There is little doubt that scalpels, bony fragments, needles and sutures can, and do lead to viral, prion and bacterial cross-infection both ways- both to the patient , but more readily to the theatre staff. HIV, HepC etc and prions are the current major concerns, of course.A surgeon, or nurse receiving a needle or suture needle injury faces months of anguish, even if both parties are 'negative' , due to the 'window' period of viral load acquisituion immediately pre-testing bit not resulting in a measurable Ab response to testing techniques.The same applies to a patient receiving a contaminated needle or suture with surgeon/ nurse's blood-although in practice this is less common.
Surgical gloves were invented in around 1886.They are used in Sanitation/Refuse/Council Industries and Law enforcement.In the O.R. however we vcannot use the heavy duty puncture-proof and muti-layered types due to loss of surgical 'feeling' and dexterity.Gimbel (TM) manufacture these for Industry and law enforcement(checking pockets etc) , but they have little utility in O.R., aside from Ward orderlies where there is a place.Most surgical O.R. gloves are latex.
J Tanner (Cochrane Systematic Review 2006 July 19) found that wearing 2 pairs of latex gloves )'double gloving') made no difference to patient infection rates. There WAS however a significant REDUCTION in inner glove wearer penetration rates. Wearing 3 gloves or knitted gloves or finger reinforced gloves also reduced penetration BUT also reduced surgeon's dexterity and ability to operate. It is not uncommon for a penetration to have occurred without the par aesthetic surgeon's hands from operating 2-3 hours and using vibrating bone saws etc( coloured glove studies showed this in trials).This is even more alarming!
Woods JA et al (J BIOMED MATER RES 1996) showed that liner gloves reduced surgeons' cutaneous sensitivity using 2 point discrimination ,determination of suture size ability and instrument handling dexterity.
Double gloving is said to REDUCE penetration and puncture risk by 18 fold!
Nitrile gloves are reported to be 3 times more puncture resistant than latex! They are used by safe crackers, it is reported and are so thin they allow the craftsman to perorm their craft without leaving finger prints!
I recently spoke at a hospital meeting along with a senior and experienced surgical glove representative and we advised that currently there are multi-layered gloves (middle layer knitted or antiseptic gel filled) BUT are NOT puncture proof nor are they accepted by surgeons as they cause loss of sensation and dexterity and affect surgery.
So, how do we prevent HIV, hepatitis B&C , prion etc transmission in O.R. by way of suture , needle stick, bony spicule etc injury ? Do we screen ALL patients and reject the high risk + ve ,with concerning answers to 'window period' questionnaires? Do we double glove and ask all of our jospitals for nitrile rather than latex gloves?Or do we just remain careful and concentrate , particularly during that time of highest risk, closing the wound-vicryl has caught me at this time over the decades.We certainly MUST push (and support manufacturers) on R&D for surgical gloves that are puncture-PROOF and allow manual surgical DEXTERITY and INSTRUMENT SENSIBILTY.
Care, double gloving and nitrile gloves with ID blood screening of ALL patients ( and O.R staff) are my recommendations UNTIL useable & puncture-proof surgical gloves are developed:nitrile gloves are 3 timesMORE needle resistant than latex and double gloving reduces inner glove penetration by 18 times. Concentration and avoidance of long lists will reduce risk also.R&D companies MUST recognise a HUGE market -but whilst Latex and Nitrile gloves are selling so well one may new forgiven for cynically assuming that the return on research will be low if performed by the major players-latex and nitrile glove manufacturers! Opposition companies here rests a HUGE opportunity!
ASSISTANT PROFESSOR MICHAEL CORONEOS CIME MASE
SENIOR BRISBANE NEUROSURGEON
CERTIFIED INDEPENDENT MEDICAL EAXMINER & TRIPLE PI ASSESSOR
NARIONAL RACS EXAMINER
MEMBER of ACADEMY of SURGICAL EDUCATORS (RACS).
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