INTRODUCTION
Surgical gloves provide a protective barrier against blood borne pathogens
such as human immunodeficiency virus, hepatitis B and hepatitis C. Glove
perforation occurs frequently – in some types of surgery at a rate of up to 45%,
but is often unnoticed by the surgeon and nurse. One estimate suggested that a
surgeon risks more than one hepatitis infection per lifetime and more than one
in 1,500 surgeons is likely to be infected by HIV during the next 35 years
because of
damaged gloves.
One study has concluded that the use of a double gloving system featuring a
colored under-glove gives an accuracy of detection of 97%.This study therefore aimed
to compare puncture rates between this double gloving indicator system and
single-use gloves. It also aimed to determine the extent to which glove perforations
remain undetected during surgery.
METHOD
The study analyzed all gloves used at the Satakunta Central Hospital, Pori,
Finland in September and October 1999. The study was open and prospective and
randomization was made according to the year of birth of the patient – patients born in even
years were operated on with double gloving and those born in odd years were operated on with
single gloving. Gloves were tested using the approved standardized water-leak
test method EN455-1 where the glove is filled with water and checked for two
minutes to detect any holes.The gloves used in the study were either Biogel Indicator™
or Gammex and Nutex, which were the standard gloves used at the
hospital.
An analysis was made according to glove type, operating time, surgeon or
assistant and type of surgery. A comparison was also made to see whether or not glove
perforation was noticed during the operation.
RESULTS
In a total of 885 surgical procedures 2,462 gloves were tested – 1,020
single gloves, 1,148 double glove systems and 294 combination gloves were
studied. The overall perforation rate was 192 out of 2,462 gloves (7.8%) or 162
out of 885 operations (18.3%). The inner glove of the double-gloving system was
punctured in 6 out of 88 (6.8%) outer glove perforations. Detection of
perforation during surgery was 28 out of 76 (36.8%) with single gloves, 77 out
of 89 (86.5%) with the double gloving system and 9 out of 27 (33.3%) with combination
gloves.
CONCLUSION & COMMENT
The authors conclude that in order to maintain a sterile barrier between
surgeon and patient it is important to use a double gloving puncture indication
system, particularly in operations where there is a high risk of glove
perforation.