Glove perforation rate in open lung surgery

Objective: In open lung surgery the surgical access is encircled by the rib s, which should result in a high glove perforation rate compared with other surgical specialities. Methods: Prospectively the surgeon, first and secon d assistant and the scrub nurse wore double standard latex gloves during 10 0 thoracotomies. Parameters recorded! were: procedure performed, number of perforations, localization of perforation, the seniority of the surgeon, ma noeuvre performed at the moment of perforation, immediate cause of perforat ion, operation time, performance of rib resection during thoractomy and tim e of occurrence of the first three perforations. Results: One thousand, six hundred and seventy-three gloves (902 outer, 771 inner) were tested. In 78 operations perforations occurred. There were 150 outer glove perforations (8.9%, 0-8, mean 1.23), 19 inner glove perforations (1.13%, 0-2, mean 0.19) . Cutaneous blood exposure was prevented in 78% of all operations and in 87 % of all perforations. The perforation rate for the surgeon, the scrub nurs e, the first and the second assistant were 61.2, 40.4, 9.7 and 3.1% of all operations, respectively. Rib resection and a duration of more than 2 h res ulted in a significant rise of glove perforation rate (P < 0.05). The perso nal experience of the surgeon and the type of operation did not correlate w ith glove perforation. The immediate cause leading to perforation was named in only 17 cases (13.7%) and comprised contact with bone (seven), a needle stitch (seven) and a production flaw (three). Leaks were localized mostly on the first finger (18%), second finger, (39%) palm and dorsum of the hand (16%). The average occurrence of all first perforations was 38.7 min (rang e 3-190) after the beginning of surgery, the second after 63.2 min (range 1 0-195). Fifty-four first perforations (50.5%) were found during the first 3 0 min of the operation. Conclusions: The reported perforation rate of 78% l ies in the highest range of reported perforation rates in different surgica l specialities. Double gloving effectively prevented cutaneous blood exposu re and thus should become a routine for the thoracic surgeon to prevent tra nsmission of infectious diseases from the patient to the surgeon. (C) 1999 Elsevier Science B.V. All rights reserved.