Glove change to reduce the risk of surgical site infection or prosthetic joint infection in arthroplasty surgeries: a systematic review

Abstract

Background: Microbiological contamination of surgical gloves occurs during surgery, which may warrant glove change during orthopaedic surgeries. However, no systematic review of this topic has previously been published. Therefore, this review evaluated whether changing gloves during arthroplasty surgeries reduces the risk of surgical site infection/prosthetic joint infection (SSI/PJI) and the optimal frequency of glove change. Methods: Search terms such as surgical gloves, surgical site infections, prosthesis-related infections, arthroplasty were used, including Medical Subject Headings terms. Of the 89 articles screened, 12 articles were included for qualitative synthesis. Results: No studies measured the direct effect of glove change on PJI rate. Therefore, microbiological contamination and perforation rate of gloves were used as surrogate outcomes. Eight studies evaluated microbiological contamination of surgical gloves, with rates ranging from 3.4 to 30%. Five contamination studies recommended changing gloves after draping and before handling implants. One randomized controlled trial also recommended changing gloves at least once an hour regardless of surgical stages. Five studies recommended changing gloves to prevent perforation, with recommendations ranging from 20 to 90 min. Furthermore, one study advised change of gloves after resection of bone and before implantation. Conclusion: As microbiological contamination rates of gloves increase with duration of surgery, glove changes are recommended at least once per hour. Furthermore, gloves should be changed after draping, before handling implants and if visible perforation is seen to reduce contamination. Due to the lack of studies with SSI/PJI as primary outcomes, we cannot draw a definitive conclusion regarding the effectiveness of changing gloves in reducing the risk of SSI/PJI in arthroplasty.

Influence of intraoperative closed glove exchange on glove contamination during clean soft tissue surgeries

“…Although, intraoperative bacterial contamination has not been shown to predict the occurrence of postoperative SSI, 2,23 the surgery team should be aware of potential sources of bacterial contamination during surgery and be cognizant to minimize those risks including avoiding haired or unprepared skin while draping, and changing instruments or gloves if they are noted to be contaminated. Glove exchange prior to closure seems to be beneficial in humans undergoing colorectal surgery and caesarian section, 27,28 and routine exchange of an outer pair of gloves has been proposed at regular time intervals during arthroplasty 29 . At this time, data in small animals regarding infection are lacking; however, the consistent finding of increased glove contamination at the end of surgery lends some support to the concept of routine replacement of outer gloves during high‐risk surgeries.…”

Unnoticed surgical gloves perforation: A multicentric study of the leading factors.

“…In our study, the rate of perforation was significantly higher in cardio-vascular surgical procedures (40.3%) and in the senior surgeon's gloves (41.7%). Other studies had the same findings [10][11][12][13]. This high rate is explained by the fact that surgeons are the first users of instruments and that the manipulation of instruments and implants increases the risk of perforation [14,15].…”

Glove damage in total hip arthroplasty

“…В частности, J.C. Harnoss et al еще в 2010 г. указывали, что 86 % перфораций происходит в не доминантной руке, при этом чаще всего повреждается область указательного пальца (36 %) [8], что, вероятно, объясняется потребностью в мануальном контроле за хирургическими манипуляциями при замене сустава. Во время ортопедических операций, в том числе непосредственно при ЭП ТБС, использование острых и колющих инструментов, таких как иглы, шилья, винты, серкляж, силового оборудования [26,27], а также наличие острых костных выступов повышает риск перфорации хирургических перчаток [21,28] и, как следствие, контаминации раны и передачи гемоконтактных инфекций [29][30][31]. В нашем исследовании проволоку для дополнительной фиксации костных фрагментов применяли в трех случаях ревизионного и в одном случае первичного ЭП.…”