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 asso ciated with selected obstetric procedures. The second purpose was to a ssess 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 p eriod, obstetric personnel were asked to double glove for all surgical procedures. After surgery, they placed their gloves in plastic bags a nd noted the type of procedure, time of day, and position on the surgi cal 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 tes ted for injury by two methods: by inflating them with air and subseque ntly immersing them in water to detect air bubbles and by directly fil ling them with water to observe for leaks. RESULTS: A total of 540 glo ve sets (2160 individual gloves) were examined; 407 sets were from ces arean deliveries, 65 from puerperal tubal ligations, and 68 from vagin al 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 7 8. Sixty-six holes were in the outer glove only, and 7 were in the inn er 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 dif ference 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 i n frequency of glove tears when cesarean sections were classified as u rgent versus nonurgent. There also was no difference in frequency of g love tears in procedures performed at night compared with those during the daytime. Surgical nurses had 36% of all glove injuries and were m ore likely than physicians or medical students to sustain perforations (p < 0.005). Primary surgeons and first assistants were more likely t han second assistants to sustain glove injuries (p < 0.05). For primar y surgeons and first assistants, level of training did not significant ly affect the frequency of glove perforations. CONCLUSIONS: Glove perf orations occur in approximately 12% of obstetric surgical procedures. Surgical nurses are at greatest risk for perforation. Double gloving r educes the likelihood of penetrating injury to the inner glove and sub sequent risk of blood contact.