Unnoticed Glove Perforation During Thoracoscopic and Open Thoracic Surgery

doi:10.1016/j.athoracsur.2005.03.063

The Annals of Thoracic Surgery

Volume 80, Issue 3, September 2005, Pages 1078-1080

https://doi.org/10.1016/j.athoracsur.2005.03.063 Get rights and content

Background

Surgeons tend to underestimate the risk of transferring infection during thoracoscopic operations, although data on glove perforation in thoracoscopic operations have not been reported.

Methods

Unnoticed perforations of the gloves worn by the same primary surgeon during thoracoscopic procedures and open thoracotomy were studied. Gloves with gross damage and those changed due to assumed damage were excluded. Gloves were tested by filling with water and squeezing to inflate each finger, which could detect a perforation by a 30-gauge needle.

Results

Perforation was found in 25% after thoracoscopic operation, although this was significantly lower than 70% after open thoracotomy. Twelve percent of the gloves worn during thoracoscopic operation were perforated. The perforation rate was higher for gloves worn for more than 2 hours during thoracoscopic operation.

Conclusions

Glove perforation occurred without being noticed in 25% of thoracoscopic procedures, and in 12% of the gloves used during the procedure. Glove change within 2 hours is recommended.

Section snippets

Material and Methods

Unnoticed perforations of gloves in 47 thoracic procedures (24 thoracoscopic operations and 23 open thoracotomy) were studied. Thoracoscopic procedure was defined as one using three ports without incision. Thoracoscopic procedures that were converted to thoracotomies were excluded from this study. All gloves were Conform MK-II sterile latex gloves (Ansell Healthcare Inc, CA) and were worn by the same surgeon as the primary operator. After each procedure, gloves were collected and tested for

Results

Thoracoscopic operation was performed on 24 patients (19 male, 5 female: age range from 14 to 82 years old) who underwent 13 bleb eliminations for pneumothorax and 11 tumor resections for pulmonary or pleural tumors. Open thoracotomy was performed on 23 patients (16 male, 7 female: age range from 26 to 80 years old) who underwent two bleb eliminations for pneumothorax, 16 lobectomy or wedge resections for pulmonary tumors, and 5 resections of mediastinal masses. There was no difference between

Comment

Our results showed that, although significantly less often than in open thoracotomy, unnoticed glove damage occurred in 25% of thoracoscopic procedures, and in 12% of all gloves used during a procedure. In thoracoscopic operations, the perforation rate was significantly higher when gloves were worn for more than 2 hours, consistent with previous reports in other surgical procedures [6, 7]. However, there was no difference in open thoracotomy for the time gloves were worn, probably because many

References (11)

S. Chapman et al.
Frequency of glove perforations and subsequent blood contact in association with selected obstetric surgical procedures
Am J Obstet Gynecol
(1993)
J.D. Palmer et al.
The mechanisms and risks of surgical glove perforation
J Hosp Infect
(1992)
T. Laine et al.
Glove perforation in orthopaedic and trauma surgery. A comparison between single, double indicator gloving and double gloving with two regular gloves
J Bone Joint Surg Br
(2004)
J. Hill et al.
Surgical glove perforation rates in otolaryngology
Clin Otolaryngol
(1989)
S.J. Brough et al.
Surgical glove perforations
Br J Surg
(1988)

There are more references available in the full text version of this article.

Cited by (32)

Sharps injury prevention guidance among health care professionals: A comparison between self-reported and observed compliance
2015, American Journal of Infection Control
This study was performed to compare self-report and observation methods for measuring compliance with double gloving (DG) and the hands-free technique (HFT).
The participants were 81 health care professionals (29 nurses, 52 doctors) working in 22 operating rooms in a tertiary hospital in Busan (South Korea). All participants were asked to complete a self-report questionnaire. Additionally, compliance with DG and the HFT was observed from March-May 2014. Data were analyzed using descriptive statistics, χ² test, and κ statistic using SPSS version 18.0 (SPSS, Chicago, IL).
The participants who always complied with DG and the HFT were 30.9% and 7.7% according to the self-report method, respectively, and 30.9% and 0.0% according to direct observation, respectively. The κ value comparing the self-report and observation methods was 0.557 for all study participants, 0.259 for nurses, and 0.668 for doctors for DG. The κ value was 0.027 for all participants, 0.131 for nurses, and 0.020 for doctors for the HFT.
DG compliance and HFT compliance showed moderate and low levels of agreement between the 2 methods, respectively. Doctors showed higher agreement than nurses between the 2 methods for DG compliance but similar to nurses for HFT compliance. Therefore, the levels of compliance with DG may be measured by either the self-report or observation methods for doctors.
Two senior surgeons' view: Prevention of surgical site infection associated with colorectal operations
2015, American Journal of Surgery
Glove perforation and sternal wound infection in open heart surgery
2015, Cirugia Cardiovascular
La perforación de los guantes rompe la barrera entre la microbiota de las manos del cirujano y los tejidos estériles del paciente. El objetivo de este trabajo fue evaluar el efecto de la perforación de los guantes sobre la contaminación de la herida de esternotomía y las complicaciones infecciosas postoperatorias.
Se realizó un estudio prospectivo en 139 pacientes intervenidos de cirugía cardíaca mediante esternotomía media y en 7 cirujanos. Se evaluaron la presencia y la localización de las perforaciones, y la contaminación de la herida de esternotomía al final de la intervención. Se realizó un seguimiento para detectar complicaciones infecciosas postoperatorias.
La frecuencia de perforaciones en los guantes fue del 23%, siendo más frecuentes en los dedos índice y pulgar de la mano no dominante. La tasa de contaminación de la herida de esternotomía fue del 7,91%, siendo Staphylococcus epidermidis el microorganismo más frecuente. Ninguno de los pacientes donde se detectó perforación de los guantes o contaminación de la herida quirúrgica desarrolló infección postoperatoria del sitio quirúrgico.
No existe correlación entre perforación de los guantes y la contaminación de la herida de esternotomía ni con la aparición de complicaciones infecciosas postoperatorias. El desarrollo de una infección del sitio quirúrgico es un proceso complejo que depende de muchos otros factores además de los estudiados.
Surgical glove puncture breaks the barrier between the surgeon hands and the patient sterile wound tissues. The purpose of this work was to evaluate the effect of glove perforation on contamination of the sternal wound and postoperative infectious complications.
A prospective study included 139 patients undergoing open heart surgery through a median sternotomy and seven cardiac surgeons. Glove puncture frequency and localization as well as wound contamination were evaluated at the end of the operation. Short and medium-term follow up was carried out to detect surgical site infections.
Glove perforation rate was 23% of the samples being more frequent in the index and thumb of the nondominant hand. The rate of contamination of the sternotomy wound was 7.91% being Staphylococcus epidermidis the most frequent microorganism. None of the patients with either glove punctures or wound contamination presented any surgical site infection.
There is no correlation between glove perforation and sternal wound contamination and postoperative infectious complications. Surgical site infection is a more complex problem than it seems and depends of many other factors.
What about the surgeon?
2013, International Journal of Surgery
Citation Excerpt :
This leads to the breakdown of the barrier that normally prevents hand-to-wound contamination and vice-versa. Kojima et al. (2005)8 reported a glove perforation rate of 25% after thoracoscopy and 70% after open thoracotomy. Furthermore, the risk of glove perforation also increases with the operation's duration, significantly so after two hours.8
The safety of the patient and its importance in a surgical setting is well recognised. However, in the literature far less emphasis is placed upon the safety of the surgeon and his/her team. This review discusses the risks to which a surgeon is exposed, including blood-borne pathogens, radiation exposure, biomechanical stresses and fatigue, and the adverse effects of diathermy fumes. Strategies addressing these risks are presented and recommendations to improve surgical team safety are offered.
Evaluation of an innovative antimicrobial surgical glove technology to reduce the risk of microbial passage following intraoperative perforation
2011, American Journal of Infection Control
Citation Excerpt :
A review of the recent literature suggests that glove perforation occurs within all surgical disciplines, with frequency rates ranging from 19% in major elective gynecologic surgeries to a high of 78% during emergent surgical procedures.1,14 Because of the perceived rate of unnoticed glove perforation, some surgical practitioners have suggested routine glove changes within a 2-hour cycle.4 An unresolved question involves the role of glove perforation in contamination of the surgical field.
Surgical gloves provide a protective barrier for patients and members of the surgical team. Although glove integrity is important in an era of blood-borne pathogens, little data exist on bacterial passage after glove perforation. This study evaluated the impact of antimicrobial surgical gloves in reducing microbial passage after glove puncture in a model of wound contamination.
Staphylococcus aureus (ATCC 6538) and Brevundimonas diminuta (DSM 1639) were used to prepare a standardized suspension for testing bacterial passage after glove puncture in volunteers wearing single-layer gloves (group A), double-layer gloves (group B), or antimicrobial trilayer gloves (group C). After exposure periods of 5, 10, 30 and 45 minutes, the outer test gloves were removed and microbial passage was measured on the inner surface of the base gloves. Multiple repetitions (5 or 6) were performed at each sampling time.
Microbial passage at 5-, 10-, 30-, and 45-minute exposures were analyzed both separately and combined (5 and 10 minutes and 30 and 45 minutes). No difference was observed in microbial passage between group A and group B at the 10-, 30-, and 45-minute exposures for S aureus, whereas a significant reduction in microbial passage was observed in group C compared with group A (P ≤ .05 to < .005) at the 5-, 30-, and 45-minute exposures for both S aureus and B diminuta. When timed groups were combined (5 and 10 minutes and 30 and 45 minutes), a significant reduction (P ≤ .01 to ≤ .005) in microbial passage of S aureus and B diminuta was observed in group C compared with both group A and group B.
These findings represent the first evidence that microbial passage across surgical gloves can be reduced significantly using an innovative antimicrobial glove technology.
Appropriate Glove Use Can Protect Patients and Personnel
2020, AORN Journal
Citation Excerpt :
Health care workers’ glove use also may be inadequate. Researchers conducted a study in which they assessed glove perforations during thoracic procedures and found that during 6 (25%) of 24 thoracoscopic procedures and 16 (70%) of 23 open thoracotomy procedures, surgeons did not notice glove perforations.8 After testing all the gloves from the thoracoscopic and open thoracotomy procedures, the incidence of perforation was 6 (12%) of 51 gloves and 27 (41%) of 66 gloves, respectively.

View all citing articles on Scopus

View full text

Original articleGeneral thoracicUnnoticed Glove Perforation During Thoracoscopic and Open Thoracic Surgery

Background

Methods

Results

Conclusions

Section snippets

Material and Methods

Results

Comment

Am J Obstet Gynecol

J Hosp Infect

Glove perforation in orthopaedic and trauma surgery. A comparison between single, double indicator gloving and double gloving with two regular gloves

J Bone Joint Surg Br

Surgical glove perforation rates in otolaryngology

Clin Otolaryngol

Surgical glove perforations

Br J Surg

Original article
General thoracic
Unnoticed Glove Perforation During Thoracoscopic and Open Thoracic Surgery