Removing Outer Gloves as a Method to Reduce Spinal Surgery Infection

Rehman, Amina; Rehman, Atiq-ur; Rehman, Tausif-ur; Freeman, Casey

doi:10.1097/bsd.0b013e31829046ca

Cited by 28 publications

(23 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…One recent study found that infection rates following posterior lumbar fusions decreased from 3.35% to 0.48% with removal of an outer pair of gloves before handling instrumentation. 26 Additionally, several studies have shown that prophylactic intraoperative application of powdered vancomycin in addition to preoperative intravenous cefazolin significantly decreased postoperative infection rates. 14,27 One study comparing 911 patients receiving preoperative cefazolin and 2 g vancomycin to 821 patients receiving only preoperative cefazolin found a decrease in infection rates from 2.6% in the control group to 0.2% in the treatment group (p < 0.0001).…”

Section: Discussionmentioning

confidence: 99%

Cost and quality of life outcome analysis of postoperative infections after subaxial dorsal cervical fusions

Kuhns

Lubelski

Alvin

et al. 2015

SPI

View full text Add to dashboard Cite

OBJECT Infections following spine surgery negatively affect patient quality of life (QOL) and impose a significant financial burden on the health care system. Postoperative wound infections occur at higher rates following dorsal cervical procedures than ventral procedures. Quantifying the health outcomes and costs associated with infections following dorsal cervical procedures may help to guide treatment strategies to minimize the deleterious consequences of these infections. Therefore, the goals of this study were to determine the cost and QOL outcomes affecting patients who developed deep wound infections following subaxial dorsal cervical spine fusions. METHODS The authors identified 22 (4.0%) of 551 patients undergoing dorsal cervical fusions who developed deep wound infections requiring surgical debridement. These patients were individually matched with control patients who did not develop infections. Health outcomes were assessed using the EQ-5D, Pain Disability Questionnaire (PDQ), Patient Health Questionnaire (PHQ-9), and visual analog scale (VAS). QOL outcome measures were collected preoperatively and after 6 and 12 months. Health resource utilization was recorded from patient electronic medical records over an average follow-up of 18 months. Direct costs were estimated using Medicare national payment amounts, and indirect costs were based on patients' missed workdays and income. RESULTS No significant differences in preoperative QOL scores were found between the 2 cohorts. At 6 months postsurgery, the noninfection cohort had significant pre- to postoperative improvement in EQ-5D (p = 0.02), whereas the infection cohort did not (p = 0.2). The noninfection cohort also had a significantly higher 6-month postoperative EQ-5D scores than the infection cohort (p = 0.04). At 1 year postsurgery, there was no significant difference in EQ-5D scores between the groups. Health care–associated costs for the infection cohort were significantly higher ($16,970 vs $7658; p < 0.0001). Indirect costs for the infection cohort and the noninfection cohort were $6495 and $2756, respectively (p = 0.03). Adjusted for inflation, the total costs for the infection cohort were $21,778 compared with $9159 for the noninfection cohort, reflecting an average cost of $12,619 associated with developing a postoperative deep wound infection (p < 0.0001). CONCLUSIONS Dorsal cervical infections temporarily decrease patient QOL postoperatively, but with no long-term impact; they do, however, dramatically increase the cost of care. Knowledge of the financial burden of wound infections following dorsal cervical fusion may stimulate the development and use of improved prophylactic and therapeutic techniques to manage this serious complication.

show abstract

Section: Discussionmentioning

confidence: 99%

Cost and quality of life outcome analysis of postoperative infections after subaxial dorsal cervical fusions

Kuhns

Lubelski

Alvin

et al. 2015

SPI

View full text Add to dashboard Cite

show abstract

“…65 Rehman et al proposed a theory that after initial double gloving, with removal of the outer gloves prior to handling instrumentation, SSI rates might be reduced. 66 This study evaluated 179 patients undergoing lumbar spinal fusion with instrumentation using a posterior approach. A significant reduction in SSI was noted with removal of the surgeon's outer pair of gloves prior to handling instrumentation, compared to wearing the same pair of double gloves the entire time.…”

Section: Surgical Glovesmentioning

confidence: 99%

Prevention of Surgical Site Infection in Spine Surgery

et al. 2017

View full text Add to dashboard Cite

BACKGROUND: Spine surgery is complicated by an incidence of 1% to 9% of surgical site infection (SSI). The most common organisms are gram-positive bacteria and are endogenous, that is are brought to the hospital by the patient. Efforts to improve safety have been focused on reducing SSI using a bundle approach. The bundle approach applies many quality improvement efforts and has been shown to reduce SSI in other surgical procedures. OBJECTIVE: To provide a narrative review of practical solutions to reduce SSI in spine surgery. METHODS: Literature review and synthesis to identify methods that can be used to prevent SSI. RESULTS: SSI prevention starts with proper patient selection and optimization of medical conditions, particularly reducing smoking and glycemic control. Screening for staphylococcus organisms and subsequent decolonization is a promising method to reduce endogenous bacterial burden. Preoperative warming of patients and timely administration of antibiotics are critical to prevent SSI. Skin preparation using chlorhexidine and alcohol solutions are recommended. Meticulous surgical technique and maintenance of sterile techniques should always be performed. Postoperatively, traditional methods of tissue oxygenation and glycemic control remain essential. Newer wound care methods such as silver impregnation dressing and wound-assisted vacuum dressing are encouraging but need further investigation. CONCLUSION: Significant reduction of SSIs is possible, but requires a systems approach involving all stakeholders. There are many simple and low-cost components that can be adjusted to reduce SSIs. Systematic efforts including understanding of pathophysiology, prevention strategies, and system-wide quality improvement programs demonstrate significant reduction of SSI.

show abstract

“…In addition, we included studies on glove change in hip and knee arthroplasty only. In a retrospective cohort study, Rehman et al . compared SSI rates before and after instituting a practice of removing outer gloves before handling implants during 389 lumbar spinal fusion cases.…”

Section: Discussionmentioning

confidence: 99%

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

Kim

Zhu

Munro

et al. 2018

ANZ Journal of Surgery

View full text Add to dashboard Cite

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.

show abstract

Removing Outer Gloves as a Method to Reduce Spinal Surgery Infection

Abstract: This study shows that the removal of an outer pair of gloves before handling instrumentation may be a simple, cost-effective, and practical way to reduce the burden of postoperative infection following lumbar spinal fusion.

Cited by 28 publications

References 16 publications

Cost and quality of life outcome analysis of postoperative infections after subaxial dorsal cervical fusions

Cost and quality of life outcome analysis of postoperative infections after subaxial dorsal cervical fusions

Prevention of Surgical Site Infection in Spine Surgery

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

Contact Info

Product

Resources

About