Gloves and surgery… (Day -243)

Bristol Vet School Glove Perforation Study

Something that many take for granted is once you put the sterile operating gloves on, unless you do something stupid you remain sterile. This is even more important when it comes to pet guardians who when entrusting their animals to us take it for granted that a vet will do everything possible to ensure a good outcome.

A good outcome here is there being no Surgical Site Infection because the surgeon has worn gloves, and taken all steps to reduce the risk.

However a recent study published in July this year has shown that perforations (holes) occurred in gloves during 43% of orthopaedic surgeries (you can read the study here). This followed an earlier study looking a glove perforations in general surgery which identified perforation in 26.2% of surgical procedures. The latest study confirms that perforations are more likely in orthopaedic surgeries.

This is concerning as in a human study the risk of surgical site infection doubles when there is glove perforation. When dealing with orthopaedic surgery especially the effect of an infection can be devastating especially when there is an implant or metalwork involved. Anything that can be done here to lower the risk of infection is therefore extremely important.

Unfortunately though as surgeons the ability to detect a glove perforation can be extremely difficult. The studies I read here have detection of a perforation at between 7-31% – in human surgery it is only 37%.

So as with most problems there is a solution, and in this case it is wearing a pair of sterile indicator gloves under the surgical gloves. These indicator gloves are made exactly the same as the surgical gloves with just the addition of a dye. Therefore when the outer glove is perforated and liquid contacts the inner glove a colored spot will appear on the glove at the site of perforation to alert the surgeon that it has occurred.

With the use of indicator under gloves the detection rate of glove perforation by surgeons increased to 90%.

Whilst from this it would be logical to say that every single surgeon should use indicator undergloves there are the practical concerns of veterinary medicine to consider. Currently there is no study on the ability to perform surgery to the same level and dexterity in veterinary surgery so whilst double gloving may decrease the risk of infection in 26.2% of all cases (43% in orthopaedics), in the other cases it may increase the risk of surgical mistakes when a glove slips for example.

Then there is the economical impact – indicator undergloves will increase the cost of the surgery. And already pet guardians commonly complain about the cost of veterinary medicine. So adding £10 to the cost of every surgery in case gloves break so that the surgeon can recognise they have broken may not for many owners be acceptable.

However when doing orthopaedic surgery like a joint replacement where a surgical site infection may result in removal of the implant and in some cases amputation then £10 becomes very little indeed.

I would love to hear your thoughts and comments as it is definitely one that needs consideration…