Glove change to reduce the risk of surgical site infection or prosthetic joint infection in arthroplasty surgeries: a systematic review.

BACKGROUND: Microbiological contamination of surgical gloves occurs during surgery, which may warrant glove change during orthopaedic surgeries. However, no systematic review of this topic has previously been published. Therefore, this review evaluated whether changing gloves during arthroplasty surgeries reduces the risk of surgical site infection/prosthetic joint infection (SSI/PJI) and the optimal frequency of glove change. METHODS: Search terms such as surgical gloves, surgical site infections, prosthesis-related infections, arthroplasty were used, including Medical Subject Headings terms. Of the 89 articles screened, 12 articles were included for qualitative synthesis. RESULTS: No studies measured the direct effect of glove change on PJI rate. Therefore, microbiological contamination and perforation rate of gloves were used as surrogate outcomes. Eight studies evaluated microbiological contamination of surgical gloves, with rates ranging from 3.4 to 30%. Five contamination studies recommended changing gloves after draping and before handling implants. One randomized controlled trial also recommended changing gloves at least once an hour regardless of surgical stages. Five studies recommended changing gloves to prevent perforation, with recommendations ranging from 20 to 90 min. Furthermore, one study advised change of gloves after resection of bone and before implantation. CONCLUSION: As microbiological contamination rates of gloves increase with duration of surgery, glove changes are recommended at least once per hour. Furthermore, gloves should be changed after draping, before handling implants and if visible perforation is seen to reduce contamination. Due to the lack of studies with SSI/PJI as primary outcomes, we cannot draw a definitive conclusion regarding the effectiveness of changing gloves in reducing the risk of SSI/PJI in arthroplasty.

Scarcity of healthcare worker protection in eight low- and middle-income countries: surgery and the risk of HIV and other bloodborne pathogens.

OBJECTIVE: In view of the substantial incidence of bloodborne diseases and risk to surgical healthcare workers in low- and middle-income countries (LMICs), we evaluated the availability of eye protection, aprons, sterile gloves, sterilizers and suction pumps. METHODS: Review of studies using the WHO Tool for the Situational Analysis of Access to Emergency and Essential Surgical Care. RESULTS: Eight papers documented data from 164 hospitals: Afghanistan (17), Gambia (18), Ghana (17), Liberia (16), Mongolia (44), Sierra Leone (12), Solomon Islands (9) and Sri Lanka (31). No country had a 100% supply of any item. Eye protection was available in only one hospital in Sri Lanka (4%) and most abundant in Liberia (56%). The availability of sterile gloves ranged from 24% in Afghanistan to 94% in Ghana. CONCLUSION: Substantial deficiencies of basic protective supplies exist in low- and middle-income countries.

Surgical gowning and gloving.

Surgical gowning and gloving is an essential element of perioperative practice and is undertaken by the members of the anaesthetic and surgical teams involved in a perioperative intervention or procedure. Gowning and gloving will take place immediately after surgical hand antisepsis and the whole process is often referred to as scrubbing, gowning and gloving. Surgical hand antisepsis is defined as 'an extension of hand washing' (AfPP 2007), and 'the antiseptic surgical scrub or antiseptic hand rubs performed before donning sterile attire preoperatively' (AORN 2008). The aim of these processes is to improve the perioperative outcome of interventions and procedures by enhancing and further promoting aseptic techniques (ACORN 2006, AfPP 2007).

Choosing the right surgical glove: an overview and update.

Sterile surgical gloves are routinely worn during all invasive procedures to prevent the two-way transmission of pathogens between the surgical team and the patient. This reduces the risk of surgical-site infections and blood-borne diseases. Since their introduction to the operating room over 100 years ago, surgical gloves, and the materials used to make them, have continued to evolve in line with ever-changing healthcare demands. Following recent developments in surgical glove technologies, including de-proteinized natural rubber latex and newer gloving methods such as triple gloving, it is timely that an overview and update of surgical gloves is given. By providing information on latex-associated allergies, glove materials, gloving methods and glove protection, this article will enable practitioners to choose the most appropriate surgical glove.

A blogger in their midst.

It was five minutes before show time, and only 15 people had wandered into the conference room to hear Lancaster-Webb CEO Will Somerset introduce the company's latest line of surgical gloves. More important, sales prospect Samuel Taylor, medical director of the Houston Clinic, had failed to show. Will walked out of the ballroom to steady his nerves and noticed a spillover crowd down the hall. He made a "What's up?" gesture to Judy Chen, Lancaster-Webb's communications chief. She came over to him. "It's Glove Girl. You know, the blogger," Judy said, as if this explained anything. "I think she may have stolen your crowd." "Who is she?" Will asked. Glove Girl was a factory worker at Lancaster-Webb whose always outspoken, often informative postings on her Web log had developed quite a following. Will was new to the world of blogging, but he quickly learned about its power in a briefing with his staff. After Glove Girl had raved about Lancaster-Webb's older SteriTouch disposable gloves, orders had surged. More recently, though, Glove Girl had questioned the Houston Clinic's business practices, posting damaging information at her site about its rate of cesarean deliveries--to Sam Taylor's consternation. This fictional case study considers the question of whether a highly credible, but sometimes inaccurate and often indiscreet, on-line diarist is more of a liability than an asset to her employer. What, if anything, should Will Somerset do about Glove Girl? Four commentators--David Wein-berger, author of Small Pieces Loosely Joined; Pamela Samuelson, a professor of law and information management at the University of California, Berkeley; Ray Ozzie, CEO and chairman of Groove Networks; and Erin Motameni, vice president of human resources at EMC-offer expert advice.

Biogel Skinsense N: surgical glove management for latex allergies.

Healthcare staff with a high occupational exposure to latex gloves, such as those who work in the operating theatre, have a higher than average incidence of latex allergies. Certain patient groups are also known to be considered "high risk" for latex allergies. When wearing gloves, staff allergic to latex and those working with patients allergic to latex must wear latex-free gloves to protect themselves and their patients. Of all the different types of gloves available--examination, medical or diagnostic--surgical gloves have to meet the highest standards, offering both protection and comfort. However, latex-free surgical gloves have previously lacked some of the "comfort" qualities of natural latex. This article describes appropriate glove management for latex allergies and looks at the new generation of latex-free surgical gloves.

Avoiding problems: evidence-based selection of medical gloves.

Allergenic contact reaction to glove proteins and residual chemicals increased from 1980 onwards; circumstantial and technical evidence indicates that change from reusable to disposable latex gloves was a causative factor. Several protein fractions are potentially allergenic; if low protein gloves contain a dominant protein fraction, people with sensitivity may still have an adverse reaction. Use of chlorinated powder-free gloves reduces risk of allergenic reaction; other powder-free gloves may still pose a contact risk to patients. Adverse comparative tests of vinyl vs latex medical gloves may, in some cases, have used non-medical gloves without assessment of initial quality or involved an unrealistic test method; these have discouraged use of a non-allergenic alternative to latex gloves. Vinyl medical glove properties are reviewed. Nitrile examination gloves offer better protection than latex types when handling lipid-soluble substances and chemicals. Properties of medical gloves made from other materials are described.

Medical gloves and glove materials.

Latex gloves are widely used in health care, but latex allergy is increasingly becoming a problem. Nurses should be aware of the alternatives to latex gloves and when these can be used. Nurses should know their organisation's policy on glove use and latex allergy.

A closer look at disposable gloves. An assessment of the value of vinyl, latex and plastic gloves.

Research has shown that people with broken skin can be at serious risk of cross infection. A study was undertaken to assess the relative benefits of wearing vinyl, latex and plastic gloves during invasive procedures.

Effectiveness of glove barriers used in clinical settings.

Gloves are the most common barrier used to prevent the transmission of microorganisms between patients and nurses, and clinicians should be familiar with factors that affect glove choice, including the type of unit, exposure to bloodborne pathogens, tasks performed, and personal safety. In addition to selecting the proper gloves for clinical practice, nurses can play an important role in the evaluation, quality control, and development of new effective barriers for hand protection.

Exam glove shortage leaves MMs searching for supplies.

In this issue HMM examines the impact of AIDS on the price and availability of disposable gloves. Materials managers are facing higher prices and uncertain supplies as more and more health care workers use gloves and other protective apparel.