Glove perforations during open surgery for gynaecological malignancies

Abstract

Objective To audit glove perforations at laparotomies for gynaecological cancers.Setting Gynaecological oncology unit, cancer centre, London.Design Prospective audit.Sample Twenty-nine laparotomies for gynaecological cancers over 3 months.Methods Gloves used during laparotomies for gynaecological cancer were tested for perforations by the air inflation and water immersion technique. Parameters recorded were: type of procedure, localisation of perforation, type of gloves, seniority of surgeon, operation time and awareness of perforations.Main outcome measure Glove perforation rate.Results Perforations were found in gloves from 27/29 (93%) laparotomies. The perforation rate was 61/462 (13%) per glove. The perforation rate was three times higher when the duration of surgery was more than 5 hours. The perforation rate was 63% for primary surgeons, 54.5% for first assistant, 4.7% for second assistant and 40.5% for scrub nurses. Clinical fellows were at highest risk of injury (94%). Two-thirds of perforations were on the index finger or thumb. The glove on the nondominant hand had perforations in 54% of cases. In 50% of cases, the participants were not aware of the perforations. There were less inner glove perforations in double gloves compared with single gloves (5/139 versus 26/154; P = 0.0004, OR = 5.4, 95% CI 1.9-16.7). The indicator glove system failed to identify holes in 44% of cases.Conclusions Glove perforations were found in most (93%) laparotomies for gynaecological malignancies. They are most common among clinical fellows, are often unnoticed and often not detected by the indicator glove system.

Risk of surgical glove perforation in oral and maxillofacial surgery

“…Of those procedures, the variation in perforation rates ranged from 4.0% to 63.0%. As reported by Manjunath et al, 4 gynaecological operations (93.1%) had the highest perforation rate in terms of the number of perforations (at least 1 glove perforation in 1 operation), followed by orthognathic surgery in the present study (91.1%) and open lung surgery (78.0%). 12 The perforation rate in scrub nurses in orthognathic surgery in the present study was 63.4%, nearly the same as that in operators in the gynaecological operation described above (63.0%).…”

“…12 The perforation rate in scrub nurses in orthognathic surgery in the present study was 63.4%, nearly the same as that in operators in the gynaecological operation described above (63.0%). 4 This result suggests that the orthognathic surgical team has a higher risk of cross-contamination, particularly the scrub nurse, who manages the surgical instruments even though he or she has no direct contact with patients during the surgery. With regard to other oral and maxillofacial surgeries, the perforation rate in this study was 7.6% in surgeons, which was almost in line with other previous studies (4.0 11 and 6.7% 10 ).…”

“…56-100% of glove perforations go unnoticed by plastic surgeons, 1-3 although the overall risk of glove perforation has been reported to be 0-93.1%. 4,5 In general, orthopaedic, cardiothoracic, gynaecological, and plastic surgeries are considered to have a high risk of glove perforation. 6 In Europe and the USA, double gloving appears to be the standard practice in orthopaedic and maxillofacial surgery.…”

Suppression of Surgeons' Bacterial Hand Flora during Surgical Procedures with a New Antimicrobial Surgical Glove

“…However, several studies have shown that undetected perforations of surgical gloves are common and that the frequency of such defects increases with the duration of glove wear [10][11][12][13]. The risk of glove defects is related to the type of surgery being done, ranging from 7% in urologic surgery to 65% in cardiothoracic surgery [14][15][16][17][18].…”

Needle stick injuries are a preventable healthcare hazard

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Needle stick injuries are a preventable healthcare hazard Sir, I congratulate Manjunath et al 1 for their article that highlights an issue deserving of greater prominence in health care than it currently receives. Glove perforations and associated needle stick injuries are healthcare hazards that place us at risk of catching any of a large number of blood-borne infections, including but not limited to hepatitis B/C and HIV.

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