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单手套使用是否仍可接受?普通外科无菌乳胶手套损伤情况的调查与评估。

Is Single Gloving Still Acceptable? Investigation and Evaluation of Damages on Sterile Latex Gloves in General Surgery.

作者信息

Enz Andreas, Kamaleddine Imad, Groß Justus, Schafmayer Clemens, Alwafai Emad, Sievers Larissa, Mittelmeier Wolfram, Klinder Annett

机构信息

Orthopaedic Clinic and Policlinic, University Medical Centre Rostock, 18057 Rostock, Germany.

Department of General, Visceral, Vascular and Transplant Surgery, Surgical Clinic and Polyclinic of University Medical Centre Rostock, 18057 Rostock, Germany.

出版信息

J Clin Med. 2021 Aug 29;10(17):3887. doi: 10.3390/jcm10173887.

Abstract

(1) Background: The sterile latex surgical glove is an important part of protecting both the patient and the surgical team from infections. However, mechanical stress can damage the integrity of the glove material and thus may lead to infections. (2) Method: A total of 896 gloves from 448 surgeries were tested and evaluated by the water tightening test according to EN455 and ASTM D5151-19. (3) Results: From 448 surgeries, 18.8% of the interventions showed glove damage. In vascular surgery, gloves were damaged in 20.8%, in thoracic surgery 9.1%, in laparoscopic interventions 21.7%, in the subgroup hernia surgeries (TAPP) 17.6% and in open interventions 17.6%. A total of 101 damages were found on 896 gloves; one glove could have several damages. During vascular surgery, 60% of the damages were on the subordinated hand of the surgeon, and 73.3% of the damages had a size of 1 mm. In laparoscopic procedures, the subordinated hand was also more frequently affected (61.3%) than the dominant hand; 64.5% of the damages were 1 mm in size. In the hernia surgery subgroup (TAPP), no damage was larger than 1 mm; 66.7% were in the subordinated hand area. The duration of surgery had no influence on the lesion rate. (4) Conclusion: The damage rate in low impact procedures is high and represents an underestimated problem in soft tissue surgery. The use of single gloving can therefore lead to the risk of infection. EN455 and ASTM D5151-19 does not take into consideration the risk of intraoperative lesions. Double gloving and glove change algorithms should be established.

摘要

(1) 背景:无菌乳胶手术手套是保护患者和手术团队免受感染的重要部分。然而,机械应力会破坏手套材料的完整性,从而可能导致感染。(2) 方法:根据EN455和ASTM D5151 - 19,对来自448台手术的896只手套进行水密性测试并评估。(3) 结果:在448台手术中,18.8%的手术出现手套破损。在血管外科手术中,手套破损率为20.8%,胸外科手术中为9.1%,腹腔镜手术中为21.7%,疝修补手术亚组(TAPP)中为17.6%,开放手术中为17.6%。在896只手套上共发现101处破损;一只手套可能有多处破损。在血管外科手术中,60%的破损发生在主刀医生的非优势手,73.3%的破损尺寸为1毫米。在腹腔镜手术中,非优势手也比优势手更常受到影响(61.3%);64.5%的破损尺寸为1毫米。在疝修补手术亚组(TAPP)中,没有破损大于1毫米;66.7%位于非优势手区域。手术时长对破损率没有影响。(4) 结论:低冲击手术中的破损率很高,是软组织手术中一个被低估的问题。因此,使用单层手套会导致感染风险。EN455和ASTM D5151 - 19没有考虑术中破损的风险。应建立双层手套和更换手套的算法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8645/8432096/8af2a31bcc24/jcm-10-03887-g001.jpg

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