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

Abstract

Objectives To determine the influence of intraoperative glove exchange on glove contamination during clean soft tissue surgery. Study Design Prospective clinical study. Sample Population Two hundred pairs of gloves and gowns from 50 clean soft tissue surgeries. Methods Gloves and gown cuffs were cultured from the primary surgeon and first assistant using a standardized protocol. Cultures were taken from outer surface of both gown cuffs prior to surgery and after gloves were removed at the end of surgery; gloves were cultured prior to surgery, at end of surgery and after a new pair was donned after closed glove exchange. Cultures were evaluated for colony‐forming units after 72 h of inoculation. Results Bacterial contamination was documented in 41 of the 50 surgeries (82%). The most common species cultured was Streptocococcus spp. There was no difference (p = .719) in the bacterial contamination rate of gown cuffs prior to surgery (10%; 20/200) compared to after surgery (9.5%; 19/200). The bacterial contamination rate for gloves was 10.5% (21/200) prior to surgery, 19.5% (39/196) after surgery, and 11% (22/200) after regloving. Gloves cultured following surgery were significantly more contaminated than gloves cultured preoperatively (p = .010) or gloves cultured following regloving (p = .018). Conclusion Glove exchange did not increase bacterial contamination of gloves during the clean soft tissue surgeries tested here. Clinical Significance The outside of the gown cuff does not seem to represent a major source of contamination during clean procedures. This study does not provide evidence to support a change in current practices for intraoperative closed glove exchange.

Evaluation of Surgical Gown Cuff Contamination During Orthopaedic Surgery in a Veterinary Teaching Hospital

“…29 Furthermore, the most common bacteria isolated from the surgical gown cuffs were that of human skin flora and similar to those reported in other studies, 8,29 reducing our suspicion for environmental contamination during the sampling and culturing processes. 29,30 Additionally, the sampling of the Note: Samples were inoculated onto blood agar and MacConkey agar plates as well as enrichment broth. Any colony forming units were identified for bacterial genus and/or species determination using matrix-assisted laser desorption ionisation time-of-flight mass spectrometry.…”

“…1,2,8,12,20,21 In this study, the surgical gown cuffs of a disposable surgical gown were evaluated due to its water permeable design, and that bacterial contamination of the surgical gown cuffs has not been extensively studied in a clinical setting. 13,14,29 This study documented presence of bacterial contamination of the surgical gown cuffs at both the beginning and the end of orthopaedic surgical procedures irrespective of the role of the scrubbed personnel. These findings are similar to a recent study that had similar reports of surgical gown cuff contamination before and after surgery in clean soft tissue surgical procedures.…”

“…Ultimately, the exact cause for the positive T 1 cultures in this study and other studies remain unclear. 11,29 Considering the surgical gown cuff contamination frequency of 41.6% at each time point, the incidence of surgical site infections related to the surgical interventions in this cohort was low. While this finding in this small cohort precludes statistical interpretation, every effort should be made by the surgical team to reduce contamination events and undertake precautions to limit iatrogenic contamination of the surgical attire.…”

“…Ultimately, the exact cause for the positive T 1 cultures in this study and other studies remain unclear. 11 29…”

“…Presence of bacterial contamination at T 1 was concerning; however, similar findings were noted in previous studies evaluating bacterial contamination of different gown materials when double gloving techniques were used and on surgical gown cuffs during soft tissue procedures. 11 29 Several factors may have contributed to the positive cultures of the surgical gown cuffs after hand antisepsis, but before surgery. A breach in sterility may have occurred during gown donning.…”