Review: double gloving during surgery prevents perforations of the inner glove, but its effect on infection is unknown.
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Comment↗
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[Does the use of disposable gloves provide sufficient protection against pathogenic agents? Results of a study of commonly used disposable gloves].
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Bacterial Infections↗
[The sign of the "bloated glove" ("pudgy glove")].
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Acromegaly↗
Double gloving to reduce surgical cross-infection.
BACKGROUND: The invasive nature of surgery, with its increased exposure to blood, means that during surgery there is a high risk of transfer of pathogens. Pathogens can be transferred through contact between surgical patients and the surgical team, resulting in post-operative or blood borne infections in patients or blood borne infections in the surgical team. Both patients and the surgical team need to be protected from this risk. This risk can be reduced by implementing protective barriers such as wearing surgical gloves. Wearing two pairs of surgical gloves, triple gloves, glove liners or cloth outer gloves, as opposed to one pair, is considered to provide an additional barrier and further reduce the risk of contamination. OBJECTIVES: The primary objective of this review was to determine if additional glove protection reduces the number of surgical site or blood borne infections in patients or the surgical team. The secondary objective was to determine if additional glove protection reduces the number of perforations to the innermost pair of surgical gloves. The innermost gloves (next to skin) compared with the outermost gloves are considered to be the last barrier between the patient and the surgical team. SEARCH STRATEGY: We searched the Cochrane Wounds Group Specialised Register (January 2006), and the Cochrane Central Register of Controlled Trials (CENTRAL)(The Cochrane Library Issue 4, 2005). We also contacted glove manufacturing companies and professional organisations. SELECTION CRITERIA: Randomised controlled trials involving: single gloving, double gloving, triple gloving, glove liners, knitted outer gloves, steel weave outer gloves and perforation indicator systems. DATA COLLECTION AND ANALYSIS: Both authors independently assessed the relevance and quality of each trial. Data was extracted by one author and cross checked for accuracy by the second author. MAIN RESULTS: Two trials were found which addressed the primary outcome, namely, surgical site infections in patients. Both trials reported no infections. Thirty one randomised controlled trials measuring glove perforations were identified and included in the review. Fourteen trials of double gloving (wearing two pairs of surgical latex gloves) were pooled and showed that there were significantly more perforations to the single glove than the innermost of the double gloves (OR 4.10, 95% CI 3.30 to 5.09). Eight trials of indicator gloves (coloured latex gloves worn underneath latex gloves to more rapidly alert the team to perforations) showed that significantly fewer perforations were detected with single gloves compared with indicator gloves (OR 0.10, 95% CI 0.06 to 0.16) or with standard double glove compared with indicator gloves (OR 0.08, 95% CI 0.04 to 0.17). Two trials of glove liners (a glove knitted with cloth or polymers worn between two pairs of latex gloves)(OR 26.36, 95% CI 7.91 to 87.82), three trials of knitted gloves (knitted glove worn on top of latex surgical gloves)(OR 5.76, 95% CI 3.25 to 10.20) and one trial of triple gloving (three pairs of latex surgical gloves)(OR 69.41, 95% CI 3.89 to 1239.18) all compared with standard double gloves, showed there were significantly more perforations to the innermost glove of a standard double glove in all comparisons. AUTHORS' CONCLUSIONS: There is no direct evidence that additional glove protection worn by the surgical team reduces surgical site infections in patients, however the review has insufficient power for this outcome. The addition of a second pair of surgical gloves significantly reduces perforations to innermost gloves. Triple gloving, knitted outer gloves and glove liners also significantly reduce perforations to the innermost glove. Perforation indicator systems results in significantly more innermost glove perforations being detected during surgery.
Blood-Borne Pathogens↗
The effects of gloves on grip strength and three-point pinch.
No-glove, leather-glove, nitrile-glove, and vinyl-glove conditions were evaluated to determine their effects on grip strength and three-point pinch. Forty-one adult volunteers from a local university and local hospital participated in the two-day study. The order of testing was randomly assigned. A hydraulic hand dynamometer and a hydraulic pinch gauge were used to evaluate grip strength and three-point pinch with no glove and with each glove type. Grip strength and three-point pinch were tested on separate days. Grip strength test results showed statistically significant differences (p < 0.05) for no glove vs. leather glove, no glove vs. nitrile glove, no glove vs. vinyl glove, leather glove vs. nitrile glove, and leather glove vs. vinyl glove, but no statistically significant difference for nitrile glove vs. vinyl glove. Three-point pinch test results also showed statistically significant differences (p < 0.05) for no glove vs. leather glove, leather glove vs. nitrile glove, and leather glove vs. vinyl glove, but no statistically significant differences for no glove vs. nitrile glove, no glove vs. vinyl glove, and nitrile glove vs. vinyl glove. The results indicate that glove type may have clinical applications for occupational and physical therapists whose patients use gloves in the workplace.
Adolescent↗
Biomechanical performance of latex and non-latex double-glove systems.
The purpose of this study was to evaluate ten commercially available latex, powder-free surgical gloves and four commercially available non-latex, powder-free surgical gloves using standardized, reproducible biomechanical parameters that included glove thickness, puncture resistance, and glove donning force. For all gloves tested, with one exception (Neolontrade mark PF), puncture resistance increased for double-gloves as compared to single-gloves. In addition, single-glove thickness was not a reliable determinant of puncture resistance for either latex or non-latex gloves. For the latex gloves, the Ultrafree double and single-gloves exhibited the highest puncture resistance. The glove donning forces for the Biogeltrade mark M and Biogel Sensortrade mark single-gloves were the lowest. In contrast, the Biogel Revealtrade mark and Encoretrade mark Ultra-Thick exhibited the lowest double-glove donning forces. On the basis of these performance tests of latex gloves, the surgeon should consider the Biogel Reveal as well as the Ultrafree gloves for their latex double-glove system. For the non-latex gloves, the Pure Advantage Nitriletrade mark glove had the highest puncture resistance for one layer and two layers of glove material. The thin Pure Advantage Nitrile glove was the most resistant to glove puncture. The Pure Advantage Nitrile glove had low glove donning forces for both single-glove donning configurations and double-glove donning configurations. Consequently, we recommend the Pure Advantage Nitrile glove as the powder-free, non-latex, double-glove system.
Biomechanical Phenomena↗
Anatomy of a defective barrier: sequential glove leak detection in a surgical and dental environment.
OBJECTIVES: a) To determine the frequency of perforations in latex surgical gloves before, during, and after surgical and dental procedures; b) to evaluate the topographical distribution of perforations in latex surgical gloves after surgical and dental procedures; and c) to validate methods of testing for latex surgical glove patency. DESIGN: Multitrial tests under in vitro conditions and a prospective sequential patient study using consecutive testing. SETTING: An outpatient dental clinic at a university dental school, the operating suite in a medical school affiliated with the Veteran's Hospital, and a biomechanics laboratory. PERSONNEL: Surgeons, scrub nurses, and dental technicians participating in 50 surgical and 50 dental procedures. METHODS: We collected 679 latex surgical gloves after surgical procedures and tested them for patency by using a water pressure test. We also employed an electronic glove leak detector before donning, after sequential time intervals, and upon termination of 47 surgical (sequential surgical), 50 dental (sequential dental), and in three orthopedic cases where double gloving was used. The electronic glove leak detector was validated by using electronic point-by-point surface probing, fluorescein dye diffusion, as well as detecting glove punctures made with a 27-gauge needle. RESULTS: The random study indicated a leak rate of 33.0% (224 out of 679) in latex surgical gloves; the sequential surgical study demonstrated patency in 203 out of 347 gloves (58.5%); the sequential dental study showed 34 leaks in the 106 gloves used (32.1%); and with double gloving, the leak rate decreased to 25.0% (13 of 52 gloves tested). While the allowable FDA defect rate for unused latex surgical gloves is 1.5%, we noted defect rates in unused gloves of 5.5% in the sequential surgical, 1.9% in the sequential dental, and 4.0% in our electronic glove leak detector validating study. In the sequential surgical study, 52% of the leaks had occurred by 75 mins, and in the sequential dental study, 75% of the leaks developed by 30 mins. In terms of the anatomical localization, the thumb and forefinger accounted for more than 60% of the defects. There were no differences in the frequency of glove leaks between the left and right hand. Leak rates were highest for the surgeon (52%), followed by the first assistant (29%) and the scrub nurse (25%). No false negatives were noted using the electronic glove leak detector; one false positive was seen out of 225 gloves tested (0.44%), as noted in our validation studies. CONCLUSIONS: Significantly high glove leak rates were noted after surgical and dental procedures, indicating that the present day latex surgical gloves can become an incompetent barrier once they are used. Unused latex surgical gloves demonstrated a higher rate of defects than allowed by the Food and Drug Administration standards, indicating substantial noncompliance of quality control standards by manufacturers as well as inadequate governmental oversight. Double gloving, or the use of thicker latex surgical gloves, would probably reduce the frequency of glove leaks. Latex surgical gloves should be tested for patency before use and during surgical and dental procedures.
Dentistry↗
Biomechanical performance of orthopedic gloves.
The purpose of this study was to compare the biomechanical performance of commercially available orthopedic gloves to that of a single surgical glove, as well as a double glove system. The orthopedic gloves were found to be thicker than the single surgical glove. This increased thickness of the orthopedic glove was associated with a greater resistance to glove puncture. The thickest orthopedic gloves also had reduced tactile sensitivity when compared to the single surgical glove. In addition, the glove donning forces and glove hydration rates varied considerably. These latter biomechanical performance parameters were not significantly related to glove thickness. The double glove systems tested in this study had similar performance characteristics in regard to many of the orthopedic gloves. The glove donning forces for the double glove systems were the lowest of the gloves tested. In addition, the double glove systems displayed the greatest resistance to glove hydration of the gloves tested. Their performance in the glove hydration tests and the force required to don the double glove systems were much more desirable than any of the orthopedic gloves. The results of this study indicate that the double glove systems may provide a desirable alternative to the use of the single orthopedic gloves.
Biocompatible Materials↗
A prospective study of the efficacy of various gloving techniques in the application of Erich arch bars.
PURPOSE: This is a prospective study of the efficacy of three different techniques of triple gloving during the application of Erich arch bars. Two different cut-resistant glove liners and three layers of latex gloves were compared with double gloving. METHODS AND MATERIALS: Thirty patients underwent Erich arch bar placement from first molar bilaterally on both arches. Two surgeons per case were arbitrarily placed into one of four groups that included double latex gloving, triple gloving with kevlar or stainless steel glove liners, or triple layer latex gloving, based on the availability of glove liners. All gloves were collected postoperatively and tested for perforation using water insufflation. RESULTS: One hundred eight of 120 outer gloves were perforated. There were 16 perforations in 11 inner gloves of the double latex glove group, but no perforations in the inner gloves of the triple latex glove group. There were two inner gloves with one perforation each in the stainless steel group and one glove with a perforation in the kevlar group. All techniques of triple gloving were found to be superior to double gloving. There was no difference between the techniques of triple gloving. CONCLUSION: During certain high-risk procedures greater protection to the surgeon can be obtained by triple gloving. The use of cut-resistant glove liners or triple layer latex gloving is superior to double layer latex gloving.
Equipment Design↗
[Protein content of latex gloves used in hospitals].
In this study the total protein content and the latex allergenic protein content in different types of medical gloves commonly used in our hospital were evaluated. The correlation between these two parameters and the correctness of the data provided by the glove manufacturers have been also verified. The main purpose of this study was to acquire information useful for preventing latex allergy in our hospital personnel. 29 different types of medical gloves were examined. The total protein contents were evaluated with Lowry modified method and the allergenic latex protein contents were evaluated with RAST-inhibition assay, both on glove samples and glove extracts. The correlation between inhibition percentages found in glove samples and in glove extracts and the correlation between total protein content and inhibition percentages determined in samples of the same gloves was verified. The highest concentrations of total proteins and allergenic latex proteins were found in examination powdered latex gloves and in surgical powdered latex gloves. A good correlation was observed between the total protein content and the inhibition percentages determined in samples of the same gloves, and between inhibition percentages found in glove samples and glove extracts. A significant amount of latex proteins was found in some brands of nitryl gloves. The clear association between the total protein levels and the allergenic latex protein levels suggests that the gloves with highest total protein content have the greatest allergenic potential. We believe that the total protein content is relevant from a preventive point of view for a proper gloves selection in the workplaces. Therefore, manufacturing companies should provide package inserts including at least the total protein contents and possibly allergenic latex protein levels, with specific measurement methods. Since the highest total protein and allergenic latex protein contents were found in latex powdered gloves, powder-free gloves must be of first choice. RAST-inhibition assays directly on glove samples instead of glove extract seems to be a good reliable and faster alternative for the evaluation of the allergenic potential of latex gloves. For latex allergic subjects it is necessary to pay attention in choosing nitryl gloves, especially as an alternative to natural rubber gloves since some brands may contain significant amounts of allergenic latex proteins.
Allergens↗
Health care workers: risk factors for nonlatex and latex gloves during surgery.
This study examined glove failure and related factors in both nonlatex and latex surgical gloves after routine use. A federally funded research study was conducted to collect surgical gloves from those directly involved in surgical procedures. All gloves were examined in the laboratory for both visual defects and barrier integrity. A total of 11,118 usable surgical gloves were examined. The overall defect rate was 7.8%; nonlatex gloves were significantly more likely to fail (8.4%) than latex gloves (6.9%). The majority of defects in the latex gloves (90%) and nonlatex gloves (70%) were not detected by visual examination. Separate logistic regression models examined predictors of defects for the gloves. The only factor that increased the odds of a defect for a latex glove was duration of use over 6 hours. Factors increasing the odds of a defect in nonlatex gloves included gloves worn by a scrub person and gloves used in certain surgical services. Scrub persons had a higher defect rate despite wearing their gloves for a significantly shorter time than other health care workers. Latex and nonlatex gloves fail under different conditions. Latex gloves fail primarily due to length of use, whereas nonlatex gloves are more sensitive to conditions of us (e.g., type of health care worker and type of surgery). Providers can help guard against glove defects by double gloving and by changing gloves often, especially when using nonlatex gloves in higher-risk surgeries.
Equipment Failure↗
In-use barrier integrity of gloves: latex and nitrile superior to vinyl.
BACKGROUND: Although gloves manufactured with different materials have comparable barrier properties when removed directly from the box and tested, their actual on-the-job barrier performance may be extremely different. Although effective in static, pre-use conditions, barrier properties may be compromised once challenged by the rigorous hand and finger movements associated with many health care procedures. Gloves are meant to act as barriers, protecting persons by reducing the risk of exposure to bloodborne pathogens. Ineffective barriers or barriers that are easily breached during risk-associated procedures have the potential to place health care professionals at risk. Multiple studies attesting to the barrier attributes of vinyl and latex gloves during varied controlled clinical situations are available. Studies are available that address the permeation characteristics of nitrile, but no studies document the effectiveness of nitrile as a barrier to bloodborne pathogens or compare the barrier effectiveness of nitrile to gloves made of other materials during simulated use or clinical situations. OBJECTIVE: This study was undertaken to compare the barrier integrity of latex, vinyl, and nitrile gloves during controlled, simulated clinical use conditions that were specifically designed to mimic patient care activities. This study compares the performance of gloves made of natural rubber latex, long considered the gold standard; polyvinyl chloride (vinyl), a synthetic copolymer; and nitrile (acrylonitrile butadiene), a recently available synthetic for use in the health care environment. METHODS: A total of 2000 gloves (800 latex gloves, 800 vinyl gloves, and 400 nitrile gloves) were evaluated for baseline determinations in unused gloves and for failure rates after specific simulated use conditions. Potential bias was avoided through strict control of all actions and manipulations. Gloves were graded on a pass or fail system for leaks as defined by American Society for Testing and Materials D5151, Standard Test Method for Detection of Holes in Medical Gloves. To more fully characterize the gloves evaluated, individual products were also tested for physical dimensions (finger and palm thickness), powder levels, total protein (Modified Lowry), and antigenic protein (Latex ELISA [enzyme-linked immunosorbent assay] for Antigenic Proteins). RESULTS: With the exception of one vinyl glove brand with a 12% failure rate, no significant differences in failure rates were detected among the 3 types of gloves when tested directly out of the box with no manipulation. However, after manipulation intended to simulate in-use conditions, vinyl gloves failed 12% to 61% of the time. Latex and nitrile performed significantly better, with failure rates of only 0% to 4% and 1% to 3%, respectively. All latex gloves, with one exception, tested at less than 50 microg/g of total water extractable protein. The antigenic protein levels, with one exception, tested from less than 0.2 microg/g to 5.5 microg/g. The one latex product that fell outside these values had 154 microg/g of total protein and 105.7 microg/g of antigenic protein. CONCLUSIONS: This study indicates that the latex and nitrile gloves evaluated were comparable in terms of barrier performance characteristics both unused and during manipulations mimicking patient care procedures. Whereas stretch vinyl exhibited lower failure rates than standard vinyl, the higher in-use leakage rates associated with all vinyl gloves tested indicate decreased durability and, potentially, compromised barrier protection when this synthetic is used. Careful consideration to the degree of barrier effectiveness should be given before glove selection when the potential exposure to bloodborne pathogens or biohazard risks is a concern.
Equipment Failure↗
Resistance of double-glove hole puncture indication systems to surgical needle puncture.
Double-gloving has been shown to reduce conclusively the risk of operating room personnel's exposure to blood. Limiting risk of exposure to blood by double-gloving provides protection against the transmission of bloodborne diseases. Realizing the importance of double-gloving, a double-glove hole puncture indication system exists that accurately detects the presence of glove hole puncture in the presence of fluid. Once a glove puncture is recognized by this double-glove hole puncture indication system, it provides a warning to the surgeon to remove the punctured gloves, wash hands, and don a new, sterile double-glove hole puncture indication system. While accurately identifying the presence of glove hole puncture in the presence of fluid, this double-glove hole puncture indication system also has resistance to needle puncture superior to that of single gloves. It is the purpose of this study to document the resistance to needle puncture of latex and non-latex double-glove hole puncture indication systems using a reproducible experimental model. The resistance to needle puncture of the double-glove systems was significantly greater than that of the undergloves or outer gloves alone. The resistance to glove puncture of the non-latex and latex single and double-glove systems was significantly greater than those encountered by the latex single and double-glove systems, respectively. On the basis of their accuracy in detecting glove hole puncture, combined with their demonstrated superior resistance to surgical needle puncture as compared to single gloves, these latex and non-latex double-glove hole puncture indication systems are recommended for all surgical procedures.
Equipment Design↗
Frequency of glove perforations and subsequent blood contact in association with selected obstetric surgical procedures.
OBJECTIVE: One purpose of this prospective investigation was to assess the frequency of glove perforations and subsequent blood contact associated with selected obstetric procedures. The second purpose was to assess the relative risk of perforation among different members of the surgical team and determine if time of day or urgency of the procedure affected the frequency of perforation. STUDY DESIGN: Over a 3-month period, obstetric personnel were asked to double glove for all surgical procedures. After surgery, they placed their gloves in plastic bags and noted the type of procedure, time of day, and position on the surgical team. They also indicated whether they were aware of a glove tear and, if so, whether blood or fluid was on their hands. Gloves were tested for injury by two methods: by inflating them with air and subsequently immersing them in water to detect air bubbles and by directly filling them with water to observe for leaks. RESULTS: A total of 540 glove sets (2160 individual gloves) were examined; 407 sets were from cesarean deliveries, 65 from puerperal tubal ligations, and 68 from vaginal deliveries. Sixty-seven of the sets (12.4%, 95% confidence interval 9.6% to 15.2%) had at least one hole; the total number of holes was 78. Sixty-six holes were in the outer glove only, and 7 were in the inner glove only. In five sets (0.9%, 95% confidence interval 0.5% to 1.3%) there were matching holes in the outer and inner gloves. In two of these cases (0.4%, 95% confidence interval 0.1% to 0.7%) the surgeons noted blood on their hands at the conclusion of the procedure. The difference in frequency of injury in outer versus inner gloves was highly significant (p < 0.005). Forty-six of the 78 holes (59%) were on the thumb or first two fingers of the nondominant hand. Only 2 (3%) of the glove tears were recognized by the surgeon. There was no difference in frequency of glove tears when cesarean sections were classified as urgent versus nonurgent. There also was no difference in frequency of glove tears in procedures performed at night compared with those during the daytime. Surgical nurses had 36% of all glove injuries and were more likely than physicians or medical students to sustain perforations (p < 0.005). Primary surgeons and first assistants were more likely than second assistants to sustain glove injuries (p < 0.05). For primary surgeons and first assistants, level of training did not significantly affect the frequency of glove perforations. CONCLUSIONS: Glove perforations occur in approximately 12% of obstetric surgical procedures. Surgical nurses are at greatest risk for perforation. Double gloving reduces the likelihood of penetrating injury to the inner glove and subsequent risk of blood contact.
Blood↗
The mechanical and microbiological integrity of surgical gloves.
BACKGROUND: Several manufacturers supply surgical gloves that have been individually tested (IT) for leaks. Other manufacturers supply gloves in which sample gloves from each batch are tested for leaks (batch tested: BT). The latter brands may be rejected by surgeons because of presumed increased risk of wound infection and staff exposure to patient pathogens. The influence of differences between glove brands on performance in surgery has not been extensively studied. The aims of the present study were to test the mechanical and microbiological integrity of IT compared to BT gloves. METHODS: A total of 110 unused gloves from each of an IT and a BT brand were tested for leaks, first, by observation of water-jets from water-filled gloves and second, by measuring electrical resistance between inside and outside the glove surfaces, to give a baseline measure. A total of 304 IT and 280 BT gloves were then similarly leak-tested after 98 clean surgical procedures. The hands and gloves of scrub team members were cultured postsurgery. RESULTS: A total of 1/110 BT and 0/110 IT unused gloves contained leaks (NS, Fisher's exact test). Operative perforation rates were lower for BT compared with IT (8/280 cf. 22/304; P < 0.05 Fisher's exact test). There was no bias in types of operations or scrub team members to account for the difference. Growth of normal skin flora was found on virtually every wearer's hands post-operatively. Similar bacteria were frequently cultured from the outside of gloves at the conclusion of surgery (111/152 pairs IT cf. 122/140 pairs BT; P < 0.01, Fisher's exact test). CONCLUSION: This study provides evidence that the clinical performance of BT gloves is no different to IT gloves. There was no significant difference in mechanical leak rates for unused gloves. Paradoxically, although IT gloves were more likely to show macro-perforations after surgery, the incidence of contamination on the surface of BT gloves was greater, possibly reflecting a qualitative difference in glove material. This study suggests that both types of gloves develop microporosity during use, which may allow transfer of bacteria from the surgeon's skin to the surface of the glove.
Disease Transmission, Infectious↗
Ease of donning of new powder-free non-latex and latex double-glove hole puncture indication systems.
Cornstarch on surgical gloves is often used as a detackifying agent and a lubricant to facilitate glove donning. During the last century, scientific studies have demonstrated that cornstarch produces tissue injury in literally every part of the body. Because this glove lubricant cannot be removed from the glove, Dr. David Podell, an ophthalmologic surgeon, and his cousin, Howard Podell, a chemical engineer, devised the first powder-free surgical glove that could be donned easily. They coated the inner surface of the surgical glove with a methacrylate polymer lining that was bonded to the natural rubber latex. This special coating acts as a lubricant to facilitate donning with damp, wet, or dry hands. In our earlier experimental studies, we confirmed that these polymer-lined latex gloves could be donned with either wet or dry hands. More recently, the polymer-coated latex gloves were incorporated into a double-glove hole puncture indication system that accurately detected glove holes in the presence of fluid. Because this discovery has been expanded into the development of a non-latex double-glove hole puncture indication system, we have expanded our biomechanical performance studies to examine the glove donning forces of the latex and non-latex glove hole puncture indication systems. The maximum donning forces recorded for the non-latex undergloves were significantly lower than those encountered by the same respective sizes of the latex underglove. The donning forces of the thin Biogel Super-Sensitive outer gloves were remarkably similar to the donning forces of the Biogel Indicator undergloves. The thicker Biogel outer gloves encountered greater donning forces than that noted for the Biogel Super-Sensitive outer gloves. The donning forces recorded for the non-latex outer gloves were remarkably similar to those noted for the latex Biogel outer gloves. Because the results of this biomechanical performance study demonstrated that the latex and non-latex double-glove hole puncture indication systems can be easily donned by surgeons using relatively low donning forces, this study provides convincing evidence that these double-glove hole puncture indication systems can be used in all surgical procedures.
Biomechanical Phenomena↗
Glove tears during arthroscopic shoulder surgery using solid-core suture.
PURPOSE: Surgeons have noticed an increased incidence of finger lacerations associated with arthroscopic knot tying with solid-core suture material. This study examines glove perforations and finger lacerations during arthroscopic shoulder surgery. METHODS: We collected 400 surgical gloves from 50 consecutive arthroscopic shoulder repair procedures using No. 2 solid-core sutures. Two surgeons using double gloves were involved in every case, with one being responsible for tying all knots. Powder-free latex gloves were worn in all cases. Knots consisted of a sliding stitch of the surgeon's preference followed by 3 half-hitches via a knot-pusher instrument. All gloves were inspected grossly and then tested for tears with an electroconductivity meter. RESULTS: The knot-tying surgeon had significantly more glove tears than the control (P < .01). Tears were localized to the radial side of the index finger of the glove at the distal interphalangeal joint in all cases. Of the tying surgeon's gloves, 68 (34%) were found to have tears. These included 17 inner gloves (17%) and 51 outer gloves (51%). If an inner glove was torn, the corresponding outer glove was torn in all cases. A mean of 3.96 knots were tied in each case. There was a significantly higher incidence of inner glove tears when more than 3 knots were tied (P < .03). There was no significant difference in glove tears between suture types. Finger lacerations did occur in the absence of glove tears. However, in the presence of an inner glove tear, there was a statistically significant association with a finger laceration at the corresponding level (P < .03). CONCLUSIONS: Intraoperative glove tears and subsequent finger lacerations occur with a high frequency when arthroscopic knots are tied with solid-core suture material. Risk can potentially be minimized by frequent glove changes or use of more durable, less penetrable gloves. CLINICAL RELEVANCE: This study addresses surgeon and patient safety during arthroscopic shoulder surgery.
Arthroscopy↗
An evaluation of the permeability of chemotherapy gloves to three cancer chemotherapy drugs.
PURPOSE/OBJECTIVES: To evaluate the permeability of chemotherapy gloves when using carmustine (BCNU), etoposide, and paclitaxel, which were selected based on their reported toxicity and unique solvent systems. SAMPLE: Thirteen brands of chemotherapy gloves and one brand of examination glove. Of the 14 glove types tested, 11 were made of latex, and 3 were made of nitrile. METHODS: Ten samples of each type of glove were evaluated using rigorous laboratory test conditions usually not encountered in normal usage. The thickness of the gloves was measured using a digital caliper. The glove material was secured over glass vials containing the drug solution and inverted in plastic cell wells containing a filter paper disc. After a two-hour exposure time, the filter paper discs were removed and analyzed for the presence of the drug. MAIN RESEARCH VARIABLES: Permeability (i.e., greater than or equal to 1% of the total amount of drug passing through the glove material.) FINDINGS: All 14 types of gloves tested were impermeable to BCNU at two hours of exposure. Only two gloves, the Ansell Perry EP glove and the U.S. Clinical Chemo Bloc T glove, were impermeable to all three drugs. The remaining 12 gloves all demonstrated some level of permeation with etoposide at two hours, although 9 of the gloves had only 1 of 10 samples that were permeable. In all cases, percent of permeation was less than 2% of the amount of the drug in the test solution. Thirteen gloves tested for paclitaxel permeability were impermeable at the two-hour time period. CONCLUSIONS: The results of this study indicate that most of the chemotherapy gloves on the market are either impermeable or minimally permeable to these three chemotherapy drugs. IMPLICATIONS FOR NURSING PRACTICE: Because gloves are universally recognized as a means of personal protection when handling cancer chemotherapy drugs, selection of a glove that is impermeable would be an obvious choice for healthcare workers. Although the present study was a static, laboratory-based study that did not duplicate actual work practice conditions. It should offer some guidance in the selection of glove types when handling chemotherapy drugs.
Antineoplastic Agents, Alkylating↗