ABSTRACT
Objetivo: Analizar la evidencia más actualizada sobre el cambio rutinario de instrumental y guantes quirúrgicos en cirugía abdominal, y su impacto en el riesgo de infecciones. Métodos: Se realizó una búsqueda bibliográfica, en las bases de datos PubMed, ScienceDirect, Web of Science, y MEDLINE. Resultados: A la fecha, la evidencia sumamente escasa sobre el potencial impacto del cambio rutinario de instrumental y guantes quirúrgicos en cirugía abdominal, y su relación con la incidencia de infección en el sitio operatorio. Sin embargo, no deja de ser un tema de interés en cirugía global. El estudio ChEETAh, ensayo realizado en siete países de bajos y medianos ingresos, que evaluó el cambio rutinario tanto de guantes como de instrumental quirúrgico en cirugía abdominal y su relación con la infección, demostró que, la frecuencia de infección en sitio operatorio fue del 16% (n=931) en el grupo intervención, comparado a un 18,9% (n=1280) en el grupo control (RR 0,87; IC 95%: 0,79 0,95; p=0,0032). Así, podría existir cierta protección adicional con el cambio rutinario de guantes e instrumental en cirugía abdominal. Conclusión: Aunque la evidencia es limitada y heterogénea, existe una tendencia respecto a un potencial beneficio frente a la incidencia de infección en sitio operatorio, en el cambio rutinario de guantes e instrumental quirúrgico en cirugía abdominal(AU)
Objective: To analyze the most recent evidence regarding the routine change of surgical instruments and gloves in abdominal surgery and its impact on the risk of infections. Methods: A literature search was conducted in the PubMed, ScienceDirect, Web of Science, and MEDLINE databases. Results: To date, the evidence regarding the potential impact of routine changes in surgical instruments and gloves in abdominal surgery and their relationship with the incidence of surgical site infections is extremely scarce. Nevertheless, it remains a topic of interest in global surgery. The ChEETAh study, conducted in seven low and middle-income countries, which assessed the routine change of both gloves and surgical instruments in abdominal surgery and its relation to infection, demonstrated that the frequency of surgical site infection was 16% (n=931) in the intervention group compared to 18.9% (n=1280) in the control group (RR 0.87; 95% CI: 0.79 0.95; p=0.0032). Thus, there may be some additional protection with the routine change of gloves and instruments in abdominal surgery. Conclusion: Although the evidence is limited and heterogeneous, there is a trend suggesting a potential benefit in reducing the incidence of surgical site infections through the routine change of gloves and surgical instruments in abdominal surgery(AU)
Subject(s)
Humans , Male , Female , Postoperative Complications , General Surgery , Risk Factors , Abdominal CavityABSTRACT
ABSTRACT The objectives of this study were to identify the types of gloves the nursing team uses for the manual cleaning of health products and to identify the perforation rates in procedure/surgical gloves used for this purpose. Cross-sectional and descriptive, descriptive study with quantitative approach was developed at a large hospital in Goiânia, Goiás, Brazil. In total, 300 procedure/surgical gloves (Group A), 100 procedure and 100 new surgical gloves (Group B), and six nitrile gloves (Group C) were analyzed. Among the gloves in Group A, 135 (45.0%) were perforated. Superposition of gloves did not prevent perforations and, the longer they were used, the higher the index of perforation (p<0.05). No perforations were identified in Group B, whereas there were four perforations in 48 hours of use in Group C. This study reinforces the idea that procedure/surgical gloves are inappropriate for cleaning health products, representing an ineffective barrier for the safety of workers.
RESUMEN Se objetivó identificar los tipos de guantes utilizados por el equipo de enfermería para limpieza manual de productos para la salud y los índices de perforaciones en guantes de procedimiento/quirúrgicos utilizados en esta actividad. Estudio transversal, descriptivo, cuantitativo, realizado en hospital de gran porte de Goiânia, Goiás, Brazil. Fueron evaluados 300 guantes de procedimiento/quirúrgicos (grupo A), 100 guantes de procedimiento y 100 quirúrgicos nuevos (Grupo B) y seis guantes de nitrilo (Grupo C). Entre los guantes del grupo A, 135 (45,0%) estaban perforados. La superposición de guantes no impidió las perforaciones; y a mayor tiempo de uso, mayor resultó el índice de perforación (p<0,05). No hubo perforaciones en el grupo B. En el C se identificaron cuatro perforaciones en 48 horas de uso. El estudio refuerza que los guantes de procedimiento/quirúrgicos son inadecuados para el proceso de limpieza manual de productos para la salud, constituyendo una barrera ineficaz para la seguridad del trabajador.
RESUMO Os objetivos foram identificar os tipos de luvas utilizadas pela equipe de enfermagem para a limpeza manual de produtos para a saúde e identificar os índices de perfurações em luvas de procedimento/cirúrgicas utilizadas para esta atividade. Estudo transversal e descritivo, com abordagem quantitativa, realizado em um hospital de grande porte em Goiânia, Goiás, Brasil. Foram avaliadas 300 luvas de procedimento/cirúrgicas (grupo A), 100 luvas de procedimento e 100 cirúrgicas novas (grupo B) e seis luvas nitrílicas (grupo C). Entre as luvas do grupo A, 135 (45,0%) estavam perfuradas. Sobreposições de luvas não impediram as perfurações e quanto maior o tempo de uso, maior o índice de perfuração (p<0,05). Não houve perfurações no grupo B e no C identificou-se quatro perfurações em 48 horas de uso. O estudo reforça que as luvas cirúrgicas/procedimento são inadequadas para o processo de limpeza manual de produtos para a saúde, constituindo uma barreira ineficaz na segurança dos trabalhadores.
Subject(s)
Humans , Occupational Risks , Sterilization , Gloves, SurgicalABSTRACT
To assess surgical and procedure glove perforations after dental care. A total of 279 pairs of gloves pairs were analyzed, 36 surgical and 243 procedure gloves used in the dentistry specialties surgery, cosmetic dentistry, endodontics, pediatric dentistry, periodontics, and prosthodontics. A diluted alkaline solution of fuchsine in water was used for analyzing the gloves. Each glove was filled with 500 ml of the solution and manually pressed at the height of the wrist for two minutes. Statistical analysis included the chi-square test at a significance level of 5%. Of the 279 study gloves, 106 had been perforated, corresponding to 38%. Most perforations occurred in the dominant hand, mainly in the finger area. Most procedures that caused perforations lasted more than 40 minutes, and most were in the area of cosmetic dentistry. There were a considerable number of perforations in the study gloves, which can increase the risk of cross-infection between students and patients.
Avaliar as perfurações que acometem as luvas cirúrgicas e de procedimentos após o uso no tratamento odontológico. Foram analisados 279 pares de luvas, sendo 36 pares de luvas cirúrgicas e 243 pares de luvas de procedimentos, utilizados na prática odontológica nas especialidades de Cirurgia, Dentística, Endodontia, Odontopediatria, Periodontia e Prótese. Para análise das luvas, foi utilizada uma solução de fuccina básica diluída em água, cada luva foi preenchida com 500 ml de solução, seguida de compressão manual na altura do punho da luva por dois minutos. A análise estatística foi realizada pelo método do Qui-quadrado, adotando-se como nível de significância 5%. Dos 279 pares de luvas analisadas, 106 pares tiveram perfurações, o que corresponde a 38%. A mão que mais sofreu perfurações foi a mão dominante, e a região mais acometida foi a região digital. Observou-se que a maioria dos procedimentos realizados durou mais de 40 minutos, e que houve uma maior frequência de procedimentos realizados na área da Dentística. Conclui-se que houve um considerado número de perfurações presentes nas luvas analisadas, o que pode contribuir para um maior risco de infecção cruzada para acadêmicos e pacientes.
ABSTRACT
O objetivo deste estudo comparativo foi determinar a incidência e locais de ocorrência de perfurações em luvas anatômicas estéreis, utilizadas por estudantes de Odontologia durante os procedimentos clínicos das Disciplinas de Periodontia e Cirurgia Bucal. Um total de 220 luvas utilizadas por estudantes com mão dominante direita foram incluídas neste estudo. O teste da inflação com solução corante foi utilizado para avaliar visualmente a presença ou ausência de perfurações. Foram coletados dados sobre quantidade, mão (direita/esquerda) e região anatômica de ocorrência das perfurações. Para a análise estatística, foi usado o Teste Exato de Fisher. Observou-se que a probabilidade de ocorrência de perfurações em luvas utilizadas por estudantes em procedimentos cirúrgicos foi 1,4 maior, quando comparados a procedimentos periodontais. A incidência de luvas perfuradas foi de 11,8% e 37,3% nas clínicas de Periodontia e Cirurgia, respectivamente (p<0,001). As regiões mais afetadas foram os dedos polegares e indicadores. Os resultados revelam que as luvas podem perder uma integridade física durante a utilização clínica, portanto deve ser dada uma maior ênfase aos cuidados quando do manuseio de instrumentais e materiais pérfuro-cortantes.
The objective of this comparative study was to determine the incidence and sites of occurrence of perforations on anatomical sterile gloves used by students of dentistry during the Periodontics and Oral Surgery clinical procedures. A total of 220 gloves used by students with the right dominant hand were included in this study. The test of inflation with a dye solution was used to visually evaluate the presence or absence of perforations. We collected data on quantity, hand (right / left) and anatomical region of occurrence of perforations. For statistical analysis we used the Fisher exact test. It was observed that the risk of punctures in gloves used by students in surgical procedures was 1.4 higher when compared to periodontal procedures. The incidence of perforated gloves was 11.8% and 37.3% in periodontics and surgery clinical, respectively (p <0.001). The regions most affected were the thumb and index finger. The results show that the gloves may lose a limb during clinical use and should therefore be given greater emphasis to care when the instruments and materials handling sharps.
ABSTRACT
Vacuum-assisted wound healing has been proven to be more efficacious than conventional dressings. Vacuum dressing has been frequently modified given the restrictions in resources available. Here we present a modified method of vacuum dressing by using surgical or gynaecological gloves for lower and upper limb wounds. Vacuum dressing was applied with parts of a surgical or gynaecological glove and Opsite with T-tailing of the suction outlet. Vacuum-assisted wound healing using the surgical gloves showed relatively good wound healing in the amputation stump, finger, arm, and leg in the cases studied.
Subject(s)
Amputation Stumps , Arm , Bandages , Fingers , Gloves, Surgical , Leg , Occlusive Dressings , Polyurethanes , Suction , Upper Extremity , Vacuum , Wound HealingABSTRACT
PURPOSE: We present our initial experience with laparoendoscopic single-site surgery (LESS) by a single surgeon in the urologic field. MATERIALS AND METHODS: From May 2009 to April 2010, 30 consecutive patients underwent LESS including seven cases of nephrectomy, five cases of nephroureterectomy with bladder cuff excision, four cases of ureterolithotomy, eight cases of marsupialization, and six cases of varicocelectomy. We performed a retrospective analysis of the medical records of the above patients. The single port was made with a surgical glove and an Alexis(R) wound retractor (Applied Medical, Rancho Santa Margarita, CA, USA). The wound retractor was put into the peritoneal space through an umbilical incision, and a laparoscopic triangle was secured by crossing both instruments. All operations were performed by the transperitoneal approach. RESULTS: Mean patient age was 54.8 years. Mean operative time was 171.2+/-109.1 minutes. Mean estimated blood loss was 265.0+/-395.5 ml. Mean incision length was 3.2+/-1.4 cm. Mean length of hospitalization was 5.2+/-2.9 days. There was one laparoscopic conversion and two open conversions. There were two cases of transient ileus that improved with conservative treatment. Mean visual analogue pain scales on the operative day and first postoperative day were 6.3/10 and 3.1/10, respectively. CONCLUSIONS: In our experience, LESS for urologic surgery is feasible, safe, and clinically applicable. We consider the homemade single-port device to be a relatively cost-effective and convenient device. If surgical instruments for LESS and appropriate ports specified for LESS are developed, LESS would be a surgical treatment technique that could be used as an alternative to the conventional types of laparoscopic surgery.
Subject(s)
Humans , Gloves, Surgical , Hospitalization , Ileus , Laparoscopy , Medical Records , Nephrectomy , Operative Time , Pain Measurement , Retrospective Studies , Surgical Instruments , Urinary Bladder , UrologyABSTRACT
A utilização das luvas látex como barreira de proteção é indispensável em qualquer tratamento odontológico, porém as luvas não funcionam como uma barreira totalmente eficaz quando apresentam perfurações ou grandes porosidades. Por isso o objetivo desta pesquisa foi avaliar a integridade das luvas de duas marcas comerciais, após o uso em cirurgias odontológicas, para verificar a influência do tempo de uso, da mão que a utilizou, do grau de destreza e do sexo do profissional. O grupo experimental foi constituído por duzentos e setenta e quatro luvas cirúrgicas de látex, enquanto sessenta constituíram o grupo controle. Após o uso, em ambiente adequado (sala de expurgo) as luvas foram preenchidas com 500 ml de uma solução de fucsina básica diluída em água sendo aprisionadas pelo punho para a verificação dos vazamentos. Foram comparadas as diversas situações avaliadas através do teste Quiquadrado de Pearson, com nível de confiança de 95%. Na amostra 10,60% das luvas estavam perfuradas. Ambas as marcas comerciais apresentaram perfurações. As luvas utilizadas na mão esquerda apresentaram, de forma significativa, uma maior prevalênciade perfurações (p=0,03). Nos demais aspectos avaliados as diferenças observadas não foram estatisticamente significativas.
The use of the latex gloves in dental treatment is unquestionable for the safety of everyone involved (dentist, staff and patientes). However, gloves do not work as an efficient barrier when presenting big pores or perforations. Therefore the goal of this research is to evaluate the integrity of surgical gloves, after use in oral sugery, to verify: the latex resistance of two commercial brands, the influence of the time being used, the user and the level of professional dexterity on keeping the glove integrity. 334 gloves were evaluated. 274 were used during surgery and 60 formed the control group (30 of each commercial brand). After use, in a proper environment, gloves were filled with 500ml of a basic Fucsina dissolved in water, contained by the fist to check any leak. In the sample group occurred 10.60% of perforation. Thru Pearson Chi-Square, with a reability level 955, the diverse evaluated situations were compared. The gloves used in left hand were more perforated (p=0,03). In the others aspects no statistically significant differences were found.
Subject(s)
Humans , Gloves, Surgical , Surgery, OralABSTRACT
La peritonitis granulomatosa por almidón de guantes quirúrgicos es una entidad de difícil diagnóstico y escasa incidencia. Los pacientes presentan dolor abdominal, fiebre e íleo funcional prolongado tres a cuatro semanas después de una laparotomía con empleo de guantes lubricados con almidón de maíz. En la exploración quirúrgica se evidencia peritoneo y epiplón con múltiples nódulos pequeños blanquecinos y líquido libre inflamatorio. La anatomía patológica muestra tejido inflamatorio con células gigantes multinucleadas englobando material birrefringente, compatibles con cristales de polvo de guantes. Mediante luz polarizada se evidencia el típico patrón en cruz de malta del almidón de maíz. Presentamos el caso de una mujer de 54 años con dolor abdominal, fiebre e íleo funcional inusualmente prolongado. Se realizó histerectomía convencional tres meses antes. Al ingreso se realizó videolaparoscopía exploradora, en la cual se perforó accidentalmente el yeyuno distal lo cual requirió laparotomía para enterorrafia. Un mes después fue relaparotomizada debido a la persistencia de íleo, evidenciándose peritonitis granulomatosa por almidón que confirmó la anatomía patológica. Recibió hidrocortisona endovenosa durante dos semanas y prednisona vía oral durante 4 semanas con disminución gradual hasta su suspensión. La paciente permanece asintomática a siete meses del postoperatorio. El tratamiento con corticoesteroides es una opción eficaz. La prevención es clave y radica en el uso de guantes quirúrgicos libres de almidón.
Granulomatous peritonitis due to surgical glove starch is an entity of difficult diagnosis and low incidence. Patients present with abdominal pain, fever and prolonged functional ileus three to four weeks postoperatory of a laparotomy where corn starch as glove's lubricant had been used. In surgical re-exploration both the peritoneum and omentum are widely affected with multiple small white nodules together with peritoneal fluid. Histopathology shows inflammatory tissue with giant multinucleated cells containing bi-refringent cornstarch particles inside. Under polarized light the typical maltese cross appearance of cornstarch is revealed. We present a 54 year old woman admitted with abdominal pain, fever and an unusually prolonged ileus in postoperatory period after a laparotomy. Conventional hysterectomy was performed three months before. At admission, exploratory videolaparocopy was done, in which accidentally distal jejunum was perforated which required laparotomy for enterorraphy. One month after she was re-laparotomized due to persistence of ileus. Granulomatous peritonitis was evidenciated and confirmed by histopathology. Endovenous hydrocortisone was given during two weeks and shifted to oral prednisone during four weeks with gradual diminution until suppression. Patient is asymptomatic at seven months of postoperatory. Corticosteroid treatment is an efficient choice. The prevention is crucial and is based on the employment of starch free surgical gloves.