PRESENT
Although the surgical glove helps reduce cross infection from patient to
the surgeon and vice versa, it does not prevent accidental needle sticks or
sharp injury, the most common forms of exposure to infected blood or
body fluids, which are implicated in the occupational transmission of
AIDS and hepatitis B viruses. The need for protection extends into many
occupations, especially that of the healthcare professional.
Studies show the puncture rate of gloves for surgical procedures ranges
from 8-15% of single gloves. This unacceptably high perforation rate is
alarming and measures must be taken to prevent perforations, especially
in known HIV or Australian Antigen positive patients. Health workers
may be vaccinated against the hepatitis B virus as a protective measure,
but there is no present method of immunization against AIDS. Healthcare professionals should adopt a policy of considering all patients to be
potentially high risk and managed accordingly.
Surgeons and operating theater personnel also must adopt operating
room safety procedures to limit exposure to sharp instruments through
measures such as thimble protection of the most susceptible fingers (usually the left hand during suturing), avoiding hand suturing and using
stapling techniques where possible. The electrocautery device for cutting
through tissue should be used rather than the scalpel. Avoid hand-to-hand passing of sharp instruments, and wear glasses to protect against
splashing of body fluids.
Gowns that prevent blood seepage onto the skin are now commonly
used. Double gloving reduces, but does not eliminate, the risk of piercing.
Health workers handling accident patients with open wounds are particularly exposed to the blood of infected patients. Strict precautions are
necessary for ambulance workers and personnel in emergency departments.
FUTURE
My own interest in the surgical glove began after considering the problems of the surgeon dealing with patients considered to be at risk or of
known AIDS or HIV positive status. As accidental mishandling of sharp
instruments is the cause of stab injuries, then protection should be
designed into the glove. Currently there are no satisfactory rubber type
materials available to produce a flexible, tactile and sensitive glove
which will prevent stab injuries.
As mentioned, double gloving is no protection against sharp injuries.
However, a glove which incorporates a viricidal material between an
inner and outer layer might reduce the risk. If a sharp was to penetrate
such a glove there would be a wiping action of the outer layer, a viricidal
effect of the middle layer, and a further wiping action of the inner layer.
Thus the quantity of bacteria or virus should be markedly reduced or
eliminated from the surface of the penetrating sharp. A "double glove"
would need to be preformed with the two layers being bonded at the
sleeve or between the layers so that a viricidal material may be sandwiched in between. The viricidal agent would be in either a liquid or
solid form, or impregnated into another material which is interfaced
between the inner and outer glove. The material should be capable of
killing HIV in vitro. An example of such a material is an alkyl urea,
e.g., N-butylurea, of the type disclosed in US-A4880836. The material
may be pigmented to allow ready observation of any penetration.
Although the double layer might limit the tactile sensation of the fingers,
it would be a small price to pay for the additional protection. Although
such a glove would be expensive to manufacture, its use could be limited
to the stage of the procedure where sharps are used, thus encouraging
multiple glove changes and increasing barrier integrity.
Blood proof gowns are not a complete protection of the skin of a surgeon's arms. The sleeve cuff, usually made of a cotton-like material and
meant to be covered by the glove, often rolls up during procedure and is
exposed to body fluids. This material is absorbent and blood soon comes
into contact with the forearm. My own experience suggests that the more
blood and water repellent the gown, the less adhesiveness and friction
between the gown sleeve and the glove. The result is a break in continuity of an effective barrier to body fluids and protection is no longer
guaranteed. Gloves designed to adhere and grip the waterproof gown
sleeve may become necessary to seal the surgeon's arms from exposure.
Possible methods of ensuring a protective barrier to fluid contact of the
forearm might include:
- A longer glove to almost reach the elbow.
- Providing a separate waterproof sealing tape to fix the proximal
edge of the glove to the upper part of the waterproof sleeve of the
surgical gown.
- A latex sleeve which is drawn over the gloved hand to cover the
glove just proximal to the wrist and extending up the forearm. An
adhesive may be added to the upper and lower end of the rubber
tube to fix to the glove and sleeve.
One must not be constrained by the design of the traditional surgical
glove. The needs of the surgical personnel have changed and vary with
the type of surgical procedure performed. The hepatitis B virus and
AIDS will have a profound influence on the design of protective gloves
which may mean a greater variety from which surgeons may select to
suit the type of operation being performed.
