Breaching the barrier between surgeon and patient: are medics in the developing world at risk?

Recently published research in BMC Surgery finds an alarming rate of perforations in gloves used by surgeons in an Ethiopian hospital. As Natalia Marczewska tells us, this highlights the risks that arise from the limited resources available to doctors in the developing world.

Surgical gloves were originally introduced in the late 1880s to protect patients from pathogens present on surgeons’ hands and decrease the occurrence of post-operative infections. Nowadays, gloves play an indispensable role in protecting surgeons and medical staff from pathogens during medical operations, especially viruses such as hepatitis B, hepatitis C and HIV. However, surgical gloves, the main barrier between the surgeon and the patient, are prone to perforations and therefore this barrier may be easily compromised.

In developing countries surgeons not only have access to lower quality medical products but are also forced to wear gloves that are not the perfect fit. There are many factors that might impact a glove perforation, with the glove type, material and brand among them. The use of gloves that are either too small or too big might contribute to the increased occurrence of glove perforations and lead to intra-operative accidents.

It has been documented that the majority of surgeons in Ethiopia are not fully vaccinated against hepatitis B and work in an environment where their safety and patients’ safety is compromised. Since there are only a few studies reporting glove perforations in Ethiopia, a group of researchers from Addis Ababa University School of Medicine investigated the prevalence of surgical glove perforations during surgical procedures and compared their occurrence between emergency and elective surgeries.

there is a high rate of surgical glove perforation in Ethiopia

The researchers collected all gloves worn during surgical procedures performed between June and July 2016 at the Miniklinik II referral hospital of the Addis Ababa University. Firstly, each glove was examined visually for any perforations. Then, each glove was filled with 1L of water and methylene blue solution and squeezed around its wrist for one minute in order to locate any holes.

glove2The study examined 2634 gloves, where 1588 (194 pairs) were collected from elective surgeries and 1046 (523 pairs) from emergency operations. The results show that the perforation rate for emergency procedures was 41.4% and 34.3% for elective surgeries. Double gloves were worn in 100% of cases and perforation was detected in both inner and outer gloves in 0.4% of the gloves perforated during elective procedures. It has been shown that the left index and middle fingers are the most commonly perforated.

The study by Bekele et al. shows that there is a high rate of surgical glove perforation in Ethiopia that may cause post-operative infections among both patients and medical staff. In order to avoid contamination, it is crucial to ensure that only high quality and correctly-sized gloves are used by medical staff. What is more, the authors suggest that post procedural glove inspections may give medical staff the opportunity to take the steps necessary to avoid contamination and infection. The authors recommend that different colour gloves should be worn during surgical operations in order to identify any potential perforations as soon as they appear. Since the glove perforation rate in Ethiopia is also higher than in other countries, the authors suggest that Hepatitis B vaccination should be required by law and provided free of charge for surgical workforce.

This work shows how important it is to conduct this type of research in the developing world, given the difficult conditions medical professionals often have to work in, without the resources and safety protections taken for granted by their colleagues in the rich world.

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