Surgical Gloves and Surgical Attire

Little commented topic on which there is much to say

The distinguishing factor of this topic concerning recommendations

When it comes to the topic of gloves and gowns, prices are often a main criteria - but there is more to be considered as they play a critical role in reducing Surgical Site Infections (SSIs).

Though experimental evidence suggests shedding of microorganisms from operating room personnel, more robust clinical studies are needed to establish a conclusive link.1

The absence of specific WHO recommendations emphasizes the need for further exploration.2

Look at what guidelines and we as supplier recommend ...

Guidelines
GuidelineRecommendationCategory (if mentioned)
CDC1

“Wear a surgical mask that fully covers the mouth and nose when entering the operating room if an operation is about to begin or already under way, or if sterile instruments are exposed. Wear the mask throughout the operation.”

“Wear a cap or hood to fully cover hair on the head and face when entering the operating room.”

“Do not wear shoe covers for the prevention of SSI.”

“Wear sterile gloves if a scrubbed surgical team member. Put on gloves after donning a sterile gown.”

“Use surgical gowns and drapes that are effective barriers when wet (i.e., materials that resist liquid penetration).”

“Change scrub suits that are visibly soiled, contaminated, and/or penetrated by blood or other potentially infectious materials.”

Category IB







WHO2,3

“The panel suggests that either sterile, disposable, non-woven or sterile, reusable woven drapes and surgical gowns can be used during surgical operations for the purpose of preventing SSI.”2

“The panel decided not to formulate a recommendation due to the lack of evidence to assess whether double-gloving or changing of gloves during the operation or using specific types of gloves is more effective in reducing the risk of SSI.”2

“The operating team should cover their hair and wear sterile gowns and sterile gloves during the operation.”3

Conditional recommendation, moderate to very low quality of evidence
NICE4

“The operating team should wear sterile gowns in the operating theatre during the operation.”

“Consider wearing 2 pairs of sterile gloves when there is a high risk of glove perforation and the consequences of contamination may be serious.”


KRINKO5

Put on mouth-nose protection and hair protection before entering the operating room.

Hair protection and mouth/nose protection must completely cover all beard and head hair as well as mouth and nose, as well as any additional headgear worn for personal reasons.

Renew the mouth-nose protection before each operation and when visibly soiled or soaked.

The surgical team should put on a sterile surgical gown and then sterile gloves in the operating room after surgical hand disinfection.

Two pairs of gloves are recommended for operations that experience has shown to be associated with increased glove lesions.

Gloves should be changed after manual handling of sharp-edged implants or explant components or removal of cement fragments (e.g., during endoprosthesis replacement), as well as immediately before implantation of a joint endoprosthesis.

Sterile surgical gowns certified as medical devices and made of disposable or reusable material should be used as protective gowns. Liquid-repellent gowns ("low performance") should be used for operations with low liquid incidence and liquid-tight gowns ("high performance") should be used for operations with expected high liquid incidence and known infection of the patient with high personnel risk (e.g. HIV, HCV).

Protective goggles or shields should be worn during operations where aerosols/secret splashes are expected to occur.

If contamination of the surgical gown... or surgical gloves occurs during surgery, change gowns or gloves....

Change surgical gowns or surgical gloves away from the surgical field.

Category IB

Category II

Category II

Category IB

Category II

Category IB

Category II

Category IB

Category II/IV

Category IB

Category IB


Denise Leistenschneider, Senior Clinical Consultant
"The safety aspect of gloves and surgical attire ranges from the appropriate material to correct use."

Instructions for surgical attire and surgical gloves

General

  • Put on a cap/hood/hair protection to fully cover hair on the head before entering the operating room.1,3,5
  • Wear a surgical mask that fully covers the mouse and nose before entering the operating room.1,5
  • Renew the mask before each operation and when visibly soiled or soaked.5
  • Do not wear shoe covers in the context of SSI prevention.1
  • Wear protective goggles or shields during operations where aerosols/secret splashes are expected to occur.5

Surgical gown

  • The operating team should wear sterile gowns during the operation.1–5 Certified products should be used.5
  • Use liquid-repellent gowns ("low performance") for operations with low liquid incidence and liquid-tight gowns ("high performance") for operations with expected high liquid incidence and known patient infection with high personnel risk (e.g. HIV, HCV).5
  • If gowns need to be changed during surgery: away from the surgical field.5
  • Denise Leistenschneider, Senior Clinical Consultant
    "Consider design of your surgical gown especially when it comes to inner protection field (front and sleeves)."

    Surgical Gloves

    • Put on sterile gloves after donning a sterile gown.1
    • Wear two pairs of gloves during operations that have shown to be associated with increased glove lesions.5
    • Change gloves after manual handling of sharp-edged implants or explant components or removal of cement fragments, as well as immediately before implantation of a joint endoprosthesis.
    • If gowns need to be changed during surgery: away from the surgical field.5

    Safety concerns: take care of your patient and yourself

    Surgical Glove perforation

    • The rate of perforations in surgical gloves increases with increasing wearing time.6
    • They occur
      • most frequently (58%) on the non-dominant hand - on the thumb and index finger.7
      • due to: Bone splinters, sharp surgical instruments, needle sticks, use of steel wire (chest).

    Perforations after wearing time6

    Not all sterile gloves are the same

    For reasons of occupational safety surgical gloves should be5

    • skin-friendly
    • non-powdered
    • low in allergens

    The requirement for sterile protective clothing depends on various factors

    Fulfilment of EN Standard is just one criteria – important, but there is more:

    the duration of the operation

    the amount of fluid involved

    the mechanical stress

    Do you still use powdered surgical gloves?

    5 Convincing arguments for switching to powder-free medical gloves

    1. Powdered latex gloves can cause type I latex allergy.
    2. Frequent hand washing to remove powder residues can cause skin complications and reduces the efficacy of alcohol-based disinfectants.
    3. Powder is not essential for an easy donning.
    4. Powder can cause postoperative complications, delayed wound healing and additional surgeries for patients.
    5. Removal of glove powder from hands of wearer needs time and causes costs.

    Double gloving: a HARTMANN’s hint

    If a puncture in theovergloveoccurs, in contact with fluids (like blood in the operating room), a green dark colour alerts us that theovergloveis damaged and wehave toremove and replace it.

    Double gloving before puncture

    Double gloving after puncture

    Please click to see full list References:
    1.CDC (1999) Guideline for Prevention of Surgical Site Infection. Infect Control Hosp Epidemiol. 20(4): 247–278.
    2.WHO (2016) Global guidelines for the prevention of surgical site infection. World Health Organization 2016.
    3.WHO (2009) WHO Guidelines for Safe Surgery 2009.
    4.NICE (2019) Surgical site infections: prevention and treatment. NICE guidelines. Published 11 April 2019. www.nice.org.uk/guidance/ng125.
    5.KRINKO (2018) PräventionpostoperativerWundinfektionen. Empfehlungen der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsbl 61: 448–473.
    6.Partecke LI, et al. (2009) Incidence of microperforation for surgical gloves depends on duration of wear. Infect Control Hosp Epidemiol 30(5): 409–414.
    7.Kralj N, et al. (1999) ChirurgischeHandschuhewie gut schützensievorInfektionen? Gesundheitswesen 61(8-9): 398–403.

    In focus

    Hand disinfection or gloves?

    What are the standard proceduresfor the two measures and in whichsituations can they contribute toinfection prevention together?

    Learn more...

    Elements of standard precautions

    Hand hygiene is the key measure of Elements of standard precautions. In addition to alcohol-based hand disinfection, the main infection protection measure, it comprises skin care, skin protection and skin cleansing.

    Learn more…

    Double gloving

    Is there evidence to formulate a clear recommendation for double gloving?

    Answers to this and other questions you can find here…

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