Glove Tears Research Articles

Evaluating the effectiveness of Hybrid arch bar with Erich arch bar during maxillomandibular fixation

Aim: To evaluate the effectiveness of Hybrid arch bar and Erich arch bar during Maxillomandibular Fixation. Materials And Methods: We designed a parallel-group, randomized controlled trial to compare the 2 types of arch bars. A total of 20 patients with mandibular parasymphysis fractures within the age group of 25 - 30 years presenting to our institution were enrolled in the study and randomized into 1 of 2 groups: the hybrid arch bar group and the Erich arch bar group. The primary outcome variable was arch bar placement time. The secondary outcomes were glove tears during application and removal , patient comfort and the removal time of the device. The groups were compared using t tests. Results: A total of 20 patients participated in the study, out of which 10 were females and 10 were males.In group A the mean application time noted was 7 minutes . In group B the mean application time noted was 30 minutes (P < .0001). Significantly more glove tears or penetrations occurred during application in the Erichs arch bar when compared to the Erichs arch bar.

TO COMPARE THE EFFECTIVENESS OF INTERMAXILLARY FIXATION USING ERICH ARCH BAR AND SCREWS IN MANDIBULAR FRACTURES – A RANDOMIZED CLINICAL STUDY.

Purpose: Intermaxillary xation (IMF) is an essential principle in the management of mandibular fractures; but with the recent advent of open reduction and internal xation (ORIF), the use of IMF is almost limited to intraoperative procedure only. This study aims to investigate and compare the effectiveness of Erich arch bar & intermaxillary xation (IMF) screws for the management of mandibular fractures. Materials And Method: A randomized prospective study was conducted on 20 patients with mandibular fracture, who were randomly allotted to two groups. Group A patients received intermaxillary xation using Erich arch bar and group B patients received IMF screws. The parameters assessed were time taken for application and removal of appliance, stability of occlusion, glove perforation, and pre-and post-operative plaque accumulation. Results: The mean time for placement of the Erich arch bar was 43.10 minutes as compared to 18.60 minutes with intermaxillary xation screws. Better occlusal stability was shown with an arch bar over IMF screws, and was statistically signicant. More glove tears or penetrations occurred during application in group A than Group B (p<0.01). Also, The Plaque Index assessment on removal of appliance showed a statistically signicant difference between the two groups; higher in the arch bar group. Conclusion: This study indicates that with acceptable occlusal stability, IMF screws technique is an effective and favourable alternative to Erich arch bars for temporary intermaxillary xation in mandibular fractures.

At what point during total knee arthroplasty operations are gloves most frequently torn?

The aim of this study was to determine the time points during a total knee arthroplasty operation when there is the greatest possibility of tearing a surgical glove and thus the stage of the operation at which there is the greatest risk of infection. The study included 300 total knee arthroplasty cases performed by 10 orthopedic surgeons. Using a chronometer during the operation, the upper layer of each surgical glove was removed and inflated with sterile saline at 10-min intervals. When a tear was determined, a record was made of the time it occurred, the stage of the operation, the finger that was torn, and the side (right or left hand). The mean time of the glove perforation was 40.74 ± 10.69 min. Glove tears occurred at the rate of 28.9% (n = 39) in the thumb, 63.7% (n = 86) in the index finger, 2.2% (n = 3) in the middle finger, and 5.2% (n = 7) in the ring finger. The tears occurred after the femoral cut in 8.1% (n = 11), after the tibial cut in 14.8% (n = 20), at the stage of trial component reduction in 52.6% of cases (n = 71), after placement of the prosthesis in 7.4% (n = 10), and at the closure stage in 17% (n = 23) (p < 0.001). The fingers requiring the most care during total knee arthroplasty are the thumb and index finger. The stages of the operation with the greatest risk for glove tears are trial component reduction and wound closure. Changing gloves after these high-risk surgical stages would help to decrease the risk of periprosthetic infections. Level IV/Case series.

Hybrid arch bars reduce placement time and glove perforations compared to Erich arch bars during the application of maxillomandibular fixation: a randomized controlled trial

Purpose The use of a bone-fixated hybrid arch bar system provides an alternative method to Erich arch bars to apply maxillomandibular fixation (MMF) during the treatment for mandibular fractures. The purpose of the study is to compare the time for placement and removal, effect on the gingiva, and operator safety. Methods The authors designed a parallel-group, randomized controlled trial to compare the 2 types of arch bars. Patients with mandibular fractures presenting to the authors’ institution were enrolled in the study and randomized into 2 groups: (1) the Erich arch bar group secured with circumdental stainless steel wires and (2) the Hybrid arch bar group secured with bone-borne self-drilling locking screws. The primary outcome variable was arch bar placement time. Secondary outcomes were glove tears or penetrations during application, gingival appearance score at removal, loose hardware at removal, removal time, and glove tears or penetrations at removal. The groups were compared by using the Student t test. Results A total of 90 patients were enrolled in the study. There were 43 patients randomized to the Erich arch bar group and 47 patients randomized to the Hybrid arch bar group. The mean time for application of Erich arch bars was 31.3 Â ± 9.3 minutes and 6.9 Â ± 3.1 for the Hybrid arch bars (P Conclusions Hybrid arch bars with bone-borne locking screws offer a number of advantages, including faster placement, shorter removal time, and a greater margin of safety for the operating surgeons, as demonstrated by significantly fewer glove tears and penetrations.

Hybrid Arch Bars Reduce Placement Time and Glove Perforations Compared With Erich Arch Bars During the Application of Intermaxillary Fixation: A Randomized Controlled Trial

The purpose of this study was to compare the time for placement and removal, the effect on the gingiva, and the operator safety of the Stryker Universal SMARTLock Hybrid MMF system (Stryker Craniomaxillofacial, Kalamazoo, MI) with traditional Erich arch bars. We designed a parallel-group, randomized controlled trial to compare the 2 types of arch bars. Patients with mandibular fractures presenting to our institution were enrolled in the study and randomized into 1 of 2 groups: the Erich arch bar group and the hybrid arch bar group. The primary outcome variable was arch bar placement time. Secondary outcomes were glove tears or penetrations during application, gingival appearance score at removal, loose hardware at removal, removal time, and glove tears or penetrations at removal. The groups were compared using t tests. We enrolled 90 patients in the study, with 43 randomized to the Erich arch bar group and 47 randomized to the hybrid arch bar group. The mean application time was 31.3±9.3minutes for Erich arch bars and 6.9±3.1minutes for hybrid arch bars (P<.0001). Significantly more glove tears or penetrations occurred during application in the Erich Arch Bar group (0.56±0.91 per application) than in the hybrid group (0.11±0.32 per application) (P=.0025). At removal, no difference in overall gingival appearance or amount of loose hardware was noted. The time for removal was significantly less for the hybrid arch bar group (10.5±5.1minutes vs 17.9±10.7minutes, P=.0007). Hybrid arch bars with bone-borne locking screws offer a number of advantages over traditional Erich arch bars and circumdental wires, including shorter placement and removal times and a greater margin of safety for the operating surgeon as shown by significantly fewer glove tears and penetrations.

Do Skin Lacerations Imply Tissue Transfer From Surgeon to Patient During Arthroscopic Knot Tying?

To use simulated arthroscopic knot tying to assess (1) whether epithelial cells from the surgeon's hands were transmitted to the suture and (2) whether the number of knots tied or the presence of glove tears would correlate with the number of cells transmitted. Knots were tied in a simulated arthroscopic environment using a nonabsorbable No. 2 suture over a metal hook. The surgeon was double gloved for each knot tied. For each "anchor," a surgeon's knot was tied, followed by 3 reversed half-hitches on alternating posts. Multiple skin lacerations were sustained by the surgeon during each knot-tying session. Gloves were collected after tying 2, 4, or 6 anchors. Gloves were tested for perforation by (1) electroconductivity and (2) saline solution load testing. Cytopathologic ThinPrep analysis was applied and allowed for the number of epithelial cells found on each suture (within 10 high-powered fields) to be counted. Statistical analysis included analysis of variance and logistic regression. There was no significant difference in the number of epithelial cells identified in any of the groups compared with the negative control groups (P > .05) or with each other (P>.05). Glove tears were present in 3.3% of gloves (50% in inner and 50% in outer gloves) and 1.7% of gloves (50% in inner and 50% in outer gloves) by electroconductivity and saline solution load testing, respectively. There was no significant association between glove tears and the number of epithelial cells found on the suture (P > .05). Epithelial cells were transmitted to the suture during simulated arthroscopic knot tying. However, despite multiple skin lacerations produced during knot-tying sessions, the number of cells transmitted was not significantly different when compared with the negative controls. The number of cells transmitted did not correlate with the number of knots tied and/or the presence of glove tears. Skin lacerations on the surgeon's fingers are often noted after arthroscopic knot tying. However, despite these skin lacerations, no skin tissue is transferred across the surgical gloves to the suture itself.

Glove failure in elective thyroid surgery: A prospective randomized study.

To analyze perforation rate in sterile gloves used by surgeons in the operating theatre of the Department of Endocrinological and General Surgery of Medical University of Lodz. Randomized and controlled trial. This study analyses the incidents of tears in sterile surgical gloves used by surgeons during operations on 3 types of thyroid diseases according to the 10th revision of International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes. Nine hundred seventy-two pairs (sets) of gloves were collected from 321 surgical procedures. All gloves were tested immediately following surgery using the water leak test (EN455-1) to detect leakage. Glove perforation was detected in 89 of 972 glove sets (9.2%). Statistically relevant more often glove tears occurred in operator than the 1st assistant (p < 0.001). The sites of perforation were localized mostly on the middle finger of the non-dominant hand (22.5%), and the non-dominant ring finger (17.9%). This study has proved that the role performed by the surgeon during the procedure (operator, 1st assistant) has significant influence on the risk of glove perforations. Nearly 90% of glove perforations are unnoticed during surgery.

Risk of Glove Perforation With Arthroscopic Knot Tying Using Different Surgical Gloves and High–Tensile Strength Sutures

To examine the risk of glove tears associated with arthroscopic knot tying using 4 commonly used high-tensile strength sutures and 2 different types of gloves. We analyzed 2 different surgical latex glove types (0.24-mm-thick powder-free and 0.32-mm-thick powdered) for perforation after arthroscopic knot tying with 4 different high-tensile strength sutures: Hi-Fi (ConMed Linvatec, Largo, FL), Ultrabraid (Smith & Nephew, Memphis, TN), FiberWire (Arthrex, Naples, FL), and Orthocord (DePuy Mitek, Raynham, MA). All knots were tied by a double-gloved single surgeon. Twelve trials of 4 knots each were performed for every glove-suture combination. All gloves were analyzed for perforation by a blinded evaluator using visual inspection, hydro-insufflation, and electroconductivity. The overall incidence of glove perforation was 3.4% and was detectable only by the electroconductivity method; the other 2 methods did not detect any perforations. There was a statistically significantly higher rate (P < .001) of perforations in the 0.32-mm powdered gloves (6.8%) compared with the 0.24-mm powder-free gloves (0%). Perforation of the inner glove occurred 5.7 times more frequently than perforation of the outer glove. However, simultaneous perforation of both the inner and outer gloves did not occur in any set. The Hi-Fi suture was involved in 6 perforations compared with 4 for FiberWire, 3 for Ultrabraid, and 0 for Orthocord. Double gloving provides an adequate surgical barrier between the surgeon and the patient during arthroscopic knot tying with high-tensile strength sutures as indicated by the low incidence of glove perforations in our study in an in vitro biomechanical evaluation. There were no instances of simultaneous perforation of both the inner and outer gloves. All perforations occurred only in the thicker (0.32-mm) powdered gloves. Glove tears and finger lacerations have been reported with the use of high-tensile strength sutures during arthroscopic shoulder surgery, thereby raising a concern for safety and disease transmission. This study addresses these concerns by evaluating the risk of glove tears during arthroscopic knot tying.

Exploring the Benefits of Double Gloving During Surgery

Breaches in the glove barrier pose a risk for transmission of bloodborne pathogens during surgical procedures. Double gloving or double gloving with an indicator glove system may provide added protection. For this 24-month study, we used a comparative design to examine the effect of double gloving with inner indicator gloves on the durability of inner gloves and the detection of glove tears or perforations during surgery. The frequency of seeing blood on the hand after surgery was greater with single gloving than with double gloving, and the frequency of changing gloves during surgery was significantly higher among those who double gloved with an indicator glove system versus double gloving alone. The majority of health care providers in our study expressed favorable views about double gloving.

Clinical Issues—March 2011

This MonthFirst surgical hand scrub of the dayKey words: alcohol‐based surgical hand rub products, surgical hand antisepsis, standardized surgical hand rub protocol.The correct method for sterilizing towel clipsKey words: ratcheted instruments, instrument hinges, bloodborne pathogens standard, glove tears, percutaneous punctures, instrument stringers.Patient abandonmentKey words: patient abandonment, patient assignment, nurse‐patient relationship.Determining shelf lifeKey words: event‐related sterility, expiration dates, moisture‐controlled environment, dust‐controlled environment, storage conditions, sterile storage, shelf life, sterile items.

Hands-free technique in the operating room: reduction in body fluid exposure and the value of a training video.

This study sought to determine if (1) using a hands-free technique (HFT)--whereby no two surgical team members touch the same sharp item simultaneously--> or = 75% of the time reduced the rate of percutaneous injury, glove tear, and contamination (incidents); and (2) if a video-based intervention increased HFT use to > or = 75%, immediately and over time. During three and four periods, in three intervention and three control hospitals, respectively, nurses recorded incidents, percentage of HFT use, and other information in 10,596 surgeries. The video was shown in intervention hospitals between Periods 1 and 2, and in control hospitals between Periods 3 and 4. HFT, considered used when > or = 75% passes were done hands-free, was practiced in 35% of all surgeries. We applied logistic regression to (1) estimate the rate reduction for incidents in surgeries when the HFT was used and not used, while adjusting for potential risk factors, and (2) estimate HFT use of about 75% and 100%, in intervention compared with control hospitals, in Period 2 compared with Period 1, and Period 3 compared with Period 2. A total of 202 incidents (49 injuries, 125 glove tears, and 28 contaminations) were reported. Adjusted for differences in surgical type, length, emergency status, blood loss, time of day, and number of personnel present for > or = 75% of the surgery, the HFT-associated reduction in rate was 35%. An increase in use of HFT of > or = 75% was significantly greater in intervention hospitals, during the first post-intervention period, and was sustained five months later. The use of HFT and the HFT video were both found to be effective.

Glove Tears During Arthroscopic Shoulder Surgery Using Solid-Core Suture

Surgeons have noticed an increased incidence of finger lacerations associated with arthroscopic knot tying with solid-core suture material. This study examines glove perforations and finger lacerations during arthroscopic shoulder surgery. We collected 400 surgical gloves from 50 consecutive arthroscopic shoulder repair procedures using No. 2 solid-core sutures. Two surgeons using double gloves were involved in every case, with one being responsible for tying all knots. Powder-free latex gloves were worn in all cases. Knots consisted of a sliding stitch of the surgeon's preference followed by 3 half-hitches via a knot-pusher instrument. All gloves were inspected grossly and then tested for tears with an electroconductivity meter. The knot-tying surgeon had significantly more glove tears than the control (P < .01). Tears were localized to the radial side of the index finger of the glove at the distal interphalangeal joint in all cases. Of the tying surgeon's gloves, 68 (34%) were found to have tears. These included 17 inner gloves (17%) and 51 outer gloves (51%). If an inner glove was torn, the corresponding outer glove was torn in all cases. A mean of 3.96 knots were tied in each case. There was a significantly higher incidence of inner glove tears when more than 3 knots were tied (P < .03). There was no significant difference in glove tears between suture types. Finger lacerations did occur in the absence of glove tears. However, in the presence of an inner glove tear, there was a statistically significant association with a finger laceration at the corresponding level (P < .03). Intraoperative glove tears and subsequent finger lacerations occur with a high frequency when arthroscopic knots are tied with solid-core suture material. Risk can potentially be minimized by frequent glove changes or use of more durable, less penetrable gloves. This study addresses surgeon and patient safety during arthroscopic shoulder surgery.

Effectiveness of the hands-free technique in reducing operating theatre injuries

Background: Operating theatre personnel are at increased risk for transmission of blood borne pathogens when passing sharp instruments. The hands-free technique, whereby a tray or other means are used to...

An outbreak of Candida parapsilosis prosthetic valve endocarditis

Candida parapsilosis, an important nosocomial pathogen and the most common species of Candida found on the hands of health care workers, is a rare cause of prosthetic valve endocarditis (PVE). From March through June 1994, four cases of C. parapsilosis PVE were diagnosed at a 400-bed community hospital. The mean time to presentation after valve replacement surgery was 148 days (range, 20 to 345). Three of the four patients died of complications of PVE. Multiple environmental cultures were performed, and only one was positive for C. parapsilosis. Cultures from the bypass pump, cell saver, cardioplegia solution, and subsequent valves were all negative. All valve replacements were performed by the same operating room team. Interviews with the surgeon and physician assistant, the only personnel involved in all cases, revealed that their hypoallergenic gloves were subject to frequent tears during valve replacement procedures, often requiring several glove changes per procedure. Hand cultures of personnel were obtained, and cultures from 20 individuals (26%) were positive for C. parapsilosis. Hand cultures of the surgeon and physician assistant obtained 8 months after the last case had surgery were negative for yeasts. Molecular typing of the 3 available case isolates, 14 epidemiologically unrelated patient isolates, 1 environmental isolate, and 20 hand isolates was performed by electrophoretic karyotyping and restriction endonuclease analysis of genomic DNA using restriction enzymes BssHII and EagI followed by pulsed field gel electrophoresis. The three case isolates were identical by restriction endonuclease analysis of genomic DNA, and two of the three shared the same electrophoretic karyotyping profile. The remaining patient, environmental, and hand isolates represented 29 different DNA types and were distinctly different from the case isolates. All of the isolates tested were susceptible to amphotericin B, 5FC, fluconazole, and itraconazole. The circumstantial evidence suggests the probability of glove tears during valve replacement surgery and subsequent transmission of C. parapsilosis to patients.

Frequency of glove perforations and subsequent blood contact in association with selected obstetric surgical procedures

One purpose of this prospective investigation was to assess the frequency of glove perforations and subsequent blood contact associated with selected obstetric procedures. The second purpose was to assess the relative risk of perforation among different members of the surgical team and determine if time of day or urgency of the procedure affected the frequency of perforation. Over a 3-month period, obstetric personnel were asked to double glove for all surgical procedures. After surgery, they placed their gloves in plastic bags and noted the type of procedure, time of day, and position on the surgical team. They also indicated whether they were aware of a glove tear and, if so, whether blood or fluid was on their hands. Gloves were tested for injury by two methods: by inflating them with air and subsequently immersing them in water to detect air bubbles and by directly filling them with water to observe for leaks. A total of 540 glove sets (2160 individual gloves) were examined; 407 sets were from cesarean deliveries, 65 from puerperal tubal ligations, and 68 from vaginal deliveries. Sixty-seven of the sets (12.4%, 95% confidence interval 9.6% to 15.2%) had at least one hole; the total number of holes was 78. Sixty-six holes were in the outer glove only, and 7 were in the inner glove only. In five sets (0.9%, 95% confidence interval 0.5% to 1.3%) there were matching holes in the outer and inner gloves. In two of these cases (0.4%, 95% confidence interval 0.1% to 0.7%) the surgeons noted blood on their hands at the conclusion of the procedure. The difference in frequency of injury in outer versus inner gloves was highly significant (p < 0.005). Forty-six of the 78 holes (59%) were on the thumb or first two fingers of the nondominant hand. Only 2 (3%) of the glove tears were recognized by the surgeon. There was no difference in frequency of glove tears when cesarean sections were classified as urgent versus nonurgent. There also was no difference in frequency of glove tears in procedures performed at night compared with those during the daytime. Surgical nurses had 36% of all glove injuries and were more likely than physicians or medical students to sustain perforations (p < 0.005). Primary surgeons and first assistants were more likely than second assistants to sustain glove injuries (p < 0.05). For primary surgeons and first assistants, level of training did not significantly affect the frequency of glove perforations. Glove perforations occur in approximately 12% of obstetric surgical procedures. Surgical nurses are at greatest risk for perforation. Double gloving reduces the likelihood of penetrating injury to the inner glove and subsequent risk of blood contact.

Preventing glove tears, sharp injuries

Preventing glove tears, sharp injuries

How do Glove Tears and Sharps Injuries Occur?

Australian Endodontic NewsletterVolume 18, Issue 1 p. 18-18 How do Glove Tears and Sharps Injuries Occur? First published: August 1992 https://doi.org/10.1111/j.1747-4477.1992.tb00338.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume18, Issue1August 1992Pages 18-18 RelatedInformation

Mechanisms of glove tears and sharp injuries among surgical personnel: Wright JG, McGeer AJ, Chyatte D, Ransohoff DF. JAMA. 1991; 266:1668–1671

Mechanisms of glove tears and sharp injuries among surgical personnel: Wright JG, McGeer AJ, Chyatte D, Ransohoff DF. JAMA. 1991; 266:1668–1671

Glove Tears and Sharp Injuries in Surgical Personnel

<h3>To the Editor.</h3> —The study by Wright et al¹should command widespread attention. However, further analysis is warranted. In their definition of "tears" they include what are usually described as "holes."²The Food and Drug Administration (FDA) and the American Society for Testing and Materials accept a current quality level of 1.5% for holesby a 1000-mL water test. Thus, some of the barrier breaches found by Wright et al might have been present in the new unused gloves. Pate³has recently reported that 5% to 81% of gloves contain holes after each of 50 coronary bypass operations. This includes any holes existing preoperatively. In the series of Wright et al, assuming that there were three potentially vulnerable persons at each of the 2292 operations each wearing two gloves means that at least 13 752 gloves would be at risk. They discovered, by the presence of a bloody spot

Glove Tears and Sharp Injuries in Surgical Personnel-Reply

In Reply. —Dr Beck has raised an important issue that many gloves have small holes prior to being used. The majority of glove perforations in our study were not small holes, but were large tears visible with the naked eye noted by the surgical staff at the conclusion of the procedure. As Beck suggests, a thimble or other form of protection on the palmar side of the distal phalanx of the nondominant hand might prevent many sharp injuries. However, only 25% to 50%1,2 of sharp injuries occur at this site and thus other strategies for prevention will be required.