Glove Perforation Rate Research Articles

Investigation of the Rate of Glove Perforations in Orthopedic Procedures with an Indicator Underglove System (IUS) in a Japanese Hospital

Investigation of the Rate of Glove Perforations in Orthopedic Procedures with an Indicator Underglove System (IUS) in a Japanese Hospital

Glove perforations during open surgery for gynaecological malignancies

Objective To audit glove perforations at laparotomies for gynaecological cancers. Setting Gynaecological oncology unit, cancer centre, London. Design Prospective audit. Sample Twenty-nine laparotomies for gynaecological cancers over 3 months. Methods Gloves used during laparotomies for gynaecological cancer were tested for perforations by the air inflation and water immersion technique. Parameters recorded were: type of procedure, localisation of perforation, type of gloves, seniority of surgeon, operation time and awareness of perforations. Main outcome measure Glove perforation rate. Results Perforations were found in gloves from 27/29 (93%) laparotomies. The perforation rate was 61/462 (13%) per glove. The perforation rate was three times higher when the duration of surgery was more than 5 hours. The perforation rate was 63% for primary surgeons, 54.5% for first assistant, 4.7% for second assistant and 40.5% for scrub nurses. Clinical fellows were at highest risk of injury (94%). Two-thirds of perforations were on the index finger or thumb. The glove on the nondominant hand had perforations in 54% of cases. In 50% of cases, the participants were not aware of the perforations. There were less inner glove perforations in double gloves compared with single gloves (5/139 versus 26/154; P = 0.0004, OR = 5.4, 95% CI 1.9-16.7). The indicator glove system failed to identify holes in 44% of cases. Conclusions Glove perforations were found in most (93%) laparotomies for gynaecological malignancies. They are most common among clinical fellows, are often unnoticed and often not detected by the indicator glove system.

Perfurações não detectadas de luvas em procedimentos de urgência

Gloves are the most important barriers that protect hospital personnel and patients. Unfortunately, glove perforation rates reach up to 78% in high risk procedures. The purpose of this prospective study was to evaluate the glove perforation rate in emergency procedures carried out in the Emergency Service of 'Santa Casa de São Paulo', School of Medicine. The study analyzed all gloves used in the emergency room during a 2 months period. Gloves were tested immediately after the surgical procedure using the approved standardized water leak method. A total of 252 surgical gloves used by residents in 42 surgical procedures and 2361 gloves used in emergency procedures were tested for the presence of punctures by the water insuflation method. Forty one (16.3%) of the gloves tested showed at least one puncture, 18 (33%) in traumatic emergencies. The overall perforation rate in the emergency room was 7,3%. We concluded that the incidence of punctures in gloves during surgical procedures was high, and occurred mostly with surgeons.

Latex-Free Gloves: Safer for Whom?

Increasing latex hypersensitivity among patients and health care workers has prompted the development of latex-free surgical gloves. Latex-free gloves must perform equally as the existing latex standard. We analyzed perforation rates in a clinical trial comparing latex and a latex-free alternative during primary hip and knee arthroplasty. The overall latex glove perforation rate was 8.4% compared with 21.6% for the latex-free alternative ( χ 2 P < .001). The operation perforation rate for latex gloves was 34.4% compared with 80% for latex-free gloves ( χ 2 P < .001). We suggest that the latex-free glove tested cannot provide a reliable barrier between the surgeon and the patient. As such, we question the safety of these gloves and the standards sets by the regulators.

Improving adherence to surgical hand preparation

At present, no universal agreement on detailed practice for surgical hand preparation exists. In order to fill this gap, in 2002 a Franco-German recommendation for surgical hand preparation was published as a first step towards a generally accepted European recommendation. Based on an assessment of the actual literature, a protocol for surgical hand preparation is discussed with the aim to recommend evidence-based standard procedures including prerequisites, washing and disinfection phase, and its practical implementation. In contrast to hygienic hand disinfection, for surgical hand preparation compliance is not an issue, since it mostly is regarded as a ceremony which is carried out without exception. Nevertheless, the following factors influence acceptance and efficacy: skin tolerance, ease of use, duration of procedure, and recommended time), potential for impaired efficacy due to incorrect performance of the procedure, possibility of systemic risks and irritating potential by applied preparations, religious restrictions, ecological aspects, costs and safety. Here, we report our experience with the introduction of a new hand preparation regime in all surgical disciplines in our university hospital based on the above factors. The following statements were evaluated: 1) The immediate efficacy of an alcohol-based hand disinfectant is impaired by a preceding hand wash for up to 10 minutes. Therefore hands should not be routinely washed before the disinfection period unless there is a good reason for it such as visible soiling. 2) A shortened application time (1.5 minutes) is equal to 3 min in terms of efficacy. 3) Hands should be air dried before gloves are put on, otherwise the perforation rate of gloves will increase. 4) The efficacy of alcohol-based disinfectants is significantly higher when hands are allowed to dry for 1 minute after the washing phase and before the disinfection phase. To clarify the above questions before the establishment of the modified technique, the surgical team was invited to a meeting. As a result, the heads of surgical departments supported the new technique and decided to change their practice.

The use of blunt needles does not reduce glove perforations during obstetrical laceration repair

The objective of the study was to compare the rate of glove perforation for blunt and sharp needles used during obstetrical laceration repair. A secondary aim was to assess physician satisfaction with blunt needles. This was an institutional review board-approved, randomized, prospective trial. Patients with obstetric lacerations were randomized to repair with either blunt or sharp needles. Patient demographics, operator experience, and other clinical variables were collected. Physicians reported any percutaneous injuries and were surveyed regarding satisfaction with the assigned needles. Glove perforation was determined using a validated water test method. There were 438 patients enrolled in the trial: 221 in the control group and 217 in the study group. There was no statistical difference between groups in patient demographics, clinical variables, severity of laceration, or experience level of the surgeon. There was no difference in the glove perforation rate between blunt and sharp needles (risk ratio, 0.79; 95% confidence interval, 0.2-2.95). There was poor correlation between reported perforations and those detected by water test (R(2) = 0.33). The physicians reported that blunt needles were more difficult to use than sharp needles (P = .0001). There was no difference in the rate of surgical glove perforation for blunt, compared with sharp, needles used during vaginal laceration repair. Physicians also reported increased difficulty performing the repair with blunt needles.

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

Glove perforations and percutaneous injuries occur commonly during the treatment of facial fractures and reveal the need for safer techniques, especially in intermaxillary fixation. The Rapid IMF device does not use any wires and may provide better cross-infection control than wiring methods. The aim of this study was to test the hypothesis that Rapid IMF is associated with fewer glove perforations/ percutaneous injuries than traditional wiring techniques. The authors carried out 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. Analysis of the results showed that the Rapid IMF group had significantly fewer glove perforations than the traditional method (0.67 per operation compared with 1.5), (P<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<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. 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.

Self protection in surgery: The use of double gloves

This study assesses the perforation rate of single and double gloves and thus the extent to which double gloving protects the surgeon from diseases transmissible from the patient. We have also investigated whether double gloving offers the patient extra protection by reducing wound sepsis. Two hundred adult hernia repairs were performed, the first 100 single gloved and the second 100 double gloved. Glove perforation rates were not significantly different between single gloves and the outer of the double gloves. Although 46 of 400 outer gloves were perforated there were only 15 inner glove perforations and only eight of these matched the outer perforations. The percentage of operations in which the latex protective barrier was breached was reduced from 31 per cent when the surgeon wore single gloves to 8 per cent with double gloves. Wound sepsis was not increased by glove perforation nor reduced by double gloving. While careful technique remains mandatory we conclude that double gloving offers increased protection to the surgeon operating on high risk infectious cases.

Efficacy of Double Gloving with an Intrinsic Indicator System

Blood-borne infection is an ever-present fear for medical professionals, especially surgeons and operating room personnel. Safety is paramount, and the reliability and efficacy of surgical gloves are crucial, as gloves are the most important barriers protecting hospital personnel and patients. Unfortunately, glove perforation rates are as high as 78% in high-risk procedures. As well as being efficacious, surgical gloves must be comfortable and easy to don, and when holes are present, it is imperative they be detected expeditiously. The purpose of this double-blind randomized study was to evaluate the ability of participants to locate 30-micron laser holes in surgical gloves while performing simulated surgery and to evaluate the Biogel Indicator Glove System, which reveals punctures. Twenty glove configurations (eight single, twelve double) were tested, half of which had laser-created holes. Each of the 25 participants tested and evaluated 20 configurations randomly. Simulated surgery terminated when a hole was identified by the participant or at the end of two minutes, whichever occurred first. Participants also rated their perceptions of each glove's features on questionnaires, all of which were returned, with 95.8% being complete. Participants found 84% and 56% of the holes in the two indicator systems, latex and synthetic, in an average of 22 seconds and 42 seconds, respectively. In the worst-performing latex and synthetic glove configurations, participants found only 8% and 12% of the holes at an average of 47 seconds and 67 seconds, respectively. Indicator gloves were highly rated for comfort and ease of use. Double gloving with an indicator system provides the best protection and allows the timeliest identification of perforations. Participants failed to identify most of the holes in the non-indicator gloves.

Glove perforation in outpatient dermatologic surgery.

Intact surgical gloves ensure protection of health-care employees and health-care recipients. Nevertheless, glove perforation is very common and puncture rates above 50% have been published in the literature. It was our aim to evaluate the perforation rate of surgical gloves in outpatient dermatologic surgery. Six-hundred and sixty latex surgical gloves used in outpatient dermatologic surgery were evaluated for perforations using the approved water-leak method. Perforations were analyzed microscopically. Twenty of the 660 gloves were found to have perforations, which corresponds to a perforation rate of 3.0%. Only 5 of these perforations (25%) were noticed by the wearer. Perforations were more numerous in nondominant-handed gloves. Microscopically, all perforations could be identified as needle stick injuries. The risk of glove perforation in outpatient dermatologic surgery is lower than in many other medical specialties. The relatively high number of surgical procedures performed successively in outpatient dermatologic surgery, however, emphasizes the decisive relevance of an intact barrier between surgeon and patient. In view of the major fact that most perforations go unnoticed by the wearer, dermatologic surgeons must balance the improved safety of double gloving with costs and the loss of sensitivity and dexterity.

Glove Perforation in Outpatient Dermatologic Surgery

BACKGROUND Intact surgical gloves ensure protection of health-care employees and health-care recipients. Nevertheless, glove perforation is very common and puncture rates above 50% have been published in the literature. OBJECTIVE It was our aim to evaluate the perforation rate of surgical gloves in outpatient dermatologic surgery. METHODS Six-hundred and sixty latex surgical gloves used in outpatient dermatologic surgery were evaluated for perforations using the approved water-leak method. Perforations were analyzed microscopically. RESULTS Twenty of the 660 gloves were found to have perforations, which corresponds to a perforation rate of 3.0%. Only 5 of these perforations (25%) were noticed by the wearer. Perforations were more numerous in nondominant-handed gloves. Microscopically, all perforations could be identified as needle stick injuries. CONCLUSION The risk of glove perforation in outpatient dermatologic surgery is lower than in many other medical specialties. The relatively high number of surgical procedures performed successively in outpatient dermatologic surgery, however, emphasizes the decisive relevance of an intact barrier between surgeon and patient. In view of the major fact that most perforations go unnoticed by the wearer, dermatologic surgeons must balance the improved safety of double gloving with costs and the loss of sensitivity and dexterity.

Non-touch suturing technique fails to reduce glove puncture rates in an accident and emergency department

Objective: To assess the impact of introducing a safer non-touch suturing technique into an inner city emergency department. Methods: The rate of glove perforation, measured by electrical conductance, was used...

Prospective study of glove perforation in obstetrical and gynecological operations: are we safe enough?

To assess the glove perforation rate, efficacy of double gloving, effect of duration of surgery, expertise of surgeon and operative urgency on the glove perforation rate in obstetrical and gynecologic operations. From February to September 2002, double glove protocol was made necessary for all major obstetrical and gynecologic procedures. The operating surgeon, first and second assistant were included in the study. Gloves damage was noted (overt by inspection, occult by hydroinsufflation technique). Of the 156 procedures included in study, 32 procedures were performed (all emergency operations) single-gloved because surgeons found double gloving clumsy (56%), made it difficult to tie knots due to lack of dexterity (24%), or were too tight (20%). One thousand one hundred and twenty single gloves were examined after each procedure by hydroinsufflation. The overall perforation rate was 13.6% (single versus double outer gloves, 13.8% versus l3.2%, P > 0.05). Matching perforations were found in six cases (4.6%). Thus, the protection offered by double gloves was 95.4% even if the outer gloves were perforated. Four inner gloves had preexisting perforations. Sixty unused gloves checked similarly revealed a perforation rate of 1.6%. Emergency cases had higher perforation rate compared to elective surgeries (16.6% versus 10.8%, P < 0.00 1). Surgeries lasting for more than 40 min had a higher perforation rate compared to those finished in less than or equal to 40 min (18.6% versus 7.6%, P < 0.001). The middle finger of the left hand was the most commonly involved. The surgeon, first assistant and second assistant were involved in 73.6, 23.3 and 3.2% cases, respectively. Double gloving offers considerable protection against exposure to contaminants in the blood and body fluids of the patient and should be made routine, especially in developing countries where HIV, hepatitis B and C are widely prevalent. Double gloving should be made mandatory in emergency procedures, which have a higher perforation rate due to operative urgency, and gloves should be changed in operations lasting for more than 40 min to ensure integrity of barrier.

Glove perforation in pediatric orthopedic practice.

A prospective study was conducted to assess the glove perforation rate during 100 consecutive pediatric orthopedic operations. Eight hundred fifty-four gloves were tested for perforations. The overall glove perforation rate was 8.43%. Assistant surgeons had a rate of 45.8%, surgeons 33.4%, and scrub nurses 20.8%. More perforations were noticed on the left glove; the thumb and index finger were the most common sites of perforation. The duration of surgery was significantly related to the perforation rate. Two patients had postoperative wound infections and the gloves of surgeons and assistant surgeons were found to be perforated. Every attempt needs to be made to reduce the risk of glove perforation.

Glove punctures in orthopaedic surgery.

From February 2001 to May 2001, 792 latex gloves used in 100 operations from three orthopaedic sub-specialties (paediatrics, hand and spine) were tested for puncture by a water infusion test. Sixty-nine gloves from 45 operations were punctured, giving an overall glove perforation rate of 8.7% (69/792) and an operative perforation rate of 45% (45/100). The hand operations had the lowest operative perforation rate (19.4%) while the spine operations had the highest (63.6%). The glove perforation rate increased in bony procedures (60% versus 22.5%), in procedures with major instrumentation (66% versus 18%) and in more lengthy procedures. The thumbs and the left index finger had more punctures than other parts. In addition, the glove perforation rate for single gloving was 9.6% (53/552) while that for the inner glove of double gloving was 0.8% (1/120). Based on these findings, we would like to recommend double gloving and regular glove changing in these high-risk surgeries.

Are we getting the point? Needlestick injuries-an ongoing problem.

The pattern of glove perforation using hollow needles is unknown and the incidence, using sensitive electronic methods has not been described. We wished to identify the glove perforation rate following the use of hollow needles in our Emergency Department. Two hundred and eighty-nine gloves were collected over three months. These gloves were electronically tested and compared with one hundred unused control gloves. There were 28/298 perforations (9.7%) vs 1/100 in the control group (P<0.01 Fisher's exact probability). Most perforations were located on the thumb and index fingers. There were no needlestick injuries reported during this period. The glove perforation rate following hollow needle use in our Emergency Department is higher than previously reported. The pattern of perforation suggests injury by the needle held in the dominant hand.

Clinical Practice 05

To assess the impact of the basic surgical skills course (BSS) on glove perforation during simple suturing. The study was conducted at a regional BSS course. Fifteen senior house officers attended. All participants were asked to place two simple sutures (Ethilon) in artificial skin whilst wearing surgical gloves (Bodyguard). After completion of this task, the gloves used were collected in bins marked dominant and non-dominant hand. Any perceived needlestick injuries were documented. Each participant performed this task three times. On the final day of the course, the suturing exercise was repeated three times and all gloves collected. Ninety gloves were tested after wearing and performing no task as control. All gloves were tested electronically for perforations. Pre-course, the perforation rate was 4.4 per cent (2/45) in the dominant hand, 11.1 per cent (5/45) in the non-dominant hand and 7.8 per cent (7/90) overall. Post-course, the perforation rate was 0 per cent (0/45) in the dominant hand, 2.2 per cent (1/45) in the non-dominant hand and 1.1 per cent (1/90) overall. No needlestick injuries were reported during the study. Control perforation rate was 1.1 per cent (1/90). The BSS course significantly reduces (P = 0.032) the glove perforation rate whilst suturing. We conclude that the BSS course improves sharp awareness and feel formal teaching should be encouraged in other specialities where suturing occurs.

The integrity of surgical gloves during gynaecological operations.

The study was designed to evaluate the integrity of all surgical gloves, worn as single-gloving, used in 100 consecutive gynaecological operations. Glove perforations were tested by a standardized hydrosufflation technique. Of the 326 pairs of gloves used, 46 were found to have perforations (an overall rate of 7.1%) and about 30% had more than 1 perforation. The rate of glove perforation was 19% among charge nursing sisters, 16% among surgeons and 13% among first assistants--these differences were not statistically significant. The duration of the operation and degree of operative difficulty strongly influenced the rate of perforation. We recommend that surgeons, charge sisters and first assistants should change their gloves after every hour of the operation and use double-gloving in anticipation of a difficult operation.

Double gloving and a system for identifying glove perforations in maxillofacial trauma surgery

The treatment of some maxillofacial fractures has an incidence of glove perforation as high as 50%, with over 80% going unnoticed at the time of operation. We investigated double gloving and a glove perforation indication system to ascertain whether the latter offered any additional protection.1061 gloves used for 113 patients were examined. The outer glove perforation rate was significantly higher than the inner glove (0.48 compared with 0.10,P <0.0001). There were fewer unnoticed perforations in the glove perforation indication group than the standard surgical glove group (19% compared with 79%, P<0.0001). The indication system was most effective in wet operating fields.The perforation rate varied with the type of fracture and treatment. Mandibular fractures that were ‘hand-held’, while bone-plated had a lower mean number of outer glove perforations/operation than fractures treated with temporary intermaxillary fixation (0.43 compared with 4.62, P<0.0001).

Glove perforation rate in open lung surgery.

In open lung surgery the surgical access is encircled by the ribs, which should result in a high glove perforation rate compared with other surgical specialities. Prospectively the surgeon, first and second assistant and the scrub nurse wore double standard latex gloves during 100 thoracotomies. Parameters recorded were: procedure performed, number of perforations, localization of perforation, the seniority of the surgeon, manoeuvre performed at the moment of perforation, immediate cause of perforation, operation time, performance of rib resection during thoracotomy and time of occurrence of the first three perforations. One thousand, six hundred and seventy-three gloves (902 outer, 771 inner) were tested. In 78 operations perforations occurred. There were 150 outer glove perforations (8.9%, 0-8, mean 1.23), 19 inner glove perforations (1.13%, 0-2, mean 0.19). Cutaneous blood exposure was prevented in 78% of all operations and in 87% of all perforations. The perforation rate for the surgeon, the scrub nurse, the first and the second assistant were 61.2, 40.4, 9.7 and 3.1% of all operations, respectively. Rib resection and a duration of more than 2 h resulted in a significant rise of glove perforation rate (P<0.05). The personal experience of the surgeon and the type of operation did not correlate with glove perforation. The immediate cause leading to perforation was named in only 17 cases (13.7%) and comprised contact with bone (seven), a needle stitch (seven) and a production flaw (three). Leaks were localized mostly on the first finger (18%),second finger, (39%) palm and dorsum of the hand (16%). The average occurrence of all first perforations was 38.7 min (range 3-190) after the beginning of surgery, the second after 63.2 min (range 10-195). Fifty-four first perforations (50.5%) were found during the first 30 min of the operation. The reported perforation rate of 78% lies in the highest range of reported perforation rates in different surgical specialities. Double gloving effectively prevented cutaneous blood exposure and thus should become a routine for the thoracic surgeon to prevent transmission of infectious diseases from the patient to the surgeon.