Postoperative Integrity of Veterinary Surgical Gloves

Character, Ben J.; McLaughlin, Richard A.; Hedlund, Cheryl S.; Boyle, Carolyn R.; Elder, Steven H.

doi:10.5326/0390311

Cited by 18 publications

(33 citation statements)

References 10 publications

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“…Interestingly, there was no difference in perforation rate between residents and faculty members acting as the primary surgeon. Character et al reported a higher rate of perforation in faculty members and suggested that more experienced surgeons are more aggressive, but this was not supported in our study. Individuals performing surgery did not accurately predict the presence or absence of glove defects, and in only 17% of procedures were they aware of a perforation.…”

Section: Discussioncontrasting

confidence: 93%

“…The overall incidence of postoperative glove perforations in our study was 18%. This is within the range of the incidence reported in other veterinary studies (10.2–26.2%) . These studies reported a similar increased risk for punctures in the nondominant hand, on gloves worn by the primary surgeon, and in surgeries of longer duration.…”

Section: Discussionsupporting

confidence: 87%

“…Surgeon‐based intraoperative glove contamination may be a result of glove puncture and bacterial migration from the surgeon's hand to the glove surface. The frequency of intraoperative glove puncture in veterinary medicine ranges from 10.2–26.2% …”

mentioning

confidence: 99%

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Survey of Intraoperative Bacterial Contamination in Dogs Undergoing Elective Orthopedic Surgery

Andrade¹,

Schmiedt²,

Cornell³

et al. 2016

Veterinary Surgery

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Objective: To investigate the frequency, source, and risk factors of intraoperative (IO) surgeon and patient bacterial contamination during clean orthopedic surgeries, and to investigate the relationship between IO contamination and surgical site infection (SSI) in dogs. Study Design: Prospective clinical study. Sample Population: Client-owned dogs undergoing stifle surgery (n ¼ 100). Methods: IO cultures were taken in each case from surgical foot wrap, peri-incisional skin, surgical gloves, and the surgical team's hands. The environment (operating room [OR] lights, computers, scrub sink faucet, anesthesia gurney, and radiology table) was sampled every 5 months. Bacteria were identified and the contamination of each case was categorized. All gloves from the surgical team were collected and tested for perforations using a water infusion test. Cases were followed for at least 8 weeks to determine the presence or absence of SSI. Perioperative variables were evaluated for association with IO contamination and SSI. Results: Bacterial isolates were yielded from 81% of procedures from 1 or more sources; 58% had positive hand cultures, 46% had positive glove cultures, 23% had positive patient skin cultures, and 12% had positive foot wrap cultures. Staphylococcus spp. was the most commonly recovered bacteria. There was no apparent association between IO contamination and SSI. The highest level of environmental contamination was associated with the scrub sink faucet, followed by the radiology table, anesthesia gurney, and OR computers. The IO glove perforation rate was 18%. Conclusion: Clean orthopedic procedures commonly had clinically insignificant bacterial contamination. In our study, bacteria responsible for SSI did not appear to colonize the patient in the OR. In the veterinary literature, surgical site infection (SSI) rates for patients undergoing clean surgical procedures range from 3.6-5.8%. 1-3 Infection occurs despite adherence to well-accepted standards of surgical technique and environmental control designed to maintain a sterile surgical field. 4 Little objective information is available to validate how successfully these techniques control intraoperative contamination of surgical gloves, patient wraps, patient skin, and surgeon skin. In addition, it is not known how bacteria associated with surgical procedures influence complications. Understanding the bacterial ecology of veterinary operating rooms during the intraoperative period is critical in the search for the source of SSI, and allows for the development of evidence-based strategies to control the impact of pathogenic microbes in the surgical environment. In human surgical practice, published intraoperative glove contamination rates range from 14-56%. 5,6 Studies have not reported a clear primary source of contamination. One study reported surgical personnel, followed by the patient, and operating room environment as the most common sources of contamination 7 ; however, another study reported the operating room environment as the major source, followe...

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Section: Discussioncontrasting

confidence: 93%

Section: Discussionsupporting

confidence: 87%

See 1 more Smart Citation

Survey of Intraoperative Bacterial Contamination in Dogs Undergoing Elective Orthopedic Surgery

Andrade¹,

Schmiedt²,

Cornell³

et al. 2016

Veterinary Surgery

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show abstract

“…Furthermore, glove punctures have been reported to occur in up to 34-43% of human surgical procedures [29-31]. In a study performed at two companion animal hospitals, glove punctures were found in one or both gloves in 148/382 (38.7%) glove pairs, and personnel were typically unable to predict whether or not a glove defect was present at the end of procedures [32]. Proper hand antisepsis prior to gloving for surgery therefore remains critical.…”

Section: Discussionmentioning

confidence: 99%

Observational study of patient and surgeon preoperative preparation in ten companion animal clinics in Ontario, Canada

2013

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BackgroundSurgical site infections (SSIs) are a recognized risk of any surgical procedure in veterinary medicine. One of the keys to prevention of SSIs is reducing exposure of the surgical site to endogenous and exogenous microbes, beginning in the preoperative period. While guidelines are available for preoperative preparation procedures, there has been no objective investigation of compliance with these recommendations in veterinary practices. The objectives of this pilot study were to describe preoperative patient and surgeon preparation practices in a sample of non-equine companion animal veterinary clinics, and to determine if there were any areas that consistently did not meet current guidelines.ResultsObservation of preparation practices was performed in 10 clinics over 9–14 days each using up to 3 small wireless surveillance cameras. Data were coded for 148 surgical patients, and 31 surgeons performing 190 preoperative preparations. When patient hair removal was observed, it was most commonly done using clippers (117/133, 88%), and in only one case was it performed prior to anesthetic induction. Patient contact time with soap ranged from 10-462 s (average of clinic means 75 s, average of clinic medians 67 s), and with alcohol from 3-220 s (average of clinic means 44 s, average of clinic medians 37 s). Alcohol-based hand rub (AHR) was used preoperatively in 2/10 facilities, but soap-and-water hand scrub was most commonly used at all clinics. Proximal-to-distal scrubbing was noted in 95/142 (67%) of soap-and-water scrubs. Contact time during surgeon hand preparation ranged from 7-529 s (average mean 121 s, average median 122 s) for soap-and-water and from 4-123 s (average mean 25 s, average median 19 s) for AHR. No significant changes in practices were identified over time during the observation period. Practices that did not conform to guidelines available in major companion animal surgical textbooks were commonly observed.ConclusionsSome preoperative preparation practices were relatively consistent between clinics in this study, while others were quite variable. Contact times with preoperative preparatory solutions for both patients and surgeons were often shorter than recommended. Evidence-based guidelines for these procedures in veterinary medicine should be established and implemented in order to help reduce preventable SSIs, while maintaining efficiency and cost-effectiveness.

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“…However, risk factors for other orthopedic instrumentation were not investigated. An additional veterinary study also identified orthopedic surgery as a risk factor for glove perforation and documented defects in 32% of procedures compared with 19% of soft tissue procedures …”

mentioning

confidence: 99%

Colored Indicator Undergloves Increase the Detection of Glove Perforations by Surgeons During Small Animal Orthopedic Surgery: A Randomized Controlled Trial

et al. 2016

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ObjectiveTo determine whether use of colored indicator gloves affects perforation detection rate and to identify risk factors for glove perforation during veterinary orthopedic surgery.Study DesignProspective randomized controlled trial.Sample Population574 double pairs of gloves worn during 300 orthopedic surgical procedures (2,296 gloves).MethodsPrimary and assistant surgeons double‐gloved for all orthopedic surgical procedures. Type of inner glove (standard or colored indicator) was randomized for the first 360 double pairs of gloves worn by surgeons during 180 procedures. Perforations detected by surgeons were recorded and gloves changed if requested. For a further 120 procedures, indicator gloves were used exclusively. All gloves were leak‐tested after surgery to identify perforations. Association between potential risk factors and perforation was explored using multivariate logistical regression analysis.ResultsGlove perforations occurred during 43% of surgeries with a mean of 2.3 holes/surgery. Inner gloves were intact in 63% of glove pairs where an outer perforation occurred. Intraoperative perforation detection was improved when colored indicator gloves were worn (83% sensitivity) vs. standard gloves (34% sensitivity; P<.001). Independent risk factors for perforation were placement of plates and/or screws (P=.001; OR=2.4; 95% CI, 1.4–4.0), placement of an external skeletal fixator (P=.002; OR=7.0; 95% CI, 2.1–23.8), use of orthopedic wire (P=.011; OR=2.4; 95% CI, 1.2–4.7), and primary surgeon being board‐certified (P=.016; OR=1.9; 95% CI, 1.1–3.1).ConclusionIncreased surgeon recognition of glove perforations through use of colored indicator gloves enables prompt change of gloves if perforation occurs and may reduce potential contamination of the surgical site.

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Postoperative Integrity of Veterinary Surgical Gloves

Cited by 18 publications

References 10 publications

Survey of Intraoperative Bacterial Contamination in Dogs Undergoing Elective Orthopedic Surgery

Survey of Intraoperative Bacterial Contamination in Dogs Undergoing Elective Orthopedic Surgery

Observational study of patient and surgeon preoperative preparation in ten companion animal clinics in Ontario, Canada

Colored Indicator Undergloves Increase the Detection of Glove Perforations by Surgeons During Small Animal Orthopedic Surgery: A Randomized Controlled Trial

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