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Heidi Misteli, MD; Walter P. Weber, MD; Stefan Reck, MD; Rachel Rosenthal, MD; Marcel Zwahlen, PhD; Philipp Fueglistaler, MD; Martin K. Bolli, MD; Daniel Oertli, MD; Andreas F. Widmer, MD; Walter R. Marti, MD

Arch Surg. 2009;144(6):553-558.

Hypothesis  Clinically apparent surgical glove perforation increases the risk of surgical site infection (SSI).

Design  Prospective observational cohort study.

Setting  University Hospital Basel, with an average of 28 000 surgical interventions per year.

Participants  Consecutive series of 4147 surgical procedures performed in the Visceral Surgery, Vascular Surgery, and Traumatology divisions of the Department of General Surgery.

Main Outcome Measures  The outcome of interest was SSI occurrence as assessed pursuant to the Centers of Disease Control and Prevention standards. The primary predictor variable was compromised asepsis due to glove perforation.

Results  The overall SSI rate was 4.5% (188 of 4147 procedures). Univariate logistic regression analysis showed a higher likelihood of SSI in procedures in which gloves were perforated compared with interventions with maintained asepsis (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.4-2.8; P < .001). However, multivariate logistic regression analyses showed that the increase in SSI risk with perforated gloves was different for procedures with vs those without surgical antimicrobial prophylaxis (test for effect modification, P = .005). Without antimicrobial prophylaxis, glove perforation entailed significantly higher odds of SSI compared with the reference group with no breach of asepsis (adjusted OR, 4.2; 95% CI, 1.7-10.8; P = .003). On the contrary, when surgical antimicrobial prophylaxis was applied, the likelihood of SSI was not significantly higher for operations in which gloves were punctured (adjusted OR, 1.3; 95% CI, 0.9-1.9; P = .26).

Conclusion  Without surgical antimicrobial prophylaxis, glove perforation increases the risk of SSI.

Author Affiliations: Department of General Surgery (Drs Misteli, Weber, Reck, Rosenthal, Fueglistaler, Bolli, Oertli, and Marti) and the Division of Infectious Disease and Hospital Epidemiology (Dr Widmer), University Hospital Basel, Basel, Switzerland; and the Research Support Unit, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland (Dr Zwahlen).

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