letters to the editor 1249 −
Antimicrobial Sterile Gloves Reduce Pathogen Transmission in an In Vitro Glove Perforation Model
To the Editor—Surgical gloves act as a barrier to the bidirec- tional transmission of pathogens between surgeon and patient.1 Nevertheless, glove defects are common and increase with the duration of glove wear.2,3 Preoperative surgical hand disinfection may well reduce the risk of germ transmission in
the event of a glove breach. However, original levels of skin flora can be re-established during surgery.4,5 Therefore, we analyzed the ability of a novel antimicrobial surgical glove to disinfect contaminated glove fluid passing through a hole in the glove in vitro. The bacteria used in our study included a methicillin-
susceptible strain of Staphylococcus aureus (ATCC 29213 [American Type Culture Collection, Manassas, VA]), Kleb- siella oxytoca (ATCC 700324), Escherichia coli (ATCC 25922), Enterococcus faecium (ATCC 6057), and Staphylococcus epidermidis (ATCC 12228). Five contaminated solutions were prepared to simulate glove fluid; each contained 1 of the aforementioned pathogens. All strains were recovered from frozen stock. After determination of purity, enrichment broth was cultured overnight and adjusted to a concentration of approximately 105 colony-forming units (CFU)/mL. Two different surgical gloves were tested: an antimicrobial
trilayer glove containing liquid droplets of antiseptic (G-Bact, Hutchinson-Santé, SNC, Paris, France) in its core and a conventional sterile glove of the same thickness (G-Derm, Hutchinson-Santé) as a control. The test conditions were designed to simulate an injury resulting from the penetration of a sharp instrument with high reproducibility. The test site consisted of a chamber supporting a mount for the finger of the glove tested. In-glove pressure was regulated by a barometer controlling the volume of fluid transmitted, the velocity of passage (ie, time of contact with the antimicrobial layer), and the stretch of the glove. The sample gloves were prepared by separating the fingers with a sterile knife, filling them with the simulated glove fluid, and affixing them to the mount. Care was taken to maintain the sterility of the external surface of the glove finger. After manual perforation using a 20-gauge needle (Microlance 3, Becton Dickinson, Heidelberg, Germany), 5 µL of the passed fluid was collected for examination. The samples were processed immediately. Each was vor-
texed for 30 seconds in 3mL of sterile saline (0.9%) diluted with inhibitor ([NaClPeptone + LTHTh, Haipha GmbH, Eppelheim, Germany]; the appropriate concentration was determined in prior experiments (data not shown). Next, 100 µL of the suspension was streaked onto Columbia agar (5% sheep blood; Oxoid, Wedel, Germany) and incubated for 48 hours at 36°C. Colonies were counted and differentiated using the VITEK 2 Compact system (Biomérieux Deutschland
GmbH, Nürtingen, Germany). Microbial growth was measured in CFUs. Each experiment was repeated 6 times with 6 replications. The mean reduction factors (RFs) were calculated for the different sample gloves and pathogens as follows: RF= log(total CFUs before passage)
The mean RF[G-Bact] results were as follows: against
methicillin-susceptible S. aureus, RF[G-Bact]=4.22; against E. coli, RF[G-Bact]=1.58; against E. faecium,RF[G-Bact]=3.56; against K. oxytoca,RF[G-Bact]=3.68; and against S. epidermidis, RF[G-Bact]=3.40. Conventional sterile gloves resulted in lower RFs; the mean RF[G-Derm] results were as follows: 0.2 against S. aureus,RF[G-Derm]=0.2; against E. coli,RF[G-Derm]=0.33; against E. faecium,RF[G-Derm]=0.04; against K. oxytoca, RF[G-Derm]=0.01; and against S. epidermidis,RF[G-Derm]=0.04. The mean reduction factors against all species (RF[All])were RF[All]=3.29 for G-Bact and RF[All]=0.1 for G-Derm. Thus, G-Bact was more antibacterially efficaceous. The skin flora of the surgical team members were identified
as a possible source of surgical site infection (SSI), mainly in the case of glove breach.1–3,6 Misteli et al7 identified “perforation of surgical glove” as a risk factor for SSI when a single antibiotic shot was not administered. Therefore, anti- microbial surgical gloves may be useful to overcome the risk of glove perforation. However, it must be emphasized that several antimicrobial
gloves using different techniques and based on different concepts are currently being examined. Assadian et al8 examined a sterile surgical glove featuring a chlorhexidine-coated inner surface and reported significant suppression of surgeon hand flora. This study design targeted inadequate hand hygiene and bacterial regrowth. Examination gloves with external antimicrobial coating are being tested in experimental settings and focus on preventing transmission of pathogens via the outer surface (not yet available as certified medical products).9 Prevention of bloodborne viral infections due to sharp instrument injuries is the aim of another antiviral trilayer glove (G-Vir, Hutchinson- Santé) that has also shown reduced transmission of bacteria.1,10 In the present experiment, we demonstrated that the G-Bact antimicrobial surgical glove disinfected glove fluid in a simu- lated glove breach in vitro. Thus, its use may prevent bacterial contamination of the surgical site under real surgical condi- tions and may increase patient safety. However, this can only be confirmed by clinical studies of sufficient power with SSI as the direct endpoint.
1. Concurrent transmission of pathogens in cases of glove breach can highly probably be reduced by an antimicrobial glove technology at the site of perforation.
2. The ideal antimicrobial glove protects its wearer from bloodborne infections via antiviral efficacy and protects the patient from surgical site contamination via suppression of the bacterial flora from surgeons’ hands or reduction of pathogen passage. The ideal antimicrobial glove prevents externally contaminated gloves from functioning as vectors of pathogenic transmission from one location to another.
log(total CFUs after passage).
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124 |
Page 125 |
Page 126 |
Page 127 |
Page 128 |
Page 129 |
Page 130 |
Page 131 |
Page 132 |
Page 133 |
Page 134 |
Page 135 |
Page 136 |
Page 137 |
Page 138 |
Page 139 |
Page 140