgical glove perforation may expose both patients and staff members to severe complications. This study aimed to determine surgical glove perforation rate and the factors associated with glove defect. This descriptive cross-sectional study was conducted between January and March 2017 at a Tunisian university hospital center in 3 different surgical departments: urology, maxillofacial, and general and digestive. The gloves were collected and tested to detect perforations using the water-leak test as described in European Norm NF EN 455-1. For percentage comparisons, the χ2 test was used with a significance threshold of 5%. A total of 284 gloves were collected. Of these, 47 were found to be perforated, a rate of 16.5%. All perforations were unnoticed by the surgical team members. The majority of perforated gloves (61.7%) were collected after urology procedures (P = .00005), 77% of perforated gloves were detected when the duration of the procedure exceeded 90 minutes (P = .001), and 96% were from brand A, which were the thicker gloves (P = .015). This study highlighted an important problem neglected by surgical teams. The findings reaffirm the importance of double-gloving and changing gloves in surgeries of more than 90 minutes' duration.

Incidence of Glove Perforation During Hand Surgical Procedures

To determine the rate of glove perforation during hand surgery. We prospectively examined the rate of glove perforations among 10 fellowship-trained hand surgeons at our institution during a 6 week period. Gloves were tested for perforation using a water-fill technique at the conclusion of each surgical procedure. Surgeons recorded the presence of any glove perforations. Eleven perforations were identified in 10 gloves among 600 surgical procedures during the study period. The perforation rate per case was 1.5% (95% confidence interval, 0.78% to 2.8%). Forty percent of perforations (n= 4) occurred during fracture surgery. Other holes occurred during isolated carpal tunnel release (n= 3) or combined carpal tunnel and trigger finger release (n= 3). The perforation was noticed intraoperatively in only 2 gloves. The difference in perforation rate between single- and double-gloved procedures was not significant. There were no perforations in the inner glove of surgeons who double gloved. A total of 73% of holes (8 of 11) occurred on surgeons' index finger; 75% of these were on the dominant hand. The dominant thumb, non-dominant ring and nondominant little fingers each had a single perforation. The rate of glove perforation during hand surgery is low. Holes can occur even during soft tissue procedures of short duration. The dominant index finger appears to be at greatest risk for perforation. When they do occur, most often holes are not noticed by the operating surgeon. The baseline glove perforation rate is unknown. A high level of vigilance is required to maintain sterile technique.

Incidence and patterns of surgical glove perforations: experience from Addis Ababa, Ethiopia

BackgroundSurgical glove perforation is a common event. The operating staff is not aware of the perforation until the procedure is complete, sometimes in as high as 70% of the incidences. Data from Ethiopia indicates that the surgical workforce suffers from a very surgery related accidents, however there is paucity of data regarding surgical glove perforation.The main objective is to describe the incidence and patterns of surgical glove perforation during surgical procedures and to compare the rates between emergency and elective surgeries at one of the main hospitals in Addis Ababa Ethiopia.MethodsThis is a prospective study, performed at the Minilik II referral hospital, Addis Ababa. All surgical gloves worn during all major surgical procedures (Emergency and Elective) from June 1-July 20, 2016 were collected and used for the study. Standardised visual and hydro insufflation techniques were used to test the gloves for perforations. Parameters recorded included type of procedure performed, number of perforations, localisation of perforation and the roles of the surgical team.ResultsA total of 2634 gloves were tested, 1588 from elective and 1026 from emergency procedures. The total rate of perforation in emergency procedures was 41.4%, while perforation in elective surgeries was 30.0%. A statistically significant difference (P < 0.05) was found in between emergency and elective surgeries.There were a very high rate of perforations of gloves among first surgeons 40.6% and scrub nurses 38.8% during elective procedures and among first surgeons (60.14%), and second assistants (53.0%) during emergency surgeries.Only 0.4% of inner gloves were perforated. The left hand, the left index finger and thumb were the most commonly perforated parts of the glove. Glove perforation rate was low among consultant surgeons than residents.ConclusionsOur reported perforation rate is higher than most publications, and this shows that the surgical workforce in Ethiopia is under a clear and present threat. Measures such as double gloving seems to have effectively prevented cutaneous blood exposure and thus should become a routine for all surgical procedures. Manufacturing related defects and faults in glove quality may also be contributing factors.

A Cross-sectional Analysis of Glove Perforation in Primary and Revision Total Hip Arthroplasty.

The number of total hip arthroplasties is ever increasing. Literature about glove perforation rates in arthroplasties in India is very scarce. The purpose of our study was to determine the incidence of glove perforation and increasing the awareness of possible glove perforations to decrease the risk of infection. We performed a prospective study in which we tested gloves worn by all scrubbed personnel. A total of 1408 gloves were collected from 42 primary total hip and 13 revision total hip arthroplasties. Incidence of glove perforation was found to be more in revision total hip arthroplasty. We found a greater outer glove perforation rate of about 38.33% as compared to 25 % inner glove perforation rate. Outer glove perforation was recognized 100% of time intraoperatively but inner glove perforation was noted only 17% of time. First assistant recorded highest rate of glove perforation.