Latex versus nonlatex gloves; endoscope disinfection; serum vitamin A; bariatric surgery

AORN Journal,  Jan, 2005  by George Allen

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Comparison of failure rates between latex and nonlatex gloves

American Journal of Infection Control August 2004

In perioperative settings, sterile gloves serve a dual purpose. They are used as a safety device to protect patients from transmission of infection during surgery and as the principal barrier that protects perioperative personnel from exposure to bloodborne pathogens. The purpose of this study was to compare frequency of defects between sterile latex and nonlatex surgical gloves and evaluate surgeons' satisfaction with latex and nonlatex gloves used during surgery. (1)

During a 14-month period, two brands of latex gloves and six brands of nonlatex gloves were evaluated in 23 ORs from two sites--a shock trauma OR and a main OR at a major academic teaching hospital. Each month, a different brand of glove was supplied to each of the surgical suites in random order. Gloves used by surgeons who were directly involved in a surgical procedure were collected at the end of each procedure. The gloves were inspected and tested for defects. Gloves that appeared to be intact on visual inspection were tested for barrier integrity using a water test. Additionally, each month during the study, surgeons were asked to rate their satisfaction with the gloves used during that month with regard to quality, safety, serviceability, standardization, perception of needle-stick injury, and durability. Common statistical techniques, including multiple regression analysis and analysis of variance, were used to analyze differences between the gloves used and surgeons' satisfaction.

Findings. Of the 6,486 gloves tested, 40.8% were latex gloves and 59.1% were nonlatex (ie, 55.8% neoprene gloves, 3.3% nitrile gloves). The total defect rate for all gloves was 6.7%. Compared to latex gloves, nonlatex gloves were significantly more likely to have visible defects ([X.sub.2] = 30.7, P < .001). There was no difference between the latex and nonlatex gloves with no visible defects that were subjected to the water leak test. Rates of developing water leak defects increased directly with the duration of glove use in both latex and neoprene gloves. Surgeons and residents were more satisfied with latex than nonlatex (ie, nitrile and neoprene) gloves (F = 21.98; df = 2,367; P < .0001).

Clinical implications. Intact latex or nonlatex surgical gloves both provide adequate barrier protection; however, in this study, nonlatex gloves tore more frequently and produced a lower surgeon satisfaction rate than latex gloves. Perioperative personnel should assess their gloves for defects frequently during surgical procedures and immediately change gloves when it appears as though the gloves' integrity has been compromised. Consideration should be given to routinely changing gloves after a certain period of time, for example, every two or four hours during a surgical procedure.

High-level disinfection of endoscopes

Gastrointestinal Endoscopy July 2004

Endoscopic procedures allow a surgeon to see inside a patient's body to make a diagnosis or provide treatment without making an invasive incision. After use, endoscopes are decontaminated, manually cleaned while immersed in a detergent, subjected to high-level disinfection using manual or mechanical processes, rinsed, dried, and stored until the endoscope is needed for another procedure. The purpose of this study was to evaluate the stability of high-level disinfection of endoscopes stored in a dust-proof cabinet. (2)

After completion of an endoscopic procedure, endoscopes were decontaminated, cleaned, and subjected to high-level disinfectant in an automatic, flexible endoscope reprocessor. The endoscopes then were hung in a dust-proof cabinet for storage. During phase I of the study, bacteriological assays were obtained from the surface of the endoscopes, the openings for the air/water and suction valves, and the distal part of the accessory channels immediately after high-level disinfection. The assays were repeated every other day for the next five days. During phase II, after five days of storage, the accessory channels of the endoscopes were brushed and flushed through with normal saline, and samples were cultured for all types of bacteria.

Findings. A total of 135 assays were performed. All the endoscopes were bacteria-free immediately after high-level disinfection. During the subsequent five-day period, less than 1% (4) of the assays were positive for skin bacteria. All 10 of the flush-through samples collected on the endoscopes after five days in storage were negative.

Clinical implications. This study revealed that when endoscopes have been cleaned, subjected to high-level disinfection, and stored in a dust-proof cabinet, reprocessing before reuse may not be necessary. Perioperative nurses should understand that the effectiveness of the high-level disinfection process for endoscopes depends on adequate pre-cleaning and drying before storage; however, consideration should be given to periodic evaluation of high-level disinfection and storage procedures to evaluate the efficacy of those procedures.