Electronic detection of breakdowns in the surgeon-patient barrier. Evaluation of the protection afforded by surgical clothing in visceral surgery

Study aim: Breakdown of the aseptic surgeon-patient barrier causing abnorma l contact between skin and body fluids represents a risk for transmission o f infectious disease. Such breakdowns are frequently not perceived by the s urgical team over prolonged periods. The aim of this prospective randomized study was to evaluate the protection afforded by double gloving and reinfo rced gowns in visceral surgery. Methods: An electronic device detected breakdowns of the surgeon-patient ba rrier in a series of 80 surgical procedures, randomly assigned to double or single gloves, and normal or reinforced gowns. Fluid contacts due to glove perforation, glove porosity or gown wetting were recorded during 151 indiv idual participations covering 238 hours. Surgical procedures were called de ep for incisions of more than 10 cm. Results: Deep surgical procedures carried a sevenfold-increased risk of bar rier breakdown, compared with superficial ones. Skin contacts through wet g owns were not prevented by the use of double thickness materials, but doubl e gloving reduced the number of perforation and porosity alarms twofold in both superficial and deep surgery. Conclusion: Without electronic detection, 96 % of barrier breakdowns would remain undetected by the surgical team and lead to prolonged contact with p otentially contaminating fluids. The use of double gloving provides a real protection against contamination risk. (C) 2000 Editions scientifiques et m edicales Elsevier SAS.