Literature Update - April 2009
Compiled by Dr Leon Worth, ID Physician
Microperforation of Surgical Gloves and ‘Wear-time’: When Should Gloves be Routinely Changed?
In addition to the type of surgery performed and the glove material used, the risk of sterile surgical glove perforation increases with longer
duration of glove wear. The time at which risk becomes significant, and proposed threshold times for the routine changing of a glove, have not
been well studied. Partecke LI et al (Infect Control Hosp Epidemiol 2009; 30:409-414) reported the incidence of microperforation in relation to
duration of glove wear, and the impact of a cornstarch/ethanol hand cream upon incidence of microperforation.
The prospective study was carried out from May 2005 through January 2006 at a single German centre. All surgical gloves worn in the department of
general surgery were collected and examined. Gloves were separated into 3 groups according to duration of wear: 1-90 minutes, 91-150 minutes and >150
minutes. During the study period, wearers of gloves were randomised to use of a hand cream containing a suspension of cornstarch and ethanol
(a sterile product applied after scrubbing to reduce excess moisture on hands). Microperforations of gloves were evaluated by use of the watertight
test, according to universally accepted methodology.
898 pairs of surgical gloves were analysed, with a total of 171 (19%) found to have undetected microperforations. The use of hand cream had no
influence on the perforation rate. Rate of perforation was associated with duration of glove wear: 15.4% when duration was 1-90 minutes; 18.1%
when duration was 91-150 minutes; 23.7% when duration was >150 minutes. The rate of microperforation according to staff category was 23.0%, 19.0%
and 20.5% for surgeons, first assistants and surgical nurses, respectively (difference not statistically significant). Among first assistants and
surgical nurses, a correlation between perforation and duration of wear was observed. However, this correlation was not observed for second or third
assistants or for surgeons. Most perforations occurred during cardiothoracic interventions, and moderate abdominal surgeries had the lowest incidence
of perforation.
On the basis of these results, the authors recommend that surgeons, first assistants and surgical nurses directly assisting in the operating field
change their gloves after 90 minutes of surgery. It is not clear from this study what impact, if any, the practice of double-gloving would
have upon perforation rates. The time periods studied were arbitrarily defined, and a more precise time-series analysis would provide data
to inform stratification on the basis of surgical procedure performed.
Isolation of Staphylococcus aureus from Intravascular Catheter Tips in
the Absence of a Positive Blood Culture
The risk for subsequent bloodstream infection and disseminated infection in patients with Staphylococcus aureus
isolated in intravascular tip culture without concurrent bacteraemia is not known. At a single centre, Zafar U et al (J Hosp Infect 2009; 71:193-195)
retrospectively evaluated all adult patients with S. aureus on catheter tip without bacteraemia during the period
January 2001 through December 2005.
Seventy-four episodes of positive catheter tip culture were identified. The majority (81.1%) were non-tunnelled catheters, with the commonest
reason for removal being fever/sepsis (58.1%). Methicillin-resistant S. aureus accounted for 73% of all isolates.
Of these 74 patients, 44 received antibiotics with activity against the S. aureus isolate – 20 received antibiotics
before and after catheter removal, 24 received antibiotics after catheter removal. One episode of S. aureus bacteraemia
was observed in the setting of post-operative wound infection 4 days after catheter removal. The remaining 30 patients did not receive antibiotics.
Of these, S. aureus bacteraemia occurred in 3 patients – 2 due to new intravascular catheter-associated infection 4 and
12 days after removal, and 1 due to a tracheostomy site abscess 9 days after catheter removal. The rate of bacteraemia was higher in untreated
patients (10.0%) compared with treated patients but this difference was not statistically significant.
Although the findings of this study support the withholding of antibiotics for patients with S. aureus isolated from a
catheter tip in the absence of bacteraemia, prospective evaluation is required, with sufficient study follow-up time to capture episodes of delayed
S. aureus bacteraemia.