Wichmann Thorsten, Moriarty T Fintan, Keller Iris, Pfister Stefan, Deggim-Messmer Vanessa, Gautier Emanuel, Kalberer Fabian, Koch Peter P, Wahl Peter
School for Medical Technology and Medical Computer Sciences, Bernese University of Applied Sciences, Bern, Switzerland.
Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Brauerstrasse 15, P.O. Box 834, 8401, Winterthur, Switzerland.
Arch Orthop Trauma Surg. 2019 Apr;139(4):451-459. doi: 10.1007/s00402-018-3061-3. Epub 2018 Nov 7.
Knitted cotton outer gloves offer protection against surgical glove perforation and provide improved grip on instruments. These gloves absorb blood and other fluids during surgery, and may therefore also accumulate contaminating bacteria. To date, there is no published data on microbial contamination of such gloves during surgery.
Knitted cotton outer gloves used in primary and revision hip and knee arthroplasty from two Swiss hospitals were analysed by quantitative bacteriology. Samples were subjected to sonication and vortexing, followed by membrane filtration of the sonicate. Membranes were incubated under aerobic and anaerobic culture conditions, respectively, for 21 days. Total microbial load for each pair of gloves was determined by colony-forming units (CFU) count. Strain identification was performed with MALDI-TOF.
A total of 43 pairs of gloves were collected from continuous series of surgeries. Under aerobic culture conditions, total CFU counts ranged 0-1103, 25 (58%) samples remaining sterile, and 4 (9%) yielding > 100 CFU. Under anaerobic culture conditions, total CFU counts ranged 0-3579, 22 (51%) samples remaining sterile, 6 (14%) yielding > 100 CFU. The only covariate significantly associated with the level of contamination was the provider hospital (p < 0.0001 for aerobic and p = 0.007 for anaerobic cultures). Strain identification revealed only skin commensals, mainly coagulase-negative staphylococci and Propionibacterium spp.
While contamination of surgical latex gloves is a well-known issue, no study has examined so far contamination of knitted cotton outer gloves. No or very low microbial contamination could be identified in the majority of the knitted cotton outer gloves assayed. However, a relevant proportion showed contamination far higher than estimated minimal thresholds for implant-associated infection. Clinical relevance of these findings remains to be established.
针织棉外层手套可防止手术手套穿孔，并能改善对器械的抓握力。这些手套在手术过程中会吸收血液和其他液体，因此也可能积聚污染细菌。迄今为止，尚无关于此类手套在手术期间微生物污染情况的公开数据。
对来自两家瑞士医院的初次和翻修髋关节及膝关节置换术中使用的针织棉外层手套进行了定量细菌学分析。样本经过超声处理和涡旋振荡，然后对超声处理后的样本进行膜过滤。将膜分别在需氧和厌氧培养条件下培养21天。通过菌落形成单位（CFU）计数确定每对手套的总微生物负荷。使用基质辅助激光解吸电离飞行时间质谱（MALDI-TOF）进行菌株鉴定。
从连续的一系列手术中总共收集了43对手套。在需氧培养条件下，总CFU计数范围为0 - 1103，25个（58%）样本保持无菌，4个（9%）样本的CFU计数大于100。在厌氧培养条件下，总CFU计数范围为0 - 3579，22个（51%）样本保持无菌，6个（14%）样本的CFU计数大于100。与污染水平显著相关的唯一协变量是提供手套的医院（需氧培养时p < 0.0001，厌氧培养时p = 0.007）。菌株鉴定仅发现皮肤共生菌，主要是凝固酶阴性葡萄球菌和丙酸杆菌属。
虽然手术乳胶手套的污染是一个众所周知的问题，但迄今为止尚无研究考察针织棉外层手套的污染情况。在大多数检测的针织棉外层手套中未发现或仅发现极低的微生物污染。然而，相当一部分手套的污染程度远高于植入相关感染估计的最低阈值。这些发现的临床相关性仍有待确定。
