Use Of Double Gloves Research Articles

Characterization of education, technical practices and attitudes of Portuguese pharmacy technicians towards manipulation of cytotoxic drugs.

Pharmacy professionals that manipulate cytotoxic drugs need to undergo educational programs, adopt the most convenient practices, and use appropriate equipment to avoid, as far as possible, occupational exposure to cytotoxic drugs. The main goal of this work is to characterize the education, technical practices, and attitudes towards cytotoxic drugs, of Portuguese pharmacy technicians. A questionnaire comprising eleven questions deemed pertinent was elaborated and subsequently validated by a pilot test. The anonymous, web-based survey was conducted between December 2022 and January 2023, by graduated pharmacy technicians that had manipulated cytotoxic drugs between 2017 and 2022. A total of 77 pharmacy technicians responded to the survey. Although sixty-six pharmacy technicians (86%) had been trained before beginning to manipulate cytotoxic drugs, the promotion of regular post-admission training by the institutions is sparse - only assumed by 53% of the pharmacy technicians (n = 41). All participants reported using gloves and gown during manipulation and the use of double gloves was common (99%; n = 76). Compliances with the recommended limit time for uninterrupted manipulation activity (82%; n = 63) and systematic double-checking (86%; n = 66) were high, but the regular use of sterile gauze around syringe connection sites 58% (n = 45), was less frequent. None of the surveyed pharmacy technicians used closed-system transfer devices (CSTD) and 41 (53%) of those who used spikes did not thoughtfully use these devices. The implementation of regular training programs in manipulating cytotoxic drugs should be fostered, to promote the more judicious use of engineering controls and transversal adoption of the safest technical practices.

Comparison of the Colonies Number of the Germs Formed Post Operation between the Utilization of Single, Double, and Orthopedic Gloves in Closed Fracture Operations More Than 2 Hours

Abstract: Post-operative infection is still one of the most common nosocomial diseases that can cause great losses because it will increase the length of stay, use of drugs, and reduce the quality of life of the patients. The risk will increase if the number of colonies is> 105 bacteria per gram of tissue. Various ways have been done to reduce the number of bacteria in the operation area, including the use of surgical gloves. This study analyzed the comparison of the level of bacterial colonies that grew on the surface of single, double, and orthopedic surgical gloves in closed fracture management for more than 2 hours at Hasan Sadikin Hospital. The statistical analysis was done with p-value = 0.011 (<0.05), which means a significant difference in the number of germ colonies that grow between single, double, and orthopedic gloves. Double gloves and orthopedic gloves have a better ability to reduce bacterial colony growth. Meanwhile, there was no significant difference in the number of bacterial colonies formed between double gloves and orthopedics. Perforation is a factor affecting the number of germ colonies that formed. The use of double gloves and orthopedic gloves in closed fracture surgery for more than 2 hours shows the number of bacterial colonies formed is less than single gloves. There was a significant difference in the rate of perforation between standard surgical gloves and orthopedic gloves. Keywords: Bacteria colony, Single glove, Double glove, Orthopaedic glove, Perforation

AGA Institute Quality Measure Development for the Diagnosis and Management of COVID-19

AGA Institute Quality Measure Development for the Diagnosis and Management of COVID-19

Entrance surface dosimetry with radiophotoluminescent films

In a wide international cooperation, thin dosimetric films were developed for radiation protection and clinical dosimetry applications. The goal was providing proof of principle of a novel approach to entrance surface dosimetry, in general, and to extremity dosimetry, in particular. The latter is an extremely challenging task since ring and wrist dosimeters do not allow reliable estimates of the higher doses typically received by the fingertips, while solid-state detector chips worn on the fingertips interfere with the tactile sense of the workers. In our current system, tissue-equivalent polyethylene films are used to embed a variety of luminescent materials, particularly radiophotoluminescent (RPL) glass grains. This work illustrates the results we have achieved so far, proving that polyethylene films loaded with RPL glass grains provide a dosimetric response and have adequate mechanical and wearability properties. Additionally, the signal build-up associated with RPL glass is significantly accelerated when the glass is kept at body temperature, i.e., in contact with the worker's hands. Finally, the use of double gloves further improves the performance of our system.

Nursing Assistants' Use of Personal Protective Equipment Regarding Contact With Excreta Contaminated With Antineoplastic Drugs.

To examine the feasibility of observing and interviewing nursing assistants about handling of antineoplastic drugs contaminated with excreta, acceptability of a measure of personal protective equipment (PPE) use with nursing assistants, and predictors of PPE use. 27 nursing assistants in an inpatient hematology-oncology unit at an academic medical center in the southeastern United States. This was an exploratory, multimethod study using observation, verbally administered questionnaires, and interviews. Research variables included recruitment rates, acceptability of observation, and understandability of a safe-handling instrument. Observed use of double gloves, chemotherapy gowns, and face shields was low; use of plastic-backed pads when flushing excreta was high. Nursing assistants are willing to participate in research. Standardized training and education about PPE use are needed.

National Survey of Operating Room Nurses' Aseptic Techniques and Interventions for Patient Preparation to Reduce Surgical Site Infections.

Surgical site infection (SSI), the third most common type of nosocomial infection in Sweden, is a patient injury that should be prevented. Methods of reducing SSIs include, for instance, disinfecting the skin, maintaining body temperature, and ensuring an aseptic environment. Guidelines for most of these interventions exist, but there is a lack of studies describing to what extent the preventive interventions have been implemented in clinical practice. We describe the daily clinical interventions Swedish operating room (OR) nurses performed to prevent SSIs following national guidelines. A descriptive cross-sectional study using a Web-based questionnaire was conducted among Swedish OR nurses. The study-specific questionnaire included 32 items addressing aspects of the interventions performed to prevent SSI, such as preparation of the patient skin (n = 12), maintenance of patient temperature (n = 10), and choice of materials (n = 10). The response format included both closed and open-ended answers. In total, 967 nurses (43% of the total) answered the questionnaire; of these, 77 were excluded for various reasons. The proportions of the OR nurses who complied with the preventive interventions recommended in the national guidelines were high: skin disinfection solution (93.5%), sterile drapes (97.4%) and gowns (83.8%) for single use, and the use of double gloves (73.0%). However, when guidelines were lacking, some interventions differed, such as the frequency of glove changes and the use of adhesive plastic drapes. To standardize OR nurses' preventive interventions, implementing guidelines seems to be the key priority. Overall, OR nurses have high compliance with the national guidelines regarding interventions to prevent bacterial growth and SSIs in the surgical patient. However, when guidelines are lacking, the preventive interventions lose conformity.

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.

Can Triclosan-Coated Sutures and the Use of Double Gloves Reduce the Incidence of Surgical Site Infections?

Background: Postoperative surgical site infections (SSIs) are one of the most frequent complications after open abdominal surgery. Triclosan-coated sutures were said to be able to reduce its occurrence. In gynecologic surgery, SSIs of the vaginal stump are a frequent cause of postoperative fever. Double gloving is also said to contribute to the prevention of SSIs. We performed abdominal hysterectomy with double gloving and sutured the vagina stump with VICRYL PLUS ® , a Polyglactin 910 suture coated with triclosan, to prevent SSIs. We investigated whether triclosan-coated sutures coupled with double gloving could indeed reduce the incidence of SSIs following abdominal hysterectomy. Methods: We retrospectively reviewed 384 cases of abdominal hysterectomies operated in our department between April 2013 and March 2015. In the first period (from April 2013 to March 2014), we performed 195 operations with single gloving and sutured the vaginal stump with VICRYL ® (Polyglactin 910 suture without triclosan coat). In the second period (from April 2014 to March 2015), we performed 189 operations with double gloving and sutured the vaginal stump with VICRYL PLUS ® (Polyglactin 910 suture with triclosan coat). The primary outcome is the incidence of SSIs. Results: The two groups were comparable with respect to risk factors for SSIs. The incidences of SSIs in the first and second groups were 17 of 195 patients (8.7%) and eight of 189 patients (4.2%), respectively. The difference in the incidence of SSIs was not significant between the two groups (P = 0.097). The numbers of cases requiring postoperative antibiotic therapy in the first and second groups were 13 (6.7%) and 4 (2.1%). The incidence was higher in the control group (P = 0.045). None of the 189 cases needed drainage therapy or a re-operation. Conclusion: It is possible that triclosan-coated sutures coupled with double gloving are able to reduce SSIs and prevent SSI aggravation. J Clin Gynecol Obstet. 2017;6(1):1-5 doi: https://doi.org/10.14740/jcgo429w

Glove Perforation Rate in Surgery: A Randomized, Controlled Study To Evaluate the Efficacy of Double Gloving.

The risk of exposure of either the patient or the surgeon to communicable disease when the surgical glove is perforated is important. Both patients and the surgical team need to be protected from this risk. Therefore, we intended to determine the efficacy of double gloving in our center. This was a prospective cohort study, involving (randomly selected) surgeons, who wore single or double latex surgical gloves during procedures. Gloves were collected and evaluated for perforations (using air insufflation and water leak methods). A total of 1,536 gloves were collected (512 single gloves and 1,024 double gloves), with 78 of 512 gloves perforated, giving a rate of 15.2%. Perforation rate was 15.2% in single gloves, 14.4% in double gloves, 15.5% in emergency operations, and 14.3% in elective surgery. It was highest (30.8%) among registrars in training, particularly when doing any deep (16.0%) surgery. Glove perforation rate was highest (17.4%) among general surgery procedures as opposed to pediatric surgery (14.6%), urology (13.9%), neurosurgery (11.7%), and plastic surgery (10.6%), with (42.1%) index finger injury. In unused (control group) gloves, the rate of perforation was (0.8%). There was a substantial difference in the overall perforation rate between single and double glove sets (15.2% versus 14.4%) (X(2) = 1748, p < 0.0001). However, among the double set, total gloves [outer and inner set] analysis revealed a perforation rate of 27.5% (141 of 512). Of this set, the number of inner gloves that perforated as a result of a through and through puncture from outer to the inner gloves gave a rate of 1.17% (six of 512). Thus, the protection offered by double gloves was 98.83% (X(2) = 280.9, p < 0.0001) even if the outer gloves were perforated. The use of double gloves has more than 90% protection to patient and the surgeon. Therefore, wearing double gloves should be encouraged in surgery.

Biossegurança aplicada à Odontologia na Universidade Federal do Pará, Cidade de Belém, Estado do Pará, Brasil

O presente estudo objetivou analisar o conhecimento e a aplicacao das normas de biosseguranca entre academicos de Odontologia da Universidade Federal do Para, a fim de verificar as divergencias entre dois diferentes momentos da formacao profissional e superar as deficiencias detectadas. Trata-se de um estudo longitudinal, para o qual foi utilizado um questionario constituido por 17 perguntas objetivas, aplicado aos academicos em dois momentos: apos seu primeiro semestre de pratica clinica e apos a conclusao do curso. Foram pesquisados 35 discentes na primeira coleta e 30, na segunda. Ao final do curso, 100% diziam-se bem informados sobre biosseguranca; o processo de desinfeccao mais aplicado ocorreu nas pecas de mao; e o metodo de esterilizacao mais empregado foi a autoclave. No decorrer do curso, aumentou a frequencia de uso de sobreluvas, porem os oculos especiais, os sapatos fechados e o prope foram os equipamentos de protecao individual mais negligenciados. Grande parte dos academicos desconhecia o fluxo de atendimento para acidentes com perfuro-cortantes, ainda que estes tenham ocorrido em 30% dos estudantes durante a graduacao. Sao fundamentais a educacao em biosseguranca e a conscientizacao dos alunos quanto a adocao de habitos corretos para o controle de infeccao cruzada, desde a graduacao e, futuramente, como cirurgioes-dentistas.

Using double gloves in surgical procedures: a literature review.

This article will present a critical review of the literature relating to the use of double gloves during surgery in order to identify best practice by using available resources and to improve health care. During surgery there is an increased risk of exposure to blood and, as a result, pathogens can be transferred through contact between the patient and surgical team. Health professionals working in the operating room are prone to frequent exposure to patients' blood and body fluids (Davanzo et al, 2008 ; Au et al, 2008 ; Myers et al, 2008). Several researchers have also demonstrated that the highest incidence of blood and body fluid exposure is in the operating room during surgical procedures (Ganczak et al, 2006 ; Myers et al, 2008 ; Naghavi and Sanati, 2009).

CZY PODWÓJNE RĘKAWICZKI CHRONIĄ PRZED KONTAMINACJĄ PODCZAS KANIULACJI NACZYŃ KRWIONOŚNYCH? BADANIE PROSPEKTYWNE RANDOMIZOWANE

Undamaged medical gloves protect medical personnel from contact with physiological fluids of the patient. Thus they protect the assistance provider from hand skin contamination with potentially infectious biological materials. The aim of the study was to evaluate the occurrence of pierce, perforations or damage of medical gloves during cannulation of blood vessels. In the prospective randomized study 303 pairs of gloves, used during cannulation of blood vessels under simulated resuscitation, were analyzed. Gloves were tested by the water leak test. The water test revealed 44 cases of damage to the gloves used during cannulation of blood vessels. Significant differences were noted in the frequency of damage to both the outer and single pairs of gloves and the inner pair of gloves. The study showed that the use of double gloves provides a higher level of security for a paramedic than the use of a single pair of gloves, however, double gloves reduce the manual dexterity of a paramedic. A large number of damages to gloves are not noticed by medical personnel during surgery.

Occult Glove Perforation During Adult Elective Orthopaedic Surgery

Aim: This prospective study was conducted in Rustaq Regional referral hospital, Oman from 01-3-2004 to 31-2-2007 to study the frequency of occult glove perforation in adult elective orthopaedic operations and to determine the efficacy of double gloving. Material and Methods: A total of 404 gloves (369 double and 35 single ) used in 175 adult orthopaedic operations were examined. All gloves were tested by standardized water leak method – EN 455-1. Glove perforation rate, incidence amony surgical team members, location of perforation and duration of surgery were analysed and compared. Results: The overall perforation rate was found to be 15% with 11.6% blood contamination in our study. Surgeons had higher perforation rate (11.1%) compared to other operating team members.The index finger and thumb of the non-dominant hand had more perforations then the dominant hand. More perforations were observed in bony operations compared to other surgeries. Perforation rate was more in operations lasting for more than 90 min. The perforation rate of unused gloves was 1%. Conclusion: Routine use of double gloves during elective orthopaedic surgery is advocated. Occult perforations are unrecognized during surgery and pose greater risk. Double gloves confers additional protection especially in high risk patients and significantly reduces blood contamination. Also regular glove changing in high risk surgeries and surgeries lasting more than 2 hours is recommended.

Effect of single- versus double-gloving on virus transfer to health care workers’ skin and clothing during removal of personal protective equipment

BackgroundThe removal of personal protective equipment (PPE) after patient care may result in transfer of virus to hands and clothing of health care workers (HCWs). The risk of transfer can be modeled using harmless viruses to obtain quantitative data. To determine whether double-gloving reduces virus transfer to HCWs’ hands and clothing during removal of contaminated PPE, we conducted a human challenge study using bacteriophages to compare the frequency and quantity of virus transfer to hands and clothes during PPE removal with single-gloving and double-gloving technique.MethodsEach experiment had a double-gloving phase and a single-gloving phase. Participants donned PPE (ie, contact isolation gown, N95 respirator, eye protection, latex gloves). The gown, respirator, eye protection, and dominant glove were contaminated with bacteriophage. Participants then removed the PPE, and their hands, face, and scrubs were sampled for virus.ResultsTransfer of virus to hands during PPE removal was significantly more frequent with single-gloving than with double-gloving. Transfer to scrubs was similar during single-gloving and double-gloving. The amount of virus transfer to hands ranged from 0.15 to 2.5 log10 most probable number. Significantly more virus was transferred to participants’ hands after single-gloving than after double-gloving.ConclusionsOur comparison of double-gloving and single-gloving using a simulation system with MS2 and a most-probable number method suggests that double gloving can reduce the risk of viral contamination of HCWs’ hands during PPE removal. If incorporated into practice when full PPE is worn, this practice may reduce the risk of viral contamination of HCWs’ hands during PPE removal. The use of double gloves should be explored in larger controlled studies.

Does double gloving prevent cerebrospinal fluid shunt infection?

Drs. Tulipan and Cleves address a very important question of whether a change in surgical technique, namely the use of double gloving, can decrease the incidence of cerebrospinal fluid (CSF) shunt infection. In their study “Effect of an intraoperative double-gloving strategy on the incidence of cerebrospinal fluid shunt infection,” they report that the use of double gloving reduced the incidence of the CSF shunt infection rate in 863 patients from 15.2 to 6.7%. They also assert that the infection rate was higher in younger children (, 11.3 years compared with . 11.3 years of age). Their change in practice was apparently prompted by a study conducted at my institution; 4 the latter was an observational study in which investigators examined risk factors for CSF shunt infection in a prospective cohort of children undergoing CSF shunt surgery. In the aforementioned study we found that holes in the gloves worn by any member of the operative team (present in 30%) was a risk factor for CSF shunt infection, and we recommended, “Surgeons should minimize manual contact with the shunt system and consider the use of double gloves.” Tulipan and Cleves have taken what would be regarded as the next logical step—an interventional study in which staff wore either single or double gloves while patients underwent surgery, and the intergroup CSF shunt infection rates were compared. Their study, however, exhibits enough methodological problems, including an extremely broad definition of infection, that the effect of double gloving on shunt infection remains uncertain. What are the methodological limitations of their study? The study is retrospective, uses historical controls, blinding or independent adjudication was absent, and the results are derived from a single center and from a single surgeon reporting his own results. There are many sources of bias in

Self protection in surgery: The use of double gloves

Self protection in surgery: The use of double gloves

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.

Increasing trends in HIV and TB rates in Odessa and the Ukraine

Our objective was to evaluate the level of occupational risk, attitude and behaviour of surgeons towards HIV-infected patients. A questionnaire survey of 264 randomly selected surgeons in training or in practice in five different health institutions in southeast Nigeria within a five-month period was carried out. A 94% response rate was obtained with completed questionnaires from 264 surgeons. The respondents included obstetricians and gynaecologists (n = 78), general surgeons (n = 121), orthopaedic surgeons (n = 40), dental surgeons (n = 10), ophthalmologists (n = 6), urologists (n = 5), and ear, nose and throat surgeons (n = 4). Of them, 31% (n = 82) were qualified surgeons in practice, while the remaining 69% (n = 182) were resident surgeons in training. In the past five years, 40.2% (n = 106) and 26% (n = 70) of the respondents reported needle-stick injuries and blood splash, respectively, during surgery. The majority of the victims were resident surgeons, obstetricians and gynaecologists, and orthopaedic surgeons. Level of clinical experience and high patient blood loss are likely to contribute to this observation. In all, 89% (n = 236) were engaged in the risky practice of operating on patients with open wounds in their hand and the wounds were contaminated with blood in 5% of cases. During surgical procedures, all (100%) respondents wore protective apron, 65.2% (n = 172) wore double gloves and 30.3% (n = 80) used protective goggles. The use of double gloves and protective eye wear increased remarkably over the past decade, probably because the fear of occupational transmission of HIV was substantial. In total, 83% (n = 220) of the respondents had some reservations about treating patients infected with HIV, while 13.3% (n = 35) viewed them with fear. The remaining 3.4% (n = 9) had a more positive attitude towards HIV-infected patients. Further, 92% advocated preoperative screening, with special precaution during surgery, if the results are positive. In addition, 79.5% were of the view that infected patients should not be discriminated against in treatment, provided necessary protective materials are available. To ensure provision of these protective materials, 91% (n = 240) and 89.4% (n = 236) of the respondents favoured involvement of government and insurance agencies, respectively. In order to achieve a greater commitment from surgeons in developing countries towards caring for HIV-infected patients, there is a need for a comprehensive AIDS management package that would offer specific preventive and psychological training in care of HIV patients and provide requisite funds and resources.

Cerebrospinal fluid shunt infection: a prospective study of risk factors.

Hydrocephalus is a common condition of childhood that usually requires insertion of a cerebrospinal fluid (CSF) shunt. Infection is one of the most devastating complications that may arise from the presence of CSF shunts. In this study, the authors prospectively analyzed perioperative risk factors for CSF shunt infection in a cohort of children. Between 1996 and 1999, 299 eligible patients underwent CSF shunt operations (insertions and revisions) that were observed by a research nurse at a tertiary care pediatric hospital. Several perioperative variables were recorded. All cases were followed postoperatively for 6 months to note any development of CSF shunt infection. A Cox proportional hazards model was used to analyze the relationship between the variables and the development of shunt infection. Thirty-one patients (10.4%) experienced shunt infection. Three perioperative variables were significantly associated with an increased risk of shunt infection: 1) the presence of a postoperative CSF leak (hazard ratio [HR] 19.16, 95% confidence interval [CI] 6.96-52.91); 2) patient prematurity (< 40 weeks' gestation at the time of shunt surgery: HR 4.72, 95% CI 1.71-13.06), and 3) the number of times the shunt system was inadvertently exposed to breached surgical gloves (HR 1.07, 95% CI 1.02-1.12). Three variables associated with an increased incidence of shunt infection have been identified. Changes in clinical practice should address these variables, as follows. 1) Great care should be taken intraoperatively to avoid a postoperative CSF leak. 2) Alternatives to placement of a CSF shunt in premature infants should be studied. 3) Surgeons should minimize manual contact with the shunt system and consider the use of double gloves.

Moyens de protection au bloc opératoire et risques d’exposition au sang. Résultats d’une enquête nationale

A national survey was conducted with 5,000 randomly chosen surgeons in order to assess the methods of protection used or warranted in the operating room against blood-borne pathogens. The rate of complete vaccination against hepatitis B was 79,2 %. The use of double gloves was constant for 72 % of orthopedist surgeons but only reached 28,2 % for the overall surgical population. Only 46.1% of the gowns used were coated, though the quality of the barrier when it is wet is very risky. The protections taken in the operating room against blood-borne pathogens can be improved.