Author response to: Glove perforations during open surgery for gynaecological malignancies

Author’s Reply

Sir,

We appreciate the interest of Ashfaq Khan¹ in our article on glove injuries.² Although there have been reports of an incidence of pre-existing glove injuries as high as 7.5%, we did not check for pre-existing glove injuries in our audit as this was not our objective. Interestingly, during the analysis of our data set, we found that there were two inner gloves perforations despite the outer gloves being intact. We have tried to explain this occurrence as being due to a pre-existing perforation or tear during the donning of gloves. Regular checking of unused gloves for pre-existing perforations is however difficult in day-to-day practice. Moreover, the Food and Drug Administration (FDA) mandates that the glove hole leakage rate must not exceed the acceptable quality level (AQL) of 2.5% for surgeon’s gloves and 4.0% for patient examination gloves (collectively known as medical gloves).³ Even this low level of glove injury poses a small but significant risk. Hence, the simple measure of wearing double glove to protect the healthcare provider is the most important message from our study.

The explanation of friction as a cause of high glove perforation rate among nurses is interesting. Although Khan’s assumption regarding the trauma from inside rather than outside for the perforations appears logical, it is difficult to confirm this in real life. Moreover, there is no evidence to suggest that one should change gloves frequently (e.g. every hour) to overcome the risk of exposure. Whatever the reason for glove injury, the important safety question is to detect the perforation as soon as it occurs. Since the majority of glove perforations go unnoticed, the barrier between the patient’s blood and surgeon’s skin may be breached unknowingly for prolonged periods when single gloves are used. Thus, we recommend the routine use of double gloves because the inner glove will protect the surgeon in 93% of cases when the outer glove is perforated.

There would be value in developing a reliable glove perforation detection system to identify the perforation as soon as it occurs to maintain the sterile barrier between healthcare providers and patients.