Vet Comp Orthop Traumatol 2023; 36(01): 21-28
DOI: 10.1055/s-0042-1756621
Original Research

Evaluation of Surgical Gown Cuff Contamination During Orthopaedic Surgery in a Veterinary Teaching Hospital

1   Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, United States
,
1   Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, United States
,
Audrey Ruple**
2   Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, United States
,
G. Kenitra Hendrix
3   Indiana Animal Disease Diagnostic Laboratory, West Lafayette, Indiana, United States
› Author Affiliations
Funding None.

Abstract

Objective The objective of this study was to determine the frequency of positive cultures of the surgical gown cuffs among scrubbed personnel prior to and immediately after orthopaedic surgical procedures performed on client-owned dogs.

Study Design In this cross-sectional study, the left and right surgical gown cuffs of three scrubbed persons in 10 orthopaedic surgical procedures were individually sampled using a sterile wipe prior to and immediately after surgery in order to determine the frequency of and risk factors associated with positive bacterial cultures.

Results Fifty of 120 (41.6%) cultures were positive with an even distribution before and after surgery. The three most common genera were Staphylococcus, Corynebacterium and Streptococcus. Using multivariable logistic regression models, humidity in the operating room (odds ratio: 1.04, 95% confidence interval: 1.00–1.08; p = 0.038) and the number of individuals scrubbed into surgery (odds ratio: 0.59, 95% confidence interval: 0.39–0.91; p = 0.016) had a significant effect on the likelihood of positive culture after surgery. Of the nine patients available for follow-up, one dog developed osteomyelitis.

Conclusions Maintaining the humidity in the operating room to the lowest comfortable level may reduce contamination of the surgical gown cuffs. Confirmation of bacterial contamination of surgical gown cuffs warrants adherence to operative guidelines to minimize the risk of surgical gown cuffs' contact with sterile attire, equipment and the surgical field during surgical procedures.

Authors' Contributions

K.B. and S.M. conceived the study and participated in its design and coordination. K.B. wrote the final version of the manuscript. K.B. and S.M. collected the data. K.H. was responsible for the laboratory culturing protocol. A.R. performed statistical analysis. All authors contributed in the interpretation of the data. All authors have read and approved the final manuscript.


* Current address of K.J.B.: Small Animal Surgical Service, Animal Emergency and Specialty Center, Parker, Colorado, United States.


** Current address of A.R.: Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, United States.




Publication History

Received: 14 December 2021

Accepted: 08 August 2022

Article published online:
23 September 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Turk R, Singh A, Weese JS. Prospective surgical site infection surveillance in dogs. Vet Surg 2015; 44 (01) 2-8
  • 2 Eugster S, Schawalder P, Gaschen F, Boerlin P. A prospective study of postoperative surgical site infections in dogs and cats. Vet Surg 2004; 33 (05) 542-550
  • 3 Nicholson M, Beal M, Shofer F, Brown DC. Epidemiologic evaluation of postoperative wound infection in clean-contaminated wounds: a retrospective study of 239 dogs and cats. Vet Surg 2002; 31 (06) 577-581
  • 4 Vasseur PB, Levy J, Dowd E, Eliot J. Surgical wound infection rates in dogs and cats. Data from a teaching hospital. Vet Surg 1988; 17 (02) 60-64
  • 5 Nicoll C, Singh A, Weese JS. Economic impact of tibial plateau leveling osteotomy surgical site infection in dogs. Vet Surg 2014; 43 (08) 899-902
  • 6 Field EJ, Kelly G, Pleuvry D, Demetriou J, Baines SJ. Indications, outcome and complications with axial pattern skin flaps in dogs and cats: 73 cases. J Small Anim Pract 2015; 56 (12) 698-706
  • 7 Hosseini P, Mundis Jr GM, Eastlack R. et al. Do longer surgical procedures result in greater contamination of surgeons' hands?. Clin Orthop Relat Res 2016; 474 (07) 1707-1713
  • 8 Mills SJ, Holland DJ, Hardy AE. Operative field contamination by the sweating surgeon. Aust N Z J Surg 2000; 70 (12) 837-839
  • 9 Walker M, Singh A, Rousseau J, Weese JS. Bacterial contamination of gloves worn by small animal surgeons in a veterinary teaching hospital. Can Vet J 2014; 55 (12) 1160-1162
  • 10 Fraser JF, Young SW, Valentine KA, Probst NE, Spangehl MJ. The gown-glove interface is a source of contamination: a comparative study. Clin Orthop Relat Res 2015; 473 (07) 2291-2297
  • 11 Ward Sr WG, Cooper JM, Lippert D, Kablawi RO, Neiberg RH, Sherertz RJ. Glove and gown effects on intraoperative bacterial contamination. Ann Surg 2014; 259 (03) 591-597
  • 12 Beldame J, Lagrave B, Lievain L, Lefebvre B, Frebourg N, Dujardin F. Surgical glove bacterial contamination and perforation during total hip arthroplasty implantation: when gloves should be changed. Orthop Traumatol Surg Res 2012; 98 (04) 432-440
  • 13 Edlich RF, Wind TC, Hill LG, Thacker JG. Creating another barrier to the transmission of bloodborne operative infections with a new glove gauntlet. J Long Term Eff Med Implants 2003; 13 (02) 97-101
  • 14 Beck WC, Collette TS. False faith in the surgeon's gown and surgical drape. Am J Surg 1952; 83 (02) 125-126
  • 15 Spruce L. Back to basics: Sterile technique. AORN J 2017; 105 (05) 478-487
  • 16 Newsom SWB, Rowland C, Wells FC. What is in the surgeon's glove?. J Hosp Infect 1988; 11 (Suppl A): 244-250
  • 17 Jones C, Brooker B, Genon M. Comparison of open and closed staff-assisted glove donning on the nature of surgical glove cuff contamination. ANZ J Surg 2010; 80 (03) 174-177
  • 18 Newman JB, Bullock M, Goyal R. Comparison of glove donning techniques for the likelihood of gown contamination. An infection control study. Acta Orthop Belg 2007; 73 (06) 765-771
  • 19 Meakin LB, Gilman OP, Parsons KJ, Burton NJ, Langley-Hobbs SJ. Colored indicator undergloves increase the detection of glove perforations by surgeons during small animal orthopedic surgery: a randomized controlled trial. Vet Surg 2016; 45 (06) 709-714
  • 20 Hayes GM, Reynolds D, Moens NMM. et al. Investigation of incidence and risk factors for surgical glove perforation in small animal surgery. Vet Surg 2014; 43 (04) 400-404
  • 21 Makama JG, Okeme IM, Makama EJ, Ameh EA. Glove perforation rate in surgery: A randomized, controlled study to evaluate the efficacy of double gloving. Surg Infect (Larchmt) 2016; 17 (04) 436-442
  • 22 Fossum TW. Small Animal Surgery. 4th edition. St. Louis, Mo: Elsevier Mosby; 2013
  • 23 Verwilghen D. Preparation for surgery: Decision Making/Operative Risk, Patient, Facility, Operating Team. In: Equine Surgery. 5th edition. Elsevier; 2019: 143-184
  • 24 Brown DC, Conzemius MG, Shofer F, Swann H. Epidemiologic evaluation of postoperative wound infections in dogs and cats. J Am Vet Med Assoc 1997; 210 (09) 1302-1306
  • 25 Science Competence BODE. Sterillium rub application instructions. Accessed August 23, 2022 at: https://www.medline.com/media/assets/pdf/sterillium-rub-application-instructions.pdf
  • 26 National Healthcare Safety Network, Centers for Disease Control and Prevention. Surgical site infection (SSI) event. Accessed August 23, 2022, at: http://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf
  • 27 Ruple-Czerniak A, Bolte DS, Burgess BA, Morley PS. Comparison of two sampling and culture systems for detection of Salmonella enterica in the environment of a large animal hospital. Equine Vet J 2014; 46 (04) 499-502
  • 28 Zewde BM, Robbins R, Abley MJ, House B, Morrow WE, Gebreyes WA. Comparison of Swiffer wipes and conventional drag swab methods for the recovery of Salmonella in swine production systems. J Food Prot 2009; 72 (01) 142-146
  • 29 Sidhu DS, Gull T, Skinner OT. Influence of intraoperative closed glove exchange on glove contamination during clean soft tissue surgeries. Vet Surg 2021; 50 (07) 1510-1517
  • 30 Cogen AL, Nizet V, Gallo RL. Skin microbiota: a source of disease or defence?. Br J Dermatol 2008; 158 (03) 442-455
  • 31 Duxbury M, Brown C, Lambert A. Surgical gloves. How do you change yours?. Br J Perioper Nurs 2003; 13 (01) 17-20
  • 32 Byrd WA, Kavolus JJ, Penrose CT, Wellman SS. Donning gloves before surgical gown eliminates sleeve contamination. J Arthroplasty 2019; 34 (06) 1184-1188