[Electronic detection of breaks in the surgeon-patient barrier. Evaluation of protective clothing in visceral surgery].
OBJECTIVE
Breakdown of the aseptic surgeon-patient barrier causing abnormal contact between skin and body fluids represents a risk for transmission of infectious disease. Such breakdowns are frequently not perceived by the surgical team over prolonged periods. The aim of this prospective randomized study was to evaluate the protection afforded by double gloving and reinforced gowns in visceral surgery.


METHODS
An electronic device detected breakdowns of the surgeon-patient barrier in a series of 80 surgical procedures, randomly assigned to double or single gloves, and normal or reinforced gowns. Fluid contacts due to glove perforation, glove porosity or gown wetting were recorded during 151 individual participations covering 238 hours. Surgical procedures were called deep for incisions of more than 10 cm.


RESULTS
Deep surgical procedures carried a sevenfold-increased risk of barrier breakdown, compared with superficial ones. Skin contacts through wet gowns were not prevented by the use of double thickness materials, but double gloving reduced the number of perforation and porosity alarms twofold in both superficial and deep surgery.


CONCLUSIONS
Without electronic detection, 96% of barrier breakdowns would remain undetected by the surgical team and lead to prolonged contact with potentially contaminating-fluids. The use of double gloving provides a real protection against contamination risk.
Caillot
J L
JL
Service d'urgence chirurgicale, centre hospitalier Lyon-Sud 69495 Pierre-Bénite, France.
Côte
C
C
Lemaire
C
C
Fabry
J
J
D001062:Appendectomy; D001207:Asepsis / Q000295:instrumentation*; D001826:Body Fluids; D016009:Chi-Square Distribution; D013505:Digestive System Surgical Procedures; D004581:Electronics / Q000295:instrumentation; D004867:Equipment Design; D004868:Equipment Failure; D005932:Gloves, Surgical; D006548:Hernia, Diaphragmatic / Q000601:surgery; D006801:Humans; D017053:Infection Control / Q000295:instrumentation; D010535:Laparoscopy; D016062:Porosity; D011446:Prospective Studies; D011481:Protective Clothing; D012307:Risk Factors; D013997:Time Factors