Fingernail length as a predisposing factor for perforations of latex gloves: a simulated clinical experiment.

BACKGROUND: Concerns have been raised over the integrity of gloves and the longevity of their protective barrier function. AIMS: This study aimed to assess the effect of clinicians' fingernail length as a predisposing factor for perforation of latex gloves. METHODS: We assessed 2006 latex examination gloves for perforations using the water inflation method after being used by 6 senior dental students who had fingernail lengths ranging from 0 to 3 mm. Four simulated clinical procedures representing a variety of hand movements were used for this purpose and were repeated 30 times, followed by a water leakage assessment test. Data were analysed using the χ2 test, analysis of variance and logistic regression. RESULTS: Leakage was detected in 222 (11.1%) gloves, and was most frequent with longer fingernails (odds ratio =1.431, 95% confidence interval 1.249-1.640; P < 0.001). This was independent from the simulated clinical procedure. Most perforations were over the index fingers and thumbs (63.5% and 24.3%, respectively; P < 0.001). The simulated procedures with most perforations were wiping the scaler tip with gauze (20.8%) and placing the chamfer bur (15.3%). The procedure with the fewest perforations was placing the triple way syringe (3.5%). CONCLUSION: The length of the clinicians' fingernails significantly compromises the integrity of latex gloves. Maintaining short fingernails is important in reducing the risk of damaging latex gloves intraoperatively, and hence maintaining the barrier function of the gloves.

Deep venous thrombosis in spine surgery patients: incidence and hematoma formation.

Deep venous thrombosis (DVT) is a significant health care problem; a variety of factors place spinal surgery patients at high risk for DVT. Our aim is to define the incidence of DVT occurrence in spite of prophylactic measures (mechanical and chemoprophylaxis), and the development of spinal epidural hematoma as a complication of chemoprophylaxis. In a single-center prospective study, 158 patients who underwent spinal surgical procedures were evaluated by clinical evaluation and lower limb Doppler ultrasonography imaging. Only one patient (0.6%) developed DVT; this patient was treated successfully without thrombus progression, with full recanalization. Three patients (1.8%) developed spinal epidural hematoma, but only one required surgical evacuation, and none sustained neurologic deficit. Careful evaluation for DVT risk on an individual basis and good prophylaxis helps to minimize the risk of DVT. The neurosurgeon is thus left to weigh the risks of postoperative hematoma formation against the benefits of protecting against DVT.