title: Surgical glove perforation and the risk of surgical site infection.
abstract: OBJECTIVE
  Clinically apparent surgical glove perforation increases the risk of surgical site infection (SSI).
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  University Hospital Basel, with an average of 28,000 surgical interventions per year.
  
  
  METHODS
  Consecutive series of 4147 surgical procedures performed in the Visceral Surgery, Vascular Surgery, and Traumatology divisions of the Department of General Surgery.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  Without surgical antimicrobial prophylaxis, glove perforation increases the risk of SSI.
authors.affiliation: Department of General Surgery, University Hospital Basel, CH-4031 Basel, Switzerland.
authors.forename: Heidi
authors.initials: H
authors.lastname: Misteli
authors.forename: Walter P
authors.initials: WP
authors.lastname: Weber
authors.forename: Stefan
authors.initials: S
authors.lastname: Reck
authors.forename: Rachel
authors.initials: R
authors.lastname: Rosenthal
authors.forename: Marcel
authors.initials: M
authors.lastname: Zwahlen
authors.forename: Philipp
authors.initials: P
authors.lastname: Fueglistaler
authors.forename: Martin K
authors.initials: MK
authors.lastname: Bolli
authors.forename: Daniel
authors.initials: D
authors.lastname: Oertli
authors.forename: Andreas F
authors.initials: AF
authors.lastname: Widmer
authors.forename: Walter R
authors.initials: WR
authors.lastname: Marti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D004868:Equipment Failure; D005260:Female; D005932:Gloves, Surgical; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology* / Q000517:prevention & control