Using Surgical Gloves to Prevent Surgical Site Infections (SSIs)

Surgeon with double gloving surgical gloves cutting in stommach

Surgical gloves play a crucial role in infection control and preventing surgical site infections (SSIs). Sterile gloves act as a barrier between healthcare professionals and patients, reducing the risk of pathogen transmission during surgical procedures. With the increasing focus on patient safety, healthcare facilities are adopting best practices for using surgical gloves to minimize SSIs and enhance overall surgical outcomes.

This article explores the significance of surgical gloves in SSI prevention and provides evidence-based recommendations for their proper use. It delves into various surgical glove types and discusses techniques such as double-gloving to enhance protection. Additionally, the article highlights the importance of staff training and compliance to ensure the effective implementation of glove practices, ultimately contributing to improved patient care and reduced infection rates in surgical settings.

Understanding Surgical Site Infections (SSIs)

Definition and Types of SSIs

Surgical site infections (SSIs) are a common complication that occurs within 30 days after a surgical procedure or within 90 days if prosthetic material is implanted ^[1]. The Centers for Disease Control and Prevention (CDC) categorizes SSIs into three types:

Superficial incisional SSI: Infection occurs in the area of the skin where the incision was made.
Deep incisional SSI: Infection develops beneath the incision area in muscle and surrounding tissues.
Organ or space SSI: Infection affects any body area involved in the surgery other than skin, muscle, and surrounding tissue ^[2].

SSIs are caused by germs, with bacteria such as Staphylococcus, Streptococcus, and Pseudomonas being the most common culprits ^[2].

Risk Factors for SSIs

Several factors contribute to the risk of developing an SSI:

Patient-related factors:

Age
Tobacco use
Diabetes
Malnutrition
Obesity
Weak immune system
Cancer ^[1]

Procedure-specific factors:

Emergency surgery
Degree of bacterial contamination
Duration of surgery (over 2 hours)
Type of surgical wound ^[1] ^[2]

Impact of SSIs on Patient Outcomes

SSIs have a significant impact on patient outcomes and healthcare systems:

Morbidity and mortality: SSIs are a leading cause of readmissions following surgery, with approximately 3% of patients who contract an SSI dying as a consequence ^[1].
Extended hospital stays: Patients with SSIs have a mean length of stay of 9.2 days compared to 4.6 days for those without SSIs ^[4].
Increased healthcare costs: SSIs result in additional procedures, extended antibiotic therapy, and strain on healthcare system efficiency ^[4].
Quality of life: SSIs negatively impact patients’ physical, psycho-social, and financial well-being, as well as the doctor-patient relationship ^[4].
Global impact: Postoperative mortality, to which SSIs contribute significantly, is the third highest contributor to global deaths ^[4].

Role of Surgical Gloves in SSI Prevention

Surgical gloves play a crucial role in preventing surgical site infections (SSIs) by acting as a protective barrier between healthcare workers and patients. Their effectiveness in reducing the risk of pathogen transmission has been demonstrated in various clinical studies ^[5].

The barrier function of gloves

The primary function of surgical gloves is to create a barrier against potentially infectious materials. Research has shown that healthcare workers wearing gloves during patient contact contaminate their hands with an average of only 3 CFUs per minute, compared to 16 CFUs per minute for those not wearing gloves ^[6]. This significant reduction in hand contamination highlights the importance of glove use in preventing the spread of pathogens.

Glove material considerations

The choice of glove material is crucial for effective infection control. Natural rubber latex gloves are commonly used due to the superior feel and fit of latex, but synthetic alternatives are available for those with latex allergies. Regular use of latex gloves can result in users developing allergies, necessitating the use of synthetic materials in such cases ^[7].

Importance of proper fit

Well-fitting gloves are essential for maintaining the protective barrier.

Gloves should be changed:

Between tasks and procedures on the same patient
When visibly soiled, torn, or punctured
After contact with each patient ^[7]

Proper fit ensures that gloves do not compromise dexterity or increase the risk of tears, which could lead to contamination.

While gloves are crucial in SSI prevention, they are not a substitute for proper hand hygiene. Healthcare workers should perform hand hygiene immediately after removing gloves ^[7].

Single vs. double gloving

Double gloving has shown significant benefits in reducing the risk of surgical site infections (SSIs). Studies have demonstrated that using a double glove system reduces the rate of perforation to inner gloves ^[9]. When comparing single and double gloving, only 0.5% of operation participants were exposed to patients’ blood with double gloves, compared to 7.4% with single gloves ^[9]. Another study reported a perforation rate of 51% for single gloves, which decreased to 7% with double gloving ^[9]. These findings consistently indicate that double-gloving systems may reduce infection rates during surgeries.

Glove change timing

Regular glove replacement is crucial to avoid potential problems caused by surgical glove perforations. Research has shown that the occurrence rates of surgical glove perforations increase significantly after two hours of use ^[9]. As a result, some experts recommend changing gloves every two hours during surgical procedures ^[9]. Additionally, a study found that changing gloves and instruments before abdominal wound closure reduced SSI rates by 13% at 30 days post-surgery ^[8].

Perforation indicator systems

Perforation indicator systems have proven effective in early detection of glove breaches. The WRP Profeel Double-Gloving system, for example, allows for quicker recognition of perforations. In one study, the average time difference between inspector nurse detection and operative participants’ detection of perforation was 20.6 seconds when using indicator gloves ^[9]. Colored indicator gloves worn as the inner pair in double-gloving systems can increase perforation detection by surgeons during procedures ^[10]. When perforation occurs in the outer glove, fluid leaks through the breach, causing a colored spot to appear and alerting the wearer ^[10].

Staff Training and Compliance

Educating the surgical team on glove use

Proper education of surgical teams on glove use is crucial for preventing surgical site infections (SSIs). Healthcare facilities should provide comprehensive training on the importance of sterile gowns and gloves in reducing microbial contamination ^[11]. This training should cover aseptic techniques, gowning and gloving procedures, and the principles of infection control ^[11]. Educational programs should emphasize the significance of double-gloving, which has been shown to reduce the risk of blood exposure by 87% when using indicator undergloves ^[12].

Monitoring glove compliance

Healthcare facilities should implement monitoring systems to ensure adherence to proper glove use protocols. Observational audits can effectively assess compliance with standard surgical gloving techniques ^[13]. After initial observations, facilities can provide targeted interventions, such as video demonstrations, pamphlets, and live practical demonstrations, to improve compliance ^[13]. Regular assessments and feedback can help identify areas for improvement and reinforce best practices.

Addressing barriers to proper glove use

Several factors can hinder proper glove use, including lack of awareness, religious beliefs, staff workload, and availability of hand hygiene materials ^[13]. To overcome these barriers, healthcare facilities should:

Involve staff in glove selection processes to increase acceptance and compliance ^[12].
Ensure adequate supply and availability of appropriate gloves in patient care areas ^[14].
Address concerns about glove fit and comfort through proper sizing and material selection ^[14].
Implement a “just culture” approach to encourage shared accountability and problem-solving ^[12].

By addressing these barriers and providing ongoing education and support, healthcare facilities can improve compliance with proper glove-use practices and reduce the risk of SSIs.

Conclusion

The use of surgical gloves has a significant impact on preventing surgical site infections, playing a key role in patient safety. Double gloving, regular glove changes, and perforation indicator systems are proven strategies to lower infection rates. What’s more, educating surgical teams and keeping an eye on compliance is essential to make sure these practices are put into action effectively. By sticking to these evidence-based methods, healthcare facilities can greatly reduce the risk of SSIs and boost overall surgical outcomes.

To wrap up, proper surgical glove use is crucial to preventing infections and protecting patients and healthcare workers. By focusing on staff training, addressing barriers to proper glove use, and implementing best practices, healthcare facilities can create a safer surgical environment. This approach not only helps to cut down on SSIs but also contributes to better patient care and more efficient healthcare delivery.

References

Best Practices for Using Surgical Gloves to Prevent Surgical Site Infections (SSIs)