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Sir,

We read with interest the article by Manjunath et al. on ‘Glove perforations during open surgery for gynaecological malignancies. Glove perforations in gynaecological cancer surgeries’.1 The authors mention that the incidence of pre-existing perforations in unused gloves can be as high as 7.5 %. If this is correct, then the perforation rate actually due to the surgery might be 5.7% rather than the 13.2% that the authors report. We believe it is a very important compounding factor that can potentially reduce the perforation rate (in all gloves) from 13.2 to 5.7%. The authors mentioned that overstretching during donning or pre-existing perforations could have been the reason for inner glove damages in at least two of five (40%) cases. Unfortunately, no measure was taken to eliminate the effect of this compounding confounding factor in data analysis.1 The data showed that in the double gloves group (including with indicator gloves) 139 of the inner gloves and 169 of the outer gloves were tested for perforation. No explanation was given why they failed to check 30 (30/169) of inner gloves. The results of those could have different impact on the final results.

Another interesting finding of the study was the high glove perforation rate among the nurses. These perforations cannot be related to operative procedures, as scrub nurses do not participate directly in the surgery directly. Again, it is very difficult to justify that more than 40% scrub nurses perforated their gloves mostly. It is difficult to believe that so many nurses perforated their gloves during sharps disposal after surgery. Nurses during surgery are least likely to get needle injuries and no such incidence was mentioned in the study.

We consider that many of these perforations may because of stretching of gloves during donning, or friction of the gloves against the operators’ hand during surgery. Scrub nurses had to use their hands all through the surgery to supply and receive the instruments from surgeons. They are prone to have more frictions from these movements, which may explain why nurses had a high perforation rate. The Senior House Officers, who usually have minimal hand movements during surgery, had the least perforations.

So, we suggest that trauma from inside rather than outside could cause many of these, if not the most of, these perforations. If that is the case, it would be prudent to change the gloves during surgeries at regular intervals (i.e. every hour) rather than wearing double gloves that are associated with reduced sensations and dexterity. Future studies looking at the pre- and postsurgical skin abrasions and lacerations would give us the desired answer to shed more light on this very important health and safety-related question.

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