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Ann Thorac Surg 2003;75:1680-1681
© 2003 The Society of Thoracic Surgeons

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Correspondence

Glove punctures in cardiac surgery

^a Department of Surgery, Cardiothoracic Division, University of Tennessee Health Science Center, 956 Court Ave, Memphis, TN 38163, USA

e-mail: jpate{at}utmem.edu

To the Editor:

The report by Eklund and associates [1] again draws attention to a serious problem that has persisted in spite of earlier warnings. They report that surgeons changed gloves owing to recognized loss of integrity 70 times in 116 heart operations; postoperative testing revealed that 39% of the presumed-intact gloves had unrecognized holes. In 1987 Berg and colleagues [2] drew attention to punctured surgical gloves and their implications for patients having valve replacement. These reports and Eklund’s recommendation for frequent effective disinfection of the hands are important to patients. However, the danger to the surgical team is not adequately stressed.

Widespread concern about possible transmission of HIV to and from surgeons led us to our 1990 prospective, protocol-driven study [3] of all "operating" personnel in 50 consecutive coronary bypass operations and 17 valve replacements in two hospitals. It revealed that from 11 to 16 gloves were used because of grossly recognized "puncture or disintegration" in each operation. In one repeat coronary operation 60 gloves were used and in one re-do mitral replacement, 57. More worrisome, actual skin punctures, lacerations, or eye splashes to the surgical team occurred in 0.4 to 1.5 instances per operation. (While hepatitis B and C have proven more risky than HIV, exposure to patient’s blood and possible pathogens by an "operating" person engaged in 400 operations per year would be between 160 and 600 encounters!

This 2002 report of Eklund reveals that these dangers to both patients and operating team are still present 12 years later and certainly deserve more serious attention than we usually exhibit.

References

1. Eklund A.M., Ojajärvi J., Laitinen K., et al. Glove punctures and postoperative skin flora of hands in cardiac surgery. Ann Thorac Surg 2002;74:149-153.[Abstract/Free Full Text]
2. Berg G.A., Kirk A.J.B., Bain W.H. Punctured surgical gloves and bacterial re-colonisation of hands during open heart surgery: implications for prosthetic valve replacement. Br J Clin Pract 1987;41:903-906.[Medline]
3. Pate J.W. Risks of blood exposure to the cardiac surgical team. Ann Thorac Surg 1990;50:248-250.[Abstract]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): James W. Pate Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Pate, J. W. Search for Related Content PubMed PubMed Citation Articles by Pate, J. W. Related Collections Cardiac - other