Lefebvre Daniel R, Strande Louise F, Hewitt Charles W
Division of Surgical Research, Department of Surgery, Robert Wood Johnson Medical School, Cooper University Hospital, Camden, NJ 08103, USA.
J Am Coll Surg. 2008 Jan;206(1):113-22. doi: 10.1016/j.jamcollsurg.2007.06.282. Epub 2007 Sep 17.
Acquiring a blood-borne disease is a risk of performing operations. Most data about seroconversion are based on hollow-bore needlesticks. Some studies have examined the inoculation volumes of pure blood delivered by suture needles. There is a lack of data about the effect of double-gloving on contaminant transmission in less viscous fluids that are not prone to coagulation.
We used enzymatic colorimetry to quantify the volume of inoculation delivered by a suture needle that was coated with an aqueous contaminant. Substrate color change was measured using a microplate reader. Both cutting and tapered suture needles were tested against five different glove types and differing numbers of glove layers (from zero to three).
One glove layer removed 97% of contaminant from tapered needles and 65% from cutting needles, compared with the no-glove control data. Additional glove layers did not significantly improve contaminant removal from tapered needles (p > 0.05). For the cutting needle, 2 glove layers removed 91% of contaminant, which was significantly better than a single glove (p = 0.002). Three glove layers did not afford statistically significant additional protection (p = 0.122). There were no statistically significant differences between glove types (p = 0.41).
With an aqueous needle contaminant, a single glove layer removes contaminant from tapered needles as effectively as multiple glove layers. For cutting needles, double-glove layering offers superior protection. There is no advantage to triple-glove layering. A surgeon should double-glove for maximum safety. Additionally, a surgeon should take advantage of other risk-reduction strategies, such as sharps safety, risk management, and use of sharpless instrumentation when possible.
感染血源性疾病是手术操作存在的一种风险。大多数关于血清转化的数据是基于空心针穿刺伤。一些研究已经考察了缝合针所传递的纯血量。目前缺乏关于双层手套对不易凝固的低粘性液体中污染物传播影响的数据。
我们使用酶比色法来量化涂有水性污染物的缝合针所传递的接种量。使用酶标仪测量底物颜色变化。对切割型和锥形缝合针针对五种不同类型的手套以及不同层数的手套（从零到三层）进行了测试。
与不戴手套的对照数据相比，一层手套可去除锥形针97%的污染物和切割针65%的污染物。额外增加手套层数并不能显著提高锥形针的污染物去除率（p>0.05）。对于切割针而言，两层手套可去除91%的污染物，这明显优于单层手套（p = 0.002）。三层手套并未提供具有统计学意义的额外保护（p = 0.122）。不同类型手套之间没有统计学上的显著差异（p = 0.41）。
对于水性针污染物，单层手套去除锥形针污染物的效果与多层手套一样有效。对于切割针，双层手套提供更好的保护。三层手套并无优势。外科医生应戴双层手套以确保最大安全。此外，外科医生应利用其他降低风险的策略，如锐器安全、风险管理，并尽可能使用无锐器器械。
