gms | German Medical Science

126. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

28.04. - 01.05.2009, München

Surgical glove perforation and the risk of surgical site infection

Meeting Abstract

  • corresponding author H. Misteli - Chirurgische Klinik, Bürgerspital Solothurn
  • W.P. Weber - Department of General Surgery, Universtity Hospital Basel
  • S. Reck - Department of General Surgery, Universtity Hospital Basel
  • R. Rosenthal - Department of General Surgery, Universtity Hospital Basel
  • M. Zwahlen - Institute of Social and Preventive Medicine, University of Berne
  • P. Fueglistaler - Department of General Surgery, Universtity Hospital Basel
  • D. Oertli - Department of General Surgery, Universtity Hospital Basel
  • A. Widmer - Infectious Disease and Hospital Epidemiology, University Hospital of Basel
  • W.R. Marti - Department of General Surgery, Universtity Hospital Basel

Deutsche Gesellschaft für Chirurgie. 126. Kongress der Deutschen Gesellschaft für Chirurgie. München, 28.04.-01.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09dgch11470

DOI: 10.3205/09dgch283, URN: urn:nbn:de:0183-09dgch2837

Veröffentlicht: 23. April 2009

© 2009 Misteli et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: While surgical glove leakage is a known risk factor in the transfer of pathogens during surgery, the implications of such a breach in asepsis for the development of surgical site infections (SSI) has not been thoroughly investigated. The present study and analysis were conducted to test the hypothesis that clinically visible surgical glove perforation is associated with an increased SSI risk.

Material and methods: The data for this prospective observational cohort study of 4.147 surgical procedures were collected between January 1, 2000 and December 31, 2001 at Basel University Hospital. All procedures performed in the Vascular, Visceral and Traumatology Divisions of the Department of General Surgery were consecutively enrolled. Outcome of interest was the incidence of SSI which was assessed pursuant to Centers for Disease Control and Prevention standards. Eighty two variables were recorded for each surgical procedure. The main predictor variable was compromised asepsis due to visible glove perforation. The use of single gloves was standard practice. Prophylactic antibiotic administration was standardized to the Centers for Disease Control and Prevention guidelines. Patients received prophylactic antibiotics if they underwent surgery classified as wound class 1–3. Wound class 4 was excluded because of peri- and postoperative antibiotic therapy.

Results: Of a total of 6540 procedures, 6283 were monitored. After excluding wound class 4 and cases with missing information on the state of asepsis during surgery, 4.147 procedures were further analysed. The overall SSI rate was 4.5% (188/4.147). From 677 interventions with compromised asepsis, 7.5% (51) instances of SSI were recorded, compared to 4.0% (137) from 3470 procedures where asepsis was not breached. Therefore crude analysis showed a higher likelihood of SSI in which gloves were perforated than in interventions where asepsis was maintained (odds ratio 1.98; 95% confidence interval, 1.4 to 2.8; p < 0.001), but crude and multivariate logistic regression analyses showed that the increase of SSI risk with perforation of gloves was different for procedures with than without antibiotic prophylaxis (test for effect modification: p=0.005). In the absence of surgical antimicrobial prophylaxis, glove perforation entailed significantly higher odds of SSI than in the reference group (i.e., with no breach of asepsis) (odds ratio 4.24; 95% confidence interval, 1.7 to 10.8; p = 0.003), whereas when surgical antimicrobial prophylaxis was applied, the likelihood of SSI was not significantly higher for operations in which gloves were punctured (odds ratio = 1.25; 95% confidence interval, 0.85 to 1.85; p = 0.263)

Conclusion: Glove perforation increases the risk of SSI. In addition to lowering the risk of glove perforation by double gloving or routinely changing gloves in lengthy surgical procedures, the advantages of extending the indication of surgical antimicrobial prophylaxis for reducing the incidence of SSI should be considered.