Akbulut Volkan Özgür, Sümer Dinçer, Kından Aziz, Kurt Ahmet, Kından Aykut, Ağaoğlu Recep Taha, Filiz Ahmet Arif, Canga Kubilay, Ayhan Hatice, Çağlar Ali Turhan
Ankara Etlik City Hospital, Department of Perinatology, Ankara, Turkey.
Department of Obstetrics and Gynecology, Ankara Etlik City Hospital, Ankara, Turkey.
BMC Pregnancy Childbirth. 2025 Aug 12;25(1):835. doi: 10.1186/s12884-025-08002-3.
Infectious complications at the surgical site complicates 1-4% of cesarean deliveries. Strict aseptic technique, hand hygiene and the use of sterile surgical gloves are essential to reduce the risk of surgical site contamination. Glove perforations are observed in almost 30% of all procedures and represent an underestimated potential risk factor for postoperative infections. The aim of this prospective study was to investigate glove perforation rates in cesarean deliveries and to analyze the impact of unrecognized glove perforations during surgery on surgical site infection rates after cesarean delivery.
Surgical gloves from cesarean section were collected prospectively. All gloves were inspected for perforation holes. Cases in which surgical gloves had visible (macro) perforations were excluded from the study. Remaining gloves were examined using a water-fill test. Gloves with a positive water filling test were defined as the study group and negative gloves as the control group. Superficial Surgical Site Infections (SSI) were analyzed for the groups.
A total of 1,779 pairs of used surgical gloves were collected and examined for perforations across 593 cesarean operations. Macro perforation were observed in 56 (9.4%) operations. The remaining 1,611 pairs of gloves underwent water-fill testing. Of these, 505 operations had completely intact gloves, while in 32 (5.4%) cases, micro-perforations were identified. SSI occurred in 18 women (3.3%): 7 in the perforation group (21.8%) and 11 in the control group (2.2%) (p < 0.001). In multivariable logistic regression analysis, glove micro-perforation was found to be a significant independent predictor of SSI (adjusted odds ratio: 12.705; 95% CI: 4.244-38.039; p < 0.001), even after adjusting for potential confounders including diabetes, obesity, emergency cesarean, operative duration, and intraoperative blood loss.
Our data show that glove perforation is unexpectedly common and underestimated in terms of unfavorable surgical outcomes. The rate of surgical site infections is increasing and we suggest that unrecognized glove perforation must be considered as a risk factor for surgical site infection after cesarean section.
手术部位感染并发症使1%至4%的剖宫产手术变得复杂。严格的无菌技术、手部卫生和使用无菌手术手套对于降低手术部位污染风险至关重要。在所有手术过程中，近30%的手术手套会出现穿孔，这是一个被低估的术后感染潜在风险因素。这项前瞻性研究的目的是调查剖宫产手术中手套穿孔率，并分析手术过程中未被识别的手套穿孔对剖宫产术后手术部位感染率的影响。
前瞻性收集剖宫产手术的手术手套。检查所有手套是否有穿孔。手术手套有可见（宏观）穿孔的病例被排除在研究之外。其余手套采用注水试验进行检查。注水试验呈阳性的手套被定义为研究组，阴性手套为对照组。分析两组的浅表手术部位感染（SSI）情况。
共收集了1779双使用过的手术手套，并在593例剖宫产手术中检查了穿孔情况。在56例（9.4%）手术中观察到宏观穿孔。其余1611双手术手套进行了注水试验。其中，505例手术的手套完全完好，而在32例（5.4%）病例中发现了微穿孔。18名女性（3.3%）发生了SSI：穿孔组7例（21.8%），对照组11例（2.2%）（p<0.001）。在多变量逻辑回归分析中，发现手套微穿孔是SSI的一个显著独立预测因素（调整后的优势比：12.705；95%置信区间：4.244 - 38.039；p<0.001），即使在调整了包括糖尿病、肥胖、急诊剖宫产、手术时间和术中失血等潜在混杂因素后也是如此。
我们的数据表明，手套穿孔出乎意料地常见，且在不良手术结果方面被低估。手术部位感染率在上升，我们建议必须将未被识别的手套穿孔视为剖宫产术后手术部位感染的一个风险因素。
