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In procedures lasting more than two hours, the rate of glove perforations ranges from 8% to 50%, according to a study published in the June issue of the Archives of Surgery.
Sterile gloves worn by surgical staff can be perforated by needles, bone fragments and sharp surgical instruments, and the resulting holes enable skin-borne pathogens to travel from the hands of surgical staff into patients.
In the study, Dr. Heidi Misteli and colleagues analyzed 4,417 surgical procedures performed at University Hospital Basel between 2000 and 2001, and found that sterile glove perforations occurred in 677 of the surgeries. Antibiotic therapy given before surgery to prevent infection was used in 3,233 of the surgeries, including 605 of the surgeries involving perforated gloves.
Overall, there were 188 surgical site infections (4.5% of surgeries), with 7.5% of infections occurring in procedures performed with perforated gloves and 3.9% occurring in procedures where gloves remained intact, the researchers found.
In surgeries where antibiotics were used, glove perforation wasn't associated with surgical site infection. Among patients who didn't receive antibiotics, surgical site infection rates were 12.7% when glove perforation occurred and 2.9% when there was no glove perforation.
"The present results support an extended indication of surgical antimicrobial prophylaxis [antibiotics] to all clean procedures in the absence of strict precautions taken to prevent glove perforation," Misteli and colleagues concluded. "The advantages of this surgical site infection prevention strategy, however, must be balanced against the costs and adverse effects of the prophylactic antimicrobials, such as drug reactions or increased bacterial resistance."
The study authors noted that procedures to reduce the risk of glove perforation -- such as double gloving and replacing gloves more frequently --are effective and safe and should be encouraged.
-- Robert Preidt
SOURCE: JAMA/Archives journals, news release, June 15, 2009
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