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Surgical glove bacterial contamination and perforation during total hip arthroplasty implantation: When gloves should be changed - 11/05/12

Doi : 10.1016/j.otsr.2011.10.015 
J. Beldame a, , B. Lagrave a, L. Lievain a, B. Lefebvre a, N. Frebourg b, F. Dujardin a, c
a Department of Orthopaedic Surgery, Rouen Teaching Hospital Center, 1, rue de Germont, 76031 Rouen cedex, France 
b Microbiology Department, Rouen Teaching Hospital Center, 1, rue de Germont, 76031 Rouen cedex, France 
c ERT 3835 MENTES Unit, Rouen University, Sport Sciences faculty, boulevard Siegfried, 78621 Mont-Saint-Aignan, France 

Corresponding author. Tel.: +33 2 32 88 01 64; fax: +33 2 32 88 83 12.

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Summary

Introduction

Double gloving is recommended in orthopedic surgery, notably in total hip arthroplasties (THA) to prevent contamination of the surgical site.

Hypothesis

Systematic glove changes during the key phases of hip prosthesis implantation reduce the frequency of occult perforations and bacterial loading of glove surfaces.

Patients and methods

During 29 THA implantation procedures, we evaluated the bacterial contamination of the outer glove surface and its perforation rate. Contaminations were sought by placing the gloved fingertips on blood geloses (incubation, 48h at 37°C), and perforations were sought using a water test (NF EN 455-1).

Results

One intervention was excluded from the study because an initial contamination was detected, leaving 28 cases analyzed. Fifteen interventions (53.6%) presented contaminated geloses (26 contaminated glove changes for 3.38% of the gloves used). These contaminations were found on the gloves of all of the gloved personnel, with no distinction as to the right or left side. Thirty-eight percent of the contaminations occurred during joint reduction, whereas the other surgical stages grouped 15–26% of the contaminations (P<0.05). Twenty-nine bacteria were identified: 62% coagulase-negative staphylococci (16% of which were methicillin-resistant). Twenty-eight perforations were identified (3.5% of the gloves used), 67.8% of which were located on the operator and 64.3% on the dominant side. Eighty percent of the perforations occurred during the “surgical incision” and the “cup and stem implantation” stages (respectively, 5.0% and 5.5% of the gloves used during the surgical time) (P<0.05), without being associated with an increased risk of bacterial contamination. At the 12-month clinical follow-up, no infectious complications were found. On the gloves worn by the 20 surgical team members contaminated during these 28 surgical procedures, replacing contaminated gloves with new sterile gloves rendered all the bacteriological samples of the subsequent surgical stages negative in 16 cases (80%).

Discussion

Increasing the number of outer glove renewals, notably during certain surgical stages at risk for contamination (prosthesis reduction) or perforation (surgical incision/femoral cementing) can reduce the risk of contamination and perforation. The bacteria isolated suggest a cutaneous origin. Regularly changing gloves has resulted in a sterile state in 80% of cases.

Level of evidence and type of study

Level III prospective diagnostic study.

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Keywords : Replacement of the hip joint, Asepsis, Glove perforation


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© 2012  Elsevier Masson SAS. Tous droits réservés.
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