The Mölnlycke O.R. blog
Are surgical gloves the weakest link in the O.R.?
There is no question that intact surgical gloves provide effective protection against cross infection and contamination for both the patient and the medical team during surgical procedures. However, as surgical gloves are the most intensively exposed barrier material to physical stress and various chemical agents, glove perforations are reportedly very common during surgical procedures and puncture rates as high as 61% are published in the literature. Furthermore, a significant proportion of perforations is not reported or remains unnoticed. Unless the gloves are changed at an appropriate time interval, undetected perforations may easily make the surgical glove the weakest link of infection control measures in the operating room (O.R.).
“Good Gloving Practice” including double gloving, puncture indicating systems and changing gloves at an appropriate time interval is increasingly common but not a standard in surgical practice. Several different recommendations exist in the medical literature regarding what is considered an appropriate time interval for changing surgical gloves. Partecke LI et al. found a positive correlation between the duration of wear and the incidence of microperforations and recommended to change gloves after 90 minutes of surgery. Kralj N et al. proposed for discussion an even shorter, 30-minute time interval for glove change. To move from individual study recommendations towards a higher evidence level, a systematic literature review attempted to synthesise available information on optimal time interval for changing surgical gloves with the results presented at the European Operating Room Nurses Association Congress (EORNAC), 2012.
The execution of a systematic search strategy in PubMed, Embase and the Cochrane Library databases yielded 1756 unique articles potentially containing recommendation on the optimal time interval for changing surgical gloves. Out of the 65 articles included into the analysis, there were 14 randomised controlled trials (RCTs) and 6 reviews, representing a high level of evidence. Half of the RCTs recommended changing gloves after different steps and working tasks during the surgical procedure, while half of the reviews recommended an hourly glove change. Other recommendations found include changing gloves before incision, between 30-180 minutes, every two hours and at regular intervals. Although, the results of the literature review do not enable us to make single recommendation regarding the optimal time interval for changing surgical gloves, the most important conclusion is the requisite of the changing.
How frequently do you change your pair of gloves during the surgical procedures?
To answer this question, please read the brief clinical scenario below and consider your surgical practice.
A 59 year old, 105 kg, 180 cm tall man (BMI = 32.4) presented for a left total knee arthroplasty for degenerative joint disease. His medical history included hypertension, chronic obstructive pulmonary disease, gout, and smoking. The surgery was uneventful with an operating room time of 100 minutes.
When would you change your pair of glove during the surgical procedure?
- Every 30 minutes
- Every 60 minutes
- Every 90 minutes
- After certain phases of the operating procedure