Randomized controlled trial of glove perforation in single- and double-gloving in episiotomy repair after vaginal delivery.
ABSTRACT The aims of the study presented here were to compare the rate of glove perforation between single-gloving and double-gloving methods, and the time of operation and level of surgeon in episiotomy repair after vaginal delivery.
A prospective randomized controlled trial was performed from the beginning of May to the end of December, 2002 at Ramathibodi Hospital. A comparison of glove perforation between single-gloving and double-gloving methods was performed. Glove perforations were tested by filling each glove with water. Glove perforation rate, position of perforation, time of operation and surgeon level of experience were analyzed.
One hundred and fifty sets of double-gloving method and 150 sets of single-gloving method were evaluated. The glove perforation rates were 4.6 and 18% in double-inner gloves and single-gloves, respectively, with statistical difference (P < 0.05). There was no significant difference between glove perforation rates in double-outer gloves (22.6%) and single-gloves (18%). There was matched perforation of the same finger of both outer and inner gloves in 2% of all double-inner gloves. The frequency of glove perforation was classified by the surgeon's level of experience and time of operation was no difference in each level.
The double-gloving method significantly reduced the risk of exposure of the surgeon's hand to the patient's blood, when compared with the single-gloving method in episiotomy repair. There were no differences in the rate of glove perforations compared to the time of operation and level of surgeon.
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ABSTRACT: Healthcare workers are at risk of acquiring viral diseases such as hepatitis B, hepatitis C and HIV through exposure to contaminated blood and body fluids at work. Most often infection occurs when a healthcare worker inadvertently punctures the skin of their hand with a sharp implement that has been used in the treatment of an infected patient, thus bringing the patient's blood into contact with their own. Such occurrences are commonly known as percutaneous exposure incidents. To determine the benefits and harms of extra gloves for preventing percutaneous exposure incidents among healthcare workers versus no intervention or alternative interventions. We searched CENTRAL, MEDLINE, EMBASE, NHSEED, Science Citation Index Expanded, CINAHL, NIOSHTIC, CISDOC, PsycINFO and LILACS until 26 June 2013. Randomised controlled trials (RCTs) with healthcare workers as the majority of participants, extra gloves or special types of gloves as the intervention, and exposure to blood or bodily fluids as the outcome. Two authors independently assessed study eligibility and risk of bias, and extracted data. We performed meta-analyses for seven different comparisons. We found 34 RCTs that included 6890 person-operations as participating units and reported on 46 intervention-control group comparisons. We grouped interventions as follows: increased layers of standard gloves, gloves manufactured with special protective materials or thicker gloves, and gloves with puncture indicator systems. Indicator gloves show a coloured spot when they are perforated. Participants were surgeons in all studies and they used at least one pair of standard gloves as the control intervention. Twenty-seven studies also included other surgical staff (e.g. nurses). All but one study used perforations in gloves as an indication of exposure. The median control group rate was 18.5 perforations per 100 person-operations. Seven studies reported blood stains on the skin and two studies reported self reported needlestick injuries. Six studies reported dexterity as visual analogue scale scores for the comparison double versus single gloves, 13 studies reported outer glove perforations. We judged the included studies to have a moderate to high risk of bias.We found moderate-quality evidence that double gloves compared to single gloves reduce the risk of glove perforation (rate ratio (RR) 0.29, 95% confidence interval (CI) 0.23 to 0.37) and the risk of blood stains on the skin (RR 0.35, 95% CI 0.17 to 0.70). Two studies with a high risk of bias also reported the effect of double compared to single gloves on needlestick injuries (RR 0.58, 95% CI 0.21 to 1.62).We found low-quality evidence in one small study that the use of three gloves compared to two gloves reduces the risk of perforation further (RR 0.03, 95% CI 0.00 to 0.52). There was similar low-quality evidence that the use of one fabric glove over one normal glove reduces perforations compared to two normal gloves (RR 0.24, 95% CI 0.06 to 0.93). There was moderate-quality evidence that this effect was similar for the use of one special material glove between two normal material gloves. Thicker gloves did not perform better than thinner gloves.There was moderate to low-quality evidence in two studies that an indicator system does not reduce the total number of perforations during an operation even though it reduces the number of perforations per glove used.There was moderate-quality evidence that double gloves have a similar number of outer glove perforations as single gloves, indicating that there is no loss of dexterity with double gloves (RR 1.10, 95% CI 0.93 to 1.31). There is moderate-quality evidence that double gloving compared to single gloving during surgery reduces perforations and blood stains on the skin, indicating a decrease in percutaneous exposure incidents. There is low-quality evidence that triple gloving and the use of special gloves can further reduce the risk of glove perforations compared to double gloving with normal material gloves. The preventive effect of double gloves on percutaneous exposure incidents in surgery does not need further research. Further studies are needed to evaluate the effectiveness and cost-effectiveness of special material gloves and triple gloves, and of gloves in other occupational groups.Cochrane database of systematic reviews (Online) 03/2014; 3(3):CD009573. DOI:10.1002/14651858.CD009573.pub2 · 5.94 Impact Factor
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ABSTRACT: This study examined the effects of glovebox gloves for 11 females on maximum grip and key pinch strength and on contact forces generated from simulated tasks of a roller, a pair of tweezers and a crescent wrench. The independent variables were gloves fabricated of butyl, CSM/hypalon and neoprene materials; two glove thicknesses; and layers of gloves worn including single, double and triple gloving. CSM/hypalon and butyl gloves produced greater grip strength than the neoprene gloves. CSM/hypalon gloves also lowered contact forces for roller and wrench tasks. Single gloving and thin gloves improved hand strength performances. However, triple layers lowered contact forces for all tasks. Based on the evaluating results, selection and design recommendations of gloves for three hand tools were provided to minimise the effects on hand strength and optimise protection of the palmar hand in glovebox environments.Ergonomics 07/2014; 57(10):1-14. DOI:10.1080/00140139.2014.933888 · 1.61 Impact Factor
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ABSTRACT: Objectives To describe the different types of episiotomy and to define the methods of repair. Methods A systematic review on Medline and Cochrane Database between 1980 and August 2005 was performed. Results Aseptic prevention and specific material may be used in order to reduce the risk of surgical wound infection (grade C). Episiotomy and perineal repair may be associated with considerable pain. In contrast, there has been little evaluation of the effectiveness of analgesia provided to women undergoing this procedure. The mediolateral episiotomy is a 6 cm incision at a 45° angle from the inferior portion of the hymeneal ring (professional agreement). However, shorter length and lower angled episiotomies are also currently reported for routine practice (grade C). There are no data to recommend preferential use of an absorbable synthetic material (acid polyglycolic versus polyglactin 910). The use for the more rapid polylactin 910 suture material was associated with less need to remove sutures but with more wound gapping in comparison with the standard polyglactin 910 material (grade A). The continuous subcuticular technique of perineal repair may be associated with less pain in the immediate postpartum period than the interrupted technique (grade A). Conclusion Mediolateral episiotomy is the method of choice in France. However, the procedure for this technique should be studied more. Subcuticular technique with an absorbable synthetic material may be the optimal method of repair.Fuel and Energy Abstracts 02/2006; 35:40-51. DOI:10.1016/S0368-2315(06)76497-3