High Risk of Surgical Glove Perforation From Surgical Rotatory Instruments

Abstract

Background Surgical gloves can be damaged during the course of a procedure, which can place the surgeon and patient at risk. Glove perforation may not always be readily apparent, and determining the risk factors for glove perforation can aid the surgeon in deciding when a glove change is advisable. Time of wear and needle sticks have been well studied; however, other mechanisms including mechanical stress from surgical equipment have had limited evaluation to date. Questions/purposes We evaluated the risk of glove perforation in gloves that were caught in a surgical rotatory device (such as drills and reamers). The aims of our study were (1) to determine the percentage of undetected microperforations after entanglement on a rotatory tool during orthopaedic procedures, (2) to determine which kinds of rotatory devices most commonly cause such microperforations, and (3) to assess whether time of wear had an effect on the risk of perforation. Methods From July 2014 to September 2015, 33 gloves were obtained from all orthopaedic subspecialties at our Level I trauma center if they were caught in a rotatory device greater than one revolution. Time of glove wear and location of the glove that was caught in a rotatory device were recorded. After an evaluation for macroperforations (C 5 mm), the gloves were evaluated for microperforations (\ 5 mm) via the American Society for Testing and Materials (ASTM) one-liter load test. Time of wear was compared among gloves with macroperforations, microperforations, and no perforations. Results The 33 gloves obtained came from 33 procedures. Seventeen of 33 (52 %) gloves had perforations. Seven of the 17 perforated gloves had macroperforations while 10 had microperforations. Eleven of 33 entanglements were caught by drills, nine by reamers, eight by Kwires, and the remaining five gloves were caught by various other instruments. Eight of 17 perforations were caused by drills, three by reamers, three by K-wires, and three by various other instruments. The average time of wear was 58 minutes which did not differ with pattern of glove damage.

Protocol changes to reduce implant‐associated infection rate after tibial plateau leveling osteotomy: 703 dogs, 811 TPLO (2006‐2014)

“…Orthopedic surgical gloves were worn by the primary surgeon during each TPLO to provide additional perforation resistance when manipulating bone, implant materials, and rotary orthopedic instruments . However, this glove is recommended as an over glove in a double glove technique, which was not performed in this study .…”

“…However, this glove is recommended as an over glove in a double glove technique, which was not performed in this study . In human medicine, a significant decrease in perforation rate has been seen when a double latex glove is used vs a single latex glove, but recent large‐scale, randomized trials have determined that there is no statistically significant difference in perforation rate between orthopedic gloves and double latex gloves during TPLO and other clean orthopedic procedures . This evidence, in conjunction with the lack of recommendation of use by the CDC and WHO to decrease SSI, led the authors to omit the use of a double glove or single glove technique from the revised protocol.…”

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.…”

La salud del equipo quirúrgico en cirugía ortopédica y traumatología

“…Algo frecuente y menos conocido es el atrapamiento accidental del guante con un sistema a motor giratorio. En estos casos, a pesar de que macroscópicamente el guante no aparente ruptura, un estudio reciente indica que existen frecuentemente microperforaciones no valorables a simple vista (15) .…”