Surgical gloves that develop holes or leaks during a procedure appear to increase the risk of infection at the surgical site among patients who are not given antibiotics beforehand, a Swiss study reports.

Heidi Misteli, MD, of the University Hospital Basel in Switzerland, and colleagues analyzed data from 4,147 consecutive procedures over the course of two years. They found the frequency of gloves developing holes or leaks increases in surgical procedures lasting longer than two hours and has been found to range from 8%-50%.

A total of 188 instances of surgical-site infection (4.5%) were identified, including 51 in procedures where gloves perforated and 137 in procedures where they remained intact (Arch Surg. 2009;144:553-558).

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“In the absence of surgical antimicrobial prophylaxis, glove leakage was associated with a surgical site infection rate of 12.7%, as opposed to 2.9% when asepsis was not breached,” the authors write. “This difference proved to be statistically significant when assessed with both univariate and multivariate analyses.”

“These results support an extended indication of surgical antimicrobial prophylaxis to all clean procedures in the absence of strict precautions taken to prevent glove perforation,” they conclude. “The advantages of this surgical site infection prevention strategy, however, must be balanced against the costs and adverse effects of the prophylactic antimicrobials, such as drug reactions or increased bacterial resistance.”

In an invited critique (2009;144:553-558), Edward E. Cornwell III, MD, of Howard University Hospital department of surgery in Washington, D.C., asserts that extending the use of antibiotics is not justified.

“The data in this and other studies much more strongly support the measures suggested for lowering the risk of glove perforation,” he writes. These strategies include double-gloving and routinely replacing gloves after a specified period of time.

“These measures would be substantially cheaper, more promising for efficacy, and less likely to produce allergies or adverse effects than giving prophylactic antibiotics to all patients,” Dr. Cornwell says.