Double-glove perforation rates and perforation rates in standard single-gloved operating teams were compared. in order to deh:nninc whether double gloving provides additional protection for the operating team. Patienh were randomized to undergo surge!)' with a double-gloved or single-gloved operating team. All gloves worn during the operation were tested for perforations by water-filling and individual digital distension; 115 singlegloved operations and 103 double·giO\ed operations were performed. There were 841 individual operating team members 'at risk'. In the single-glove group. 20.8%, of individual-had perforations. but only 2.5'\o had perforatiom in both inner and outer gloves (dual perforation) in the double-glove group (P < 0.0001 ). The surgeon was mm.t at risk of glove perforation (34.7% of cases in the single-glove group, 3.8'1., dual perforation in the double-glove group). Longer operations were associated with increased risk of glove perforation. Double-gloving significantly reduces the risk of skin contamination by blood and body fluids and is recommended for all high risk cases.
Wound infection rates in a general hospital over an 11-year period have been studied, the review embracing over 12,000 sutured surgical wounds. There is a remarkably constant downward trend in the wound infection rate. This is considered real, as there has been no change in the method of recording. Changes in operating theatre technique have not individually influenced the rates or the trend. In particular, the use or non-use of surgical masks made no difference to the incidence of wound infection. Changes in scrub-up-technique and the introduction of air-conditioning in the operating rooms had no appreciable effect. There is a difference between wound infection rates of acute operations and elective operations, of "clean" operations and "dirty" operations. The possible sources of surgical wound infection are discussed. The classification into "inherent" and "sporadic" groups is offered, and in "sporadic" infections the role of the patient as a source of infection is considered.
Wound infection rates from January 1967 to June 1971 are presented and evaluated. The figures are derived from the continuing study of the surgical results at the Royal Newcastle Hospital. The study embraces 6,544 recorded sutured surgical wounds in the course of the treatment of 12,387 surgical patients. The previously reported downward trend in the overall rate of wound infection continues. A special analysis of two methods of preoperative patient skin preparation has revealed no significant difference between the merits of the two different antiseptic preparations. In July 1970 a different method of recording of wound infection was introduced to permit analysis of the figures by computer. This has led to better recording of wounds (increase of 83.4% to 93.4%), as well as to more efficient analysis.
The management in a regional unit of 158 patients with thoracic trauma resulting in respiratory failure is described. Emphasis is placed on the need for accurate diagnosis of intraabdominal trauma in the presence of chest injury. Peritoneal tap is advocated, both to avoid unnecessary laparotomy and to diagnose hæmoperitoneum when intraabdominal signs are obscured by those of the thoracic injury. Following laparotomy on a patient with significant pulmonary trauma, artificial ventilation is necessary for some days, but when the trauma chiefly involves the chest, an opportunity exists to manage the patient by pain relief alone. Forty‐five patients suffering respiratory failure following injury to the chest and abdomen were managed, and 12 died, while 35 needed artificial ventilation.
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