title: An enzyme-mediated assay to quantify inoculation volume delivered by suture needlestick injury: two gloves are better than one.
abstract: BACKGROUND
  Acquiring a blood-borne disease is a risk of performing operations. Most data about seroconversion are based on hollow-bore needlesticks. Some studies have examined the inoculation volumes of pure blood delivered by suture needles. There is a lack of data about the effect of double-gloving on contaminant transmission in less viscous fluids that are not prone to coagulation.
  
  
  METHODS
  We used enzymatic colorimetry to quantify the volume of inoculation delivered by a suture needle that was coated with an aqueous contaminant. Substrate color change was measured using a microplate reader. Both cutting and tapered suture needles were tested against five different glove types and differing numbers of glove layers (from zero to three).
  
  
  RESULTS
  One glove layer removed 97% of contaminant from tapered needles and 65% from cutting needles, compared with the no-glove control data. Additional glove layers did not significantly improve contaminant removal from tapered needles (p > 0.05). For the cutting needle, 2 glove layers removed 91% of contaminant, which was significantly better than a single glove (p = 0.002). Three glove layers did not afford statistically significant additional protection (p = 0.122). There were no statistically significant differences between glove types (p = 0.41).
  
  
  CONCLUSIONS
  With an aqueous needle contaminant, a single glove layer removes contaminant from tapered needles as effectively as multiple glove layers. For cutting needles, double-glove layering offers superior protection. There is no advantage to triple-glove layering. A surgeon should double-glove for maximum safety. Additionally, a surgeon should take advantage of other risk-reduction strategies, such as sharps safety, risk management, and use of sharpless instrumentation when possible.
authors.affiliation: Division of Surgical Research, Department of Surgery, Robert Wood Johnson Medical School, Cooper University Hospital, Camden, NJ 08103, USA. lefebvre-md@hotmail.com
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Lefebvre
authors.forename: Louise F
authors.initials: LF
authors.lastname: Strande
authors.forename: Charles W
authors.initials: CW
authors.lastname: Hewitt
mesh_terms: D000062:Accidents, Occupational / Q000517:prevention & control; D001426:Bacterial Proteins; D004866:Equipment Contamination; D005932:Gloves, Surgical / Q000592:standards*; D006735:Horseradish Peroxidase; D006801:Humans; D007124:Immunoenzyme Techniques / Q000379:methods*; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control; D009339:Needles; D016602:Needlestick Injuries / Q000175:diagnosis* / Q000517:prevention & control; D009873:Operating Rooms; D011795:Surveys and Questionnaires; D013536:Suture Techniques / Q000009:adverse effects* / Q000295:instrumentation
chemical_list: D001426:Bacterial Proteins; C058865:Strep-avidin conjugated horseradish peroxidase; D006735:Horseradish Peroxidase