Surgeon‐patient barrier efficiency monitored with an electronic device in three surgical settings

Abstract

Blood-borne viral pathogens are an occupational threat to health care workers (HCWs), particularly those in the operating room. A major risk is posed by accidental penetrating injury, but skin contamination with body fluids from an infected patient, with prolonged intimate cutaneous contact, is a frequent occurrence during surgery, carrying further risk of transdermal infection. We have monitored barrier failure in three surgical settings (microsurgery, orthopedic surgery, general surgery) by means of an electronic surveillance device. A total of 111 surgical procedures were monitored: 67 microsurgeries, 22 orthopedic surgeries, and 22 general surgeries. Of the 278 electronic alarms signaling barrier failure, 44 (15.8%) were associated with glove perforation, 39 of which (88.6%) were not perceived by the operator. In 16 of those, the skin was visibly stained with the patient's blood. Altogether, 76 of the alarms (27.3%) were consequent to contacts caused by soaked gowns/sleeves, and 121 (43.5%) were attributed to hydration of latex porosities; 37 alarms (13.4%) were unexplained false positives. On only one occasion did a surgeon observe blood stains on his hands without a previous alarm; this event was classified as a device failure due to incorrect wiring. Double-gloving offered satisfactory protection against skin contamination during microsurgery but not during orthopedic surgery. The data presented here indicate that electronic monitoring of the surgical barrier enables prompt detection of barrier failure, especially at the level of the gloves, thereby limiting skin contamination with patients' body fluids during surgery.

Perfurações não detectadas de luvas em procedimentos de urgência

“…19 There are several methods available to assess glove integrity, such as the use of electronic devices, pressure-air insufflation, surgeon hand examination to detect the presence of blood and the water insufflation method proposed by Pieper et al, considered as a reliable and low-cost method. 11,20,21 In 2001, Hentz et al used an electronic device to detect glove leaks in 111 procedures and obtained 278 alarms. Only 16% of these alarms were associated with glove perforations, which, in the majority of cases (89%), were not perceived by the wearer.…”

“…The authors also observed that 13% of the alarms were false positive. 21 In 1989, Ottis & Cottoni studied the prevalence of perforations in disposable latex gloves during routine dental treatment and showed that, in order to maintain barrier integrity, they should be used for less than two hours. 22 In a recent study, Punyatanasakchai et al evaluated 150 sets of double gloves and 150 of single gloves for a seven-month period.…”

Hand Surgery on Patients Who Are “High Risk” For Blood-Borne Viruses

“…One study has also suggested that double gloving offers protection against skin contamination in microsurgical procedures (Hentz et al, 2001). A comfortable method of latex double gloving consists of wearing a one half-size larger than the normal inner glove, with a normal glove as the second layer (Smoot, 1998).…”

“…No double gloving system will prevent sharp injuries, but it does reduce cutaneous exposure (Cole and Gault, 1989; Greco and Garza, 1995; Marin-Bertolin et al, 1997; Smoot, 1998; Tanner and Parkinson, 2004; Thomas et al, 2001). One study has also suggested that double gloving offers protection against skin contamination in microsurgical procedures (Hentz et al, 2001). A comfortable method of latex double gloving consists of wearing a one half-size larger than the normal inner glove, with a normal glove as the second layer (Smoot, 1998).…”

Evidence‐based guideline for the prevention and management of perioperative infection

“…They could only provide a reference. The meta-analysis results of 3 index studies [147][148][149] showed that the perforation rate of double-layer gloves (or inner ) was significantly lower than that of single-layer gloves and 1 RCT using fluorescent markers to replace pathogens or blood contamination points as indicators 150 showed that the average number of contamination sites in the single-layer glove group was 4.1 times that of the double-layer glove group.…”