Glove Perforation During Orthopaedic Surgery– A Study

Introduction

Surgical cross infection (from patient to Surgeon) can be considered “Occupational Injury”. Surgeons and operating room personnel have the highest risk of coming into contact with patients' blood and body fluids. Operative gloves were originally developed to protect the patient from organisms on the physician's hands. On the other hand preventing patient-transmitted infection to the Surgeon gained importance too. The invasive nature of surgery, with its increased exposure to blood, means that during surgery there is a high risk of transfer of pathogens. Furthermore, neither knowledge of diagnosed HIV infection in patients, nor awareness of their high-risk status, in?uences the rate of parental exposure to blood during surgery.¹ Both patients and the surgical team need to be protected from this risk. This risk can be reduced by implementing protective barriers such as wearing surgical gloves. Adequate protection requires an Effective Barrier i.e. glove material to remain intact during the entire Procedure. Wearing two pairs of surgical gloves, as opposed to one pair, is considered to provide an additional barrier and further reduce the risk of contamination. Despite strong recommendations, only a few use double gloving.²

Objectives

The risk of perforations in surgical gloves is thought to be very high but is often unrecognized. Our aim was to-

1. Assess the frequency of perforation of surgical gloves during orthopaedic and trauma surgery.

2. To evaluate the efficacy of Gloves in relation to the duration of Surgery.

3. To differentiate the risk of glove perforation between surgeon, assistant and nurses.

Materials & Methods

A prospective study on glove perforations during different Surgical operations was carried out with special regard to user, number and location of perforations, duration and kind of the operation. This study was conducted in Tejasvini Hospital & SSIOT Mangalore, from March 2010 to March 2011. A total number of 1528 gloves which were used in 100 orthopaedic surgical procedures were examined. Of the 1528 gloves tested under actual surgical conditions, 622 were inner and 906 were outer gloves. In addition, one hundred unused pairs of gloves were examined as a control group. All the gloves that were taken for the study were manufactured by the same company. All gloves were collected by the observer and taken to the laboratory. The gloves were examined for perforations using the watertight test by a single observer. Each glove was filled with 1000 ± 50 ml of water and tested for leaks by gentle manipulation of the water into each digit. To facilitate the examination the gloves were positioned against a dark background. The location and number of perforations and the duration of surgeries were recorded. Gloves in relation to the duration of Surgery – student's t -test was used for Statistical analysis. To differentiate the risk of glove perforation between surgeon, assistant and nurses – chi square test was used.

Results

1. Frequency of Perforation:

   The total perforation rate in the entire study amounted to 17.15% i.e. 262 out of the 1528 gloves. There were no perforations in the control group(unused gloves)(Fig. 1.)

2. Relationship with Duration of Surgery:

   Wearing gloves for 90 minutes or less resulted in perforations in 36 (8.82%) of 408 gloves. Wearing gloves for 91-150 minutes resulted in perforation of 128 (18.18%) of 704 gloves. 98 (23.56%) of 416 Gloves were perforated when the duration of wear was longer than 150 minutes. Difference was statistically significant(p < 0.001). (Fig. 2)

3. Differentiate the risk of glove perforation between surgeon, assistant and nurses

   Surgeons had a higher glove perforation rate of 25.2% (169/668). Glove perforation rates of assistants was 8.3% (29/348). Glove perforation rates of nurses was 8.6% (44/512). It was statistically significant (p < 0.001). (Fig. 3)

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Fig. 1:

Frequency of perforation

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Fig. 2:

Relationship with time

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Fig. 3:

Frequency among personnel

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Fig. 4:

Sites of Perforation.

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Discussion

Perforated Gloves can transmit infection from:

1. Operating Room Members to Patient

2. Patient to Operating Room Members.

“Prevention Is Better Than Cure”.

Conclusion

Although we cannot definitively prove that double gloving reduces the risk of infection to the surgeon, its use can be defended for the several reasons as stated above.

Hence we strongly recommend :

1. The routine use of double gloving in orthopaedic procedures- both high and low risk and especially in surgeries involving internal fixation as there is a heavy use of sharp instruments.

2. Surgeons, first assistants, and surgical nurses directly assisting in the operating field should change gloves after 90 minutes of surgery as there is increase in the rate of perforation over time.

3. Although in our study there were no perforations in the control group, this (manufacturing defects) cannot be totally ruled out and hence the donning person must verify the same at the beginning of surgery.