Gown-glove interface: a possible solution to the danger zone.

The gown-glove interface is the weakest point in the present barrier system of gown and glove protection for the surgeon and other healthcare professionals who come into direct contact with body liquids. Try it yourself: put on a fluid-resistant gown and surgical gloves. See that the glove cuff is well proximal to the stockinette. Hold your wrist and forearm for a moment under running water. Wait a minute to see if your forearm is wet. A wet forearm during surgery would be a blooded one. We propose a gown redesign that creates a dart at the terminal forearm, sealed by a liquid-proof method, and then similarly sealing the proximal end of the glove to the sleeve.

Barrier breach of surgical gloves.

The barrier properties of natural rubber latex gloves have been of clinical interest since the concept of using an integrity monitor was introduced by me over 30 years ago. Although surgeons expect their gloves to serve as an effective barrier during use, products can and do fail. Failure is often unrecognized, resulting in the wearer's exposure to potential pathogens and the patient to microorganisms shed by surgical team members. Although a variety of solutions have been suggested (double gloving, cut-resistant gloves), these remedies do not alert the surgeon to a breach of barrier, the cost and consequences of which are astronomical to the health system. As a result, some form of breach detection device is now recommended to minimize the likelihood of exposure, infection, and/or allergy.

Surgical glove powders bind latex antigens.

Latex surgical gloves have recently been identified as a potential source of allergens. Much of the current information suggests that the soluble proteins in latex may cause significant reactions in sensitive individuals. The starch powders used as a lubricant on some latex gloves have also been identified as potential allergens in some patients. In this study, we determined these powders to act as potential carriers of latex allergens. We have produced a polyclonal antiserum to be used as a reagent to study latex proteins. By Western blot analysis, we identified a significant interaction between latex proteins and starch powders. The binding of latex proteins to starch particles results in a glove particle that may have an increased potential to act as an allergen. The latex protein-starch particles represent a potential mechanism for exposure and sensitization of health care workers to latex allergens. Elimination of these particles from the operating room should reduce the route of sensitization and the potential for adverse reactions to latex.

Medical waste. The growing issues of management and disposal.

When addressing the impact of medical waste management and regulatory controls on the health care industry, it is important to remember that as long as modern medicine continues to maintain and sustain its current quality of life and wellness standards, industry will continue to generate various byproducts that have adverse effects on both people and the environment. It is important, therefore, to carefully evaluate the impact of societal demands. Unless government, industry, environmental groups, and health care providers abandon their current adversarial relationships and work together to solve shared problems, there will be no improvement in the growing problem of medical waste. The long-term solutions to today's growing waste problems depend to a great extent on human factors and the willingness of industry, medical community, and governmental bodies to cooperate with each other, recognizing the cause-effect relationship of a continued demand for disposable products. There are many pieces to the waste management puzzle. Obviously, surgeons cannot perform surgery without exposure to blood, tissue or body fluids, and nurses cannot maintain asepsis without sterile products. Because the health care team cannot totally eliminate the source of medical waste, they must learn to more effectively manage and control it. Health care professionals must encourage industry and government to work together to develop standards for products and materials used as barriers and use more biodegradable materials. Health care facilities must learn to minimize the amount of medical waste designated as regulated or infectious. Segregating potentially infectious material from clean waste at the point of generation may reduce both volume and cost.

Mastectomy performed by Lawrence Heister in the eighteenth century.

In 1720, Heister successfully removed a massive tumor of the breast. The lesion was probably a massive cystosarcoma phylloides rather than infiltrating carcinoma of the duct. His thorough description reveals that patients and surgeons have changed little in two and one-half centuries.

Aseptic barriers in surgery: their present status.

Aseptic barriers are employed in the form of surgical gowns, drapes, and wrappers for sterile goods. They possess many of the attributes of textiles, but must also protect sterile zones from microbial invasion. Surgeons rely on them to resist penetration by liquids and other bacterial vehicles. A large variety of both woven and nonwoven materials are being produced for this purpose. The user is faced with difficult choices. The provider of the barrier materials must assure the surgeon of their barrier quality under the usual conditions of their use in operating rooms. Identical standards of quality can be and should be applicable whether these materials are created to be used once and discarded or are reusable.

Choosing surgical illumination.

(1) Lighting systems for the surgical task are combinations of ambient room lighting to complement the operating task light. The two must match to produce a good effect. (2) Only a few surgical task lights are available, and their characteristics and relative merits should be studied. (3) Ideally the surgeon should test the task light to judge its suitability for his taste.