When a glove breaks or is punctured during surgery without anti-microbial prophylaxis, the patient’s chance of surgical site infection increases four-fold. But in cases in which anti-microbial prophylaxis is used, the patient’s risk of infection stays about the same, whether a glove is perforated or not, according to a study published in June issue of the Archives of Surgery.
In the study, researchers at the University Hospital Basel analyzed data from 4,147 surgical procedures performed at the Swiss hospital throughout 2000 and 2001. Overall, SSIs occurred 4.5% of the time. When a glove was perforated, infections occurred 7.5% of the time, compared to 3.9% when all the gloves remained intact. However, in cases without anti-microbial prophylaxis, SSIs were reported in 12.7% of cases in which a glove was perforated, compared to 2.9% when all the gloves stayed intact. Latex gloves were used in the study, except in cases where staff members were allergic to latex.
Noting that there is no consensus on the issue, the authors recommend the use of anti-microbial prophylaxis in all clean (wound class 1) surgical procedures. "The advantages of this SSI prevention strategy, however, must be balanced against the costs and adverse effects of the prophylactic antimicrobials, such as drug reactions or increased bacterial resistance," write the authors.
Double-gloving and changing gloves every 2 hours are also effective ways to prevent glove puncture or breakage, write the authors. Studies cited in the article report that double-gloving can reduce glove failure from a high rate of 51% to 7%, depending on the study. "These measures are effective and safe," write the authors. "However, implementing them in clinical practice can be difficult. "
—Kent Steinriede
