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<b>Introduction:</b> The perforation of gloves during surgical procedures is quite common. A cheap and quite effective method of reducing the risk of blood-borne infections is wearing two pairs of gloves. Unfortunately, some surgeons are reluctant to it, and they report decreased dexterity and sensation. The aim of the study was to evaluate surgeons' double-gloving practices to determine the factors related to compliance. <br><b>Material and methods:</b> An anonymous, 21-question survey in Polish was sent by post to 41 surgical departments. The questions concerned: demographic data, type of surgical gloves used, allergy to latex, number of surgeries performed, frequency of using double gloves and negative impressions from using them and finally, the frequency of needlestick injuries during surgical procedures. <br><b>Results:</b> We received 179 questionnaires back. More than 62% of the surgeons believe that double gloves provide better protection than a single pair, 24% do not believe in this, and 14% have no opinion. Only 0.6% of respondents always use double gloves during surgery, 19% double glove in at least 25% of cases and 68% do it occasionally. 13% of the surgeons declared that they had never worn double gloves. During high-risk procedures, 86% of respondents wear double gloves. About half of respondents (50.3%) report discomfort while wearing double gloves; 45% - decreased dexterity; about 30% complain of numbness and tingling; and 64% - decreased sensation. <br><b>Conclusion:</b> Due to the high number of surgical glove perforations and relatively high prevalence of needlestick injuries, it is necessary to use methods that reduce the risk of transmission of pathogens. The habit of using a double pair of gloves should be implemented especially among young surgeons starting to train in their specialities. Consequently, the period of initial discomfort will be combined with the acquisition of surgical skills, which will allow for gradual acclimatization.

Background: Surgical glove perforation is a common event. The operating staff is not aware of the perforation until the procedure is complete, sometimes in as high as 70% of the incidences. Data from Ethiopia indicates that the surgical workforce suffers from a very surgery related accidents, however there is paucity of data regarding surgical glove perforation. The main objective is to describe the incidence and patterns of surgical glove perforation during surgical procedures and to compare the rates between emergency and elective surgeries at one of the main hospitals in Addis Ababa Ethiopia., Methods: This is a prospective study, performed at the Minilik II referral hospital, Addis Ababa. All surgical gloves worn during all major surgical procedures (Emergency and Elective) from June 1-July 20, 2016 were collected and used for the study. Standardised visual and hydro insufflation techniques were used to test the gloves for perforations. Parameters recorded included type of procedure performed, number of perforations, localisation of perforation and the roles of the surgical team., Results: A total of 2634 gloves were tested, 1588 from elective and 1026 from emergency procedures. The total rate of perforation in emergency procedures was 41.4%, while perforation in elective surgeries was 30.0%. A statistically significant difference (P < 0.05) was found in between emergency and elective surgeries. There were a very high rate of perforations of gloves among first surgeons 40.6% and scrub nurses 38.8% during elective procedures and among first surgeons (60.14%), and second assistants (53.0%) during emergency surgeries. Only 0.4% of inner gloves were perforated. The left hand, the left index finger and thumb were the most commonly perforated parts of the glove. Glove perforation rate was low among consultant surgeons than residents., Conclusions: Our reported perforation rate is higher than most publications, and this shows that the surgical workforce in Ethiopia is under a clear and present threat. Measures such as double gloving seems to have effectively prevented cutaneous blood exposure and thus should become a routine for all surgical procedures. Manufacturing related defects and faults in glove quality may also be contributing factors.

Compliance of using gloves in the operating room (OR) is still poor amongst anesthesia providers. The practice of using gloves amongst OR anesthesia providers (attending anesthesiologists, anesthesia nurses, and trainees) in a tertiary care center was observed over 8 months. Observations were made during intravenous (IV) cannulations, laryngeal mask airway (LMA)/endotracheal tube (ETT) introductions, and ETT extubation/LMA removals, without alerting anesthesia personnel. Ten observations were made from each of the procedures for every provider involved. 1,240 observations were made involving 8 attending anesthesiologists, 9 trainees, and 14 nurses. A Chi-square test showed significant difference of glove utilization rates between the groups during all 4 procedures. The highest compliance was observed in trainees (50%), followed by nurses (39.64%), and attending anesthesiologists (10.93%). All groups had their highest compliance levels during IV cannulation. Additionally, attending anesthesiologists had the lowest compliance levels during all individual procedures. Anesthesia nurses had the highest compliance during LMA removals (39.29%), whereas trainees showed the highest compliance in all other procedures. Glove usage by anesthesia providers during routine OR procedures continues to be low. Educational programs highlighting the hazards of noncompliance and strict departmental protocols may help to eliminate irregularities in the use of gloves.

Background: Using two gloves during surgical procedures is more protective than one in relation to percutaneous needle injuries, but it remains unclear whether the use of two thin-walled gloves is equally as protective as a single thicker-walled glove., Aims: To compare the volume of contaminant transmitted from fluid-coated solid cutting suture needles through the same thickness of the same glove material made up of differing numbers of layers during simulated needlestick injuries., Methods: A colorimetric enzyme assay was used to determine the volume of fluid transferred through identical glove materials in mechanized simulated needlestick injuries. The needles were mechanically transferred through varying glove layers [zero (control), one and two] where the cumulative thickness of the double layer was equal to the single thicker layer. The force required to puncture the test mater ials was also recorded., Results: In simulated 'needlestick' injury experiments, significantly less fluid was transmitted through the double, thin glove layer compared with the single thick layer (P < 0.05). The double, thin glove layer transmitted 16% of needle fluid compared with 21% for the single thicker glove layer. Significantly more force was required to puncture the double layer compared with the single thicker layer (P < 0.05), but for any individual puncture there was no association between the puncture force and the volume of fluid transmitted., Conclusions: A double layer of glove material was more resistant to puncture and removed more enzyme contaminant from a solid cutting suture needle compared with an equivalent single thick layer of glove material.

Aims: To compare the rate of glove perforations and surgeon satisfaction when utilizing blunt surgical needles compared to conventional sharp surgical needles., Methods: Patients undergoing Caesarean delivery were randomly assigned to the use of blunt or sharp surgical suture needles. Surgical team members reported any known needlesticks or perforations of gloves and the primary surgeon completed a survey to gauge their satisfaction with the needles. Glove perforation was assessed by suspending gloves and filling with water. The chi-square test was used to assess categorical variables and the Mann-Whitney U-test was used to assess ordinal data., Results: A total 240 patients were enrolled into the study. There was no statistically significant difference in the rate of glove perforation per case between groups assigned to sharp (24%) or blunt surgical needles (26%). (RR 1.05, 95% CI 0.68-1.63). There were significant differences in the surgeon satisfaction surveys, with surgeons in the sharp needle group being more satisfied with the tissue penetration of the needle (p < .001), needle integrity (p = .01), force to penetrate tissue (p < .001) and control of bleeding at the needle insertion site (p = .001). Surveys from surgeons in the blunt needle group showed a statistically significant improvement in the perceived safety profile of the blunt needles (p < .001) CONCLUSIONS: There was no significant difference in the rate of glove perforation between blunt and sharp surgical needles during Caesarean delivery. Overall surgeons were more satisfied with the sharp surgical needles.

Background: Needlestick injuries are always associated with a risk of infection, because these types of punctures may expose healthcare workers to a patient's blood and/or body fluids., Objective: To compare the efficacy of 4 different types of surgical gloves for preventing exposure to blood as a result of needlestick injury., Methods: For simulation of needlestick injury, a circular sample of pork skin was tightened onto a bracket, and a single finger from a medical glove was stretched over the sample. First, a powder-free surgical glove with a gel coating was used to test blood contact. Second, a glove with a patented puncture indication system was used to test blood contact with a double-gloved hand. Third, 2 powder-free latex medical gloves of the same size and hand were combined for double gloving, again to test blood contact. Finally, we tested a glove with an integrated disinfectant on the inside. The punctures were carried out using diverse sharp surgical devices that were contaminated with (99)Tc-marked blood. The amount of blood contact was determined from the transmitted radioactivity., Results: For the powder-free surgical glove with a gel coating, a mean volume of 0.048 microL of blood (standard error of the mean [SEM], 0.077 microL) was transferred in punctures with an automated lancet at a depth of 2.4 mm through 1 layer of latex. For the glove with an integrated disinfectant on the inside, the mean volume of blood transferred was 0.030 microL (SEM, 0.0056 microL) with a single glove and was 0.024 microL (SEM, 0.003 microL) with 2 gloves. For the glove with the patented puncture indication system, a mean volume of 0.024 microL (SEM, 0.003 microL) of blood was transferred., Conclusions: Double gloving or the use of a glove with disinfectant can result in a decrease in the volume of blood transferred. Therefore, the use of either of these gloving systems could help to minimize the risk of bloodborne infections for medical staff.

Objective: To compare the efficacy of universal gloving with emollient-impregnated gloves with standard contact precautions for the control of multidrug-resistant organisms (MDROs) and to measure the effect on healthcare workers' (HCWs') hand skin health., Design: Prospective before-after trial., Setting: An 18-bed surgical intensive care unit., Methods: During phase 1 (September 2007 through March 2008) standard contact precautions were used. During phase 2 (March 2008 through September 2008) universal gloving with emollient-impregnated gloves was used, and no contact precautions. Patients were screened for vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). HCW hand hygiene compliance and hand skin health and microbial contamination were assessed. The incidences of device-associated infection and Clostridium difficile infection (CDI) were determined., Results: The rate of compliance with contact precautions (phase 1) was 67%, and the rate of compliance with universal gloving (phase 2) was 78% (P = .01). Hand hygiene compliance was higher during phase 2 than during phase 1 (before patient care, 40% vs 35% of encounters; P = .001; after patient care, 63% vs 51% of encounters; P < .001). No difference was observed in MDRO acquisition. During phases 1 and 2, incidences of device-related infections, in number of infections per 1,000 device-days, were, respectively, 3.7 and 2.6 for bloodstream infection (P = .10), 8.9 and 7.8 for urinary tract infection (P = .10), and 1.0 and 1.1 for ventilator-associated pneumonia (P = .09). The CDI incidence in phase 1 and in phase 2 was, respectively, 2.0 and 1.4 cases per 1,000 patient-days (P = .53). During phase 1, 29% of HCW hand cultures were MRSA positive, compared with 13% during phase 2 (P = .17); during phase 1, 2% of hand cultures were VRE positive, compared with 0 during phase 2 (P = .16). Hand skin health improved during phase 2., Conclusions: Compared with contact precautions, universal gloving with emollient-impregnated gloves was associated with improved hand hygiene compliance and skin health. No statistically significant change in the rates of device-associated infection, CDI, or patient MDRO acquisition was observed. Universal gloving may be an alternative to contact precautions.

Background: Needlestick injuries are common during surgical procedures. Following such an injury, local protocols should be followed to minimize the risk of infection., Aims: To identify who sustains such injuries, under what circumstances and what actions are taken to minimize the risk and in response to intraoperative needlestick injuries., Methods: A questionnaire was submitted via e-mail to all staff in a National Health Service trust who took part in operations. The results were checked against occupational health department (OHD) records., Results: One hundred and thirty-six of 255 appropriate responders completed the questionnaire (53%). Fifteen of 31 consultants (48%), 12/36 junior doctors (33%), 0/39 midwives (0%) and 8/30 theatre staff (27%) reported having had at least one intraoperative needlestick injury over the past year. Awareness of local protocols was significantly worse in the junior doctor group. Ninety-three percent of consultants, 67% of junior doctors and 13% of theatre staff did not comply with local protocols. The length of time it takes to do so (48%) and a perceived low infection risk of the patient (78%) were the commonest reasons for this. Hand dominance, role during surgery and double gloving were not significant risk factors; however, rare use of a no-touch technique was. Comparison with OHD records suggested that a maximum of 16% of intraoperative needlestick injuries were dealt with in accordance to local policy., Conclusions: Non-compliance with needlestick injury protocols is commonest among senior surgical staff. A revision of the protocol to reduce the time it takes to complete it may improve compliance.

A cross-sectional study was conducted among health care workers at a tertiary care hospital in Goa to study the problem of needle stick injuries. A structured questionnaire was used to interview the study participants at their work place. Participants were asked to recall needle stick injuries in the preceding 12 months. Factors such as work experience, type of procedure, action taken following injury etc were also studied. Statistical analysis was done with SPSS software. Around 34.8% (200/575) of the Health care workers had experienced a needle stick injury in the last one year. Needle stick injuries were equally distributed across different work experience periods. Hollow bore needles were responsible for 77.5% of needle stick injuries followed by suturing needles (19.2%). As far as use of personal protection was concerned only 58% of the health care workers were wearing gloves at the time of the injury. There is therefore an urgent need at the hospital level to have a uniform needle stick injuries policy covering safe work practices, safe disposal of sharps, procedures in event of needle stick injury, training including pre-employment training, monitoring and evaluation of needle stick injuries and procedures for reporting needle stick injuries.

Background: Compliance with hand hygiene recommendations is the most important measure in preventing health care-associated infections. The objective of this study was to assess the nature of patient contact and the hand hygiene practices of nurses and physicians in the neonatal intensive care unit in a tertiary hospital in Ghana., Methodology: Unobtrusive observation of patient contact, hand hygiene practices, and hand washing technique among nurses and physicians attending randomly selected newborns for five hours daily for two weeks. Patient contact categorized as low-risk or high-risk. Hand hygiene practice before and after patient contact categorized as clean uncontaminated, clean recontaminated, new gloves, unchanged gloves. Compliance to alcohol rub use assessed., Results: The patient to nurse/physician ratio varied from 9:1 to 12:1. There were 97 patient contacts of which 49 were high-risk and 48 low-risk. Most (73%) patient contacts were from nurses. Compliance to hand hygiene recommendations before versus after patient contact was 15.4% versus 38.5% for physicians and 14.1% versus 9.9% for nurses. Gloves were used for 60.8% patient contacts (85.7% high-risk, 35.4% low-risk); however, compliance to recommended procedure occurred in only 12.2% of high-risk contacts and none of the low-risk contacts. Gloves were not changed between patients in 43.7% of high-risk contacts and 88.2% of low-risk contacts. Hand washing protocol was generally followed. Alcohol hand rub was always available but was not used for hand hygiene., Conclusions: Hand hygiene compliance of physicians and nurses was low. Gloves and alcohol rub were not used according to recommended guidelines. Incorporating effective education programs that improve adherence to hand hygiene guidelines into the continuing education curriculum of health professionals is recommended.

Background: The use of sterile gloves is part of general aseptic procedure, which aims to prevent surgical team members from transmitting infectious agents to patients during procedures performed in an operating room. In addition, surgical gloves also protect team members against patient-transmitted infectious agents. Adequate protection, however, requires that the glove material remain intact. The risk of perforations in surgical gloves is thought to correlate with the duration of wear, yet very few prospective studies have addressed this issue., Methods: We prospectively collected 898 consecutive pairs of used surgical gloves over a 9-month period in a single institution. After surgical team members wore the gloves during surgical procedures, the gloves were examined for microperforations using the watertight test described in European Norm 455, part 1. The gloves were analyzed as a pair; if 1 glove had a perforation, the pair was considered to be perforated. In addition, we evaluated the use of a hand cream that contained a suspension of cornstarch and ethanol to determine its potential influence on the rate of microperforation., Results: Wearing gloves for 90 minutes or less resulted in microperforations in 46 (15.4%) of 299 pairs of gloves, whereas wearing gloves for 91-150 minutes resulted in perforation of 54 (18.1%) of 299 pairs, and 71 of (23.7%) of 300 pairs were perforated when the duration of wear was longer than 150 minutes (P = .05). Subgroup analysis revealed no significant difference in the rates of microperforation for surgeons (56 [23.0%] of 244 pairs of gloves perforated), first assistants (43 [19.0%] of 226 pairs perforated), and surgical nurses (53 [20.5%] of 259 pairs perforated). Of 171 microperforations, 114 (66.7%) were found on the left hand glove (ie, the glove on subjects' nondominant hand), predominantly on the left index finger (55 [32.3%]). The use of the hand cream had no influence on the rate of microperforation., Conclusion: Because of the increase in the rate of microperforation over time, it is recommended that surgeons, first assistants, and surgical nurses directly assisting in the operating field change gloves after 90 minutes of surgery.

Objective: To evaluate infection control practices among dentists in private and public practice., Design: Survey and cross-sectional analysis., Setting: Sertãozinho city, Brazil., Participants: All dentists who were currently working at the study city, and agreed to participate, resulting in a study population of 135 dentists., Methods: Participants were personally interviewed and variables were submitted to chi2 or Fisher's exact test., Results: Hand washing before and after each patient was reported by 86.7% of dentists, but private practitioners used liquid soap and paper towels more often than their public colleagues (p < 0.001). Most of the study population (97.8%) used gloves routinely during clinical sessions, but 8.2% reused them. Dry-heat was the main method employed for sterilisation of heat-stable devices by 80.0% of dentists, but adequate temperature and time of exposure was accomplished by only 32.1% of public and 70.0% of private professionals (p < 0.001). Heat-sensitive devices were disinfected with an adequate substance by 60.0% of both affiliation dentists (p = 0.908)., Conclusions: There is a large gap between infection control recommendations and practices observed among the study population, and the situation is worse in public services. To reverse that situation, infection control issues must be openly debated by professional associations, dental schools and health authorities.

Objective: Needlestick injuries are the most common injuries that occur among operation room personnel in the health care service. The risk of infection after a needlestick injury during surgery greatly depends on the quantity of pathogenic germs transferred at the point of injury. The aim of this study was to measure the quantity of blood transferred at the point of a percutaneous injury by using radioactively labeled blood., Design: This study was conducted to evaluate the risk of infection through blood contact by simulating surgical needlestick injuries ex vivo. The tests were conducted by puncturing single and double latex gloves with diverse sharp devices and objects that were contaminated with Technetium solution-labeled blood., Results: A mean volume of 0.064 microL of blood was transferred in punctures with the an automatic lancet at a depth of 2.4 mm through 1 layer of latex. When the double-gloving indicator technique was used, a mean volume of only 0.011 microL of blood was transferred (median, 0.007 microL); thus, by wearing 2 pairs of gloves, the transferred volume of blood was reduced by a factor of 5.8., Conclusions: The results revealed that double gloving leads to a significant reduction in the quantity of blood transferred during needlestick injury.

Central venous catheter-related bloodstream infection is clinically important because of its high mortality rate. This prospective study shows by multivariate analysis that the use of maximal sterile barrier precautions (odds ratio, 5.205 [95% confidence interval, 0.015-1.136]; P=.023) and the use of antimicrobial-coated catheters (odds ratio, 5.269 [95% confidence interval, 0.073-0.814]; P=.022) are independent factors associated with a lowered risk of acquiring a central venous catheter-related bloodstream infection.

In an Italian hospital, we observed that hand hygiene was performed in 638 (19.6%) of 3,253 opportunities, whereas gloves were worn in 538 (44.2%) 1,218 of opportunities. We observed an inverse correlation between the intensity of care and the rate of hand hygiene compliance (R2=0.057; P<.001), but no such association was observed for the rate of glove use compliance (R2=0.014; P=.078). Rates of compliance with hand hygiene and glove use recommendations follow different behavioral patterns.

Occupational exposure to bloodborne pathogens remains an important and largely preventable issue in hospital practice. This article argues that formal training can increase use of best practice phlebotomy. A survey of at-risk healthcare workers at a central London hospital was conducted to identify factors associated with use of an evacuated blood collection system (BD Vacutainer and gloves while taking blood. Eighty per cent of doctors and 37% of non-doctors performing percutaneous venepuncture did not use the Vacutainer system exclusively. Doctors qualified less than three years were particularly likely to prefer needle and syringe. Venepuncture technique training significantly increased the probability of always using the Vacutainer system from 7% to 46%. The only factor independently associated with glove use was operator experience. There is considerable room for improvement in phlebotomy technique, particularly among junior doctors. The Modernising Medical Careers initiative provides a unique opportunity to implement this.

Background: The increasing prevalence of blood-borne viral diseases has drawn attention to the barrier between the surgical personnel's hands and the patients body fluids during surgery. At present, the typical practice is to use double gloving in orthopaedic surgery, and single gloving in other types of surgery. The main purpose of our study was to estimate and compare the perforation risk in different categories of surgery., Material and Methods: In a series of 655 surgical operations covering 5 main categories of surgery, all detected glove perforations were recorded and analysed., Results: Perforations were found in 203 out of 655 operations (31%). The observed perforation frequency was 44.5% in gastrointestinal surgery, 34.7% in orthopaedic surgery, 31.1% in gynaecology, 18.6% in vascular surgery and 9.2% in general surgery. In some subcategories, the frequencies were even higher., Interpretation: In several categories of surgery, we found high perforation frequencies. Perforations in single gloves are often not detected during operations. This may increase the risk of transmission of blood-borne infections, particularly because the time of exposure may be long. Double indicator gloves make the intra-operative detection of perforations easier. Also double gloving is known to significantly reduce the perforation risk. The use of double indicator gloves is recommended in all categories of surgery.

Adverse publicity (the 'superbug') has demonstrated that the problem of MRSA (methicillin-resistant Staphylococcus aureus) is prevalent in many of the country's most prestigious hospitals. The results of the mandatory UK Department of Health (DH) surveillance for early surgical site infections in orthopaedic surgery (SSIS) have been published recently for the period April 2004 to March 2005 when 41,242 operations were studied ( 28 October 2005). Infection rates were generally and gratifyingly low but 48% of surgical site infections were caused by Staph. aureus and of those 68% were MRSA. The following article will discuss the aetiology and prevention of MRSA surgical site infection.

Background: Surgeons tend to underestimate the risk of transferring infection during thoracoscopic operations, although data on glove perforation in thoracoscopic operations have not been reported., Methods: Unnoticed perforations of the gloves worn by the same primary surgeon during thoracoscopic procedures and open thoracotomy were studied. Gloves with gross damage and those changed due to assumed damage were excluded. Gloves were tested by filling with water and squeezing to inflate each finger, which could detect a perforation by a 30-gauge needle., Results: Perforation was found in 25% after thoracoscopic operation, although this was significantly lower than 70% after open thoracotomy. Twelve percent of the gloves worn during thoracoscopic operation were perforated. The perforation rate was higher for gloves worn for more than 2 hours during thoracoscopic operation., Conclusions: Glove perforation occurred without being noticed in 25% of thoracoscopic procedures, and in 12% of the gloves used during the procedure. Glove change within 2 hours is recommended.

Background: Although hand dermatitis (HD) is a common occupational problem among hospital nurses, few epidemiological studies of this disease have been conducted in regional areas or tropical environments., Aim: The aim of our investigation was, therefore, to investigate HD prevalence and correlates among nurses within a unique Australian setting., Design: We recruited a cohort of 148 female nurses from a large tertiary hospital in north Queensland, Australia, and administered a previously validated, self-reporting HD questionnaire., Results: The 12-month period prevalence ranged from 43.2% to 59.3%, with an overall group mean of 50.0%. There were no statistically significant differences in HD prevalence between the different hospital wards (p=0.4238). During multiple logistic regression, a history of allergic rash was shown to increase the HD risk 5.5-fold (odds ratio: 5.5, 95% CI: 1.9-19.2, p=0.0038). The risk of HD was also related to increased hand washing frequency (OR 5.8, 95% CI: 1.1-33.4, p=0.0402)., Conclusions: Overall, the occurrence of HD among Australian nurses was relatively consistent across the various hospital wards. Their 12-month period-prevalence of HD was, however, generally higher than previous reports from other countries.

Objective: To investigate personal protective equipment such as gloves, mask and protective eye wear used in dental practice in Turkey., Design: An e-mail based self-report questionnaire was sent to dentists during 2002., Participants: Dentists in Turkey., Results: 574 dentists aged 22-69 years responded. Thirty-six questionnaires were not included in the results. The results of the present study indicate that a high proportion of younger dentist respondents are using personal protective equipment in accordance with guidelines. More dentists use personal protective equipment for high-risk patients. The percentage of dentists using protective eyewear was low considering the general recommendations., Conclusion: The present study indicated that gloves and masks are used by a high proportion of the respondents. Further education may be appropriate in protective eyewear.

Worldwide consumption of medical gloves increased during the 1980's due to the recognized risk of cross infections in medical and dental care. In Stockholm County Council around 1 million pairs of surgical gloves and 18 millions pairs of examination gloves are purchased per year. In the following paper different glove materials and types are presented and also regulations on use and purchase. The protective capacity of gloves and contact hypersensitivity reactions are also discussed and advice is provided on glove usage.

The use of gloves when conducting invasive procedures and the reporting of needlestick injuries have been strongly encouraged. Despite this, neither practice appears to be universal. In order to determine the rates of glove usage and needlestick injury reporting, we conducted a survey of junior doctors in three hospitals in the UK. Of the 190 respondents, the majority rarely wore gloves for venesection, insertion of intravenous cannulas or arterial blood gas sampling. For more major procedures (insertion of central venous lines, insertion of thoracostomy tubes, suturing) gloves were invariably worn. Only 17.5% of needlestick injuries were reported. The rates of glove usage and needlestick injury reporting were lower than previous studies have demonstrated in North America. Surgeons suffered the most needlestick injuries and were the least likely to report them. The low reporting rate may have serious implications, particularly in view of the new Government guidelines on needlestick injuries which involve HIV-infected blood. By failing to use gloves and report needlestick injuries, junior doctors, in particular surgeons, are placing themselves and patients at increased risk of blood-borne transmissible diseases.

We describe variations in healthcare workers' attitudes toward double gloving and reporting needlesticks, and in their readiness to comply with double gloving and hepatitis B vaccine. Differences related to occupation, specialty, and gender have implications for the need to tailor interventions for specific groups of healthcare workers to improve compliance with Universal Precautions.

The principles of universal precautions are central to infection control. These principles form the basis or current guidelines for the use of personal protective equipment (PPE) in dental practice. This study, which examined the patterns of use of PPE in general dental practice, was based on a postal survey of 250 dentists in Brisbane (41 per cent of the total private general practitioners in the region). Routine use of PPE was commonplace (gloves, 84-6 per cent; masks, 55.7 per cent; eyewear, 77.6 per cent), but complete compliance with current acommendations for glove handling and hand care had not been achieved. Potential problem areas in terms of attitudes to PPE were identified, as were inconsistencies in the use of PPE in both clinical and non-clinical settings. These findings emphasize the need for further educational campaigns in practical infection control measures.

Residents of long-term-care facilities (LTCFs) are at risk for acquiring facility-associated infections and consequent mortality (1,2). Despite this risk, no national guidelines exist for infection-control practices in LTCFs, and information regarding the nature of infection-control practices in LTCFs is limited. To evaluate glove use and handwashing practices in an LTCF, and to determine factors associated with compliance with infection-control policies and the frequency of microbial transmission, Maryland Department of Health and Mental Hygiene (DHMH) and CDC staff observed glove use and handwashing practices on a chronic-care ward of an LTCF in Maryland for a 1-month period during 1992. This report summarizes the findings of this study.

Several overseas studies have documented the presence of defects in unused latex and vinyl gloves. Since such defects compromise the barrier protection afforded by gloves, information regarding the frequency and site of defects which occur during manufacture is of direct clinical relevance. This study utilized a four-stage testing procedure to evaluate defects in 13 brands of gloves which are used commonly in dental practice in Australia. Macropores in unused gloves were a significant problem, with 10 brands containing 1 per cent or more defective gloves. In addition, variations in electrical conducitivity, signifying microporosity or inconsistencies in thickness, were also observed. These findings indicate that there is room to improve further the quality of protective gloves.

This study established regular implementation of a simple feedback procedure by supervisory nurses with their assistants at a head-injury treatment center. Five nurses were trained to distribute brief written comments to their assistants about infection-control practices, including using gloves to avoid contact with body fluids. Following low rates of written feedback, nurses met with the trainer weekly to set goals for using the system, to review feedback rates, and to examine contingent letters of appreciation. Written feedback increased from 0.09 to 0.58 per day. When outcome data on glove use were subsequently added to the feedback provided to nurses, nurses' feedback on glove use increased and overall glove use by assistants increased by 36.7% for 66.7% of assistants who responded to feedback. Assistants rated feedback as highly accurate and indicated some interest in receiving future feedback. However, nurses and assistants expressed a preference for oral over written feedback.

Background: The risk of occupational exposure to the human immunodeficiency virus (HIV) may be one of the important issues facing family physicians in the 1990s. The use of universal precautions has been shown to reduce the incidence of exposures to bloodborne pathogens. Studies indicate, however, that these guidelines are not being followed consistently by physicians or their staffs., Methods: A survey of 3568 randomly sampled members of the American Academy of Family Physicians was performed using a questionnaire that was designed by the authors. Three mailings were conducted., Results: The total response rate was 39%. Approximately 80% of the respondents reported that they used gloves appropriately and disposed of sharp instruments in a puncture-resistant container. Only 39% "always" or "almost always" used eye protection when indicated, and only 35% "almost never" or "never" recapped used needles. There was a significant number of physicians who reported that they or their office staff had had an occupational exposure to bloodborne pathogens within the last year., Conclusions: Family physicians and their staffs do not uniformly follow universal precaution guidelines and, as a result, many have been exposed to blood products. If the physician or the office staff would not recap used needles and would place used sharp instruments in a puncture-resistant container, the greatest risks of occupational exposure would be reduced.

Objective: To ascertain current infection control practices, endoscope cleaning procedures, perceived risks of infection, and implementation of universal precautions in gastrointestinal endoscopy units in the United States., Design: National mailed survey of gastroenterology nurses and associates conducted anonymously in March 1988., Setting: Completed surveys were received from all 50 states and Puerto Rico and from all practice settings. The most common practice setting was private/community hospitals (66%)., Participants: Of the 4,952 survey forms mailed to all members and to interested nonmembers of the Society of Gastrointestinal Nurses and Associates, 2,158 (44%) were returned and 2,030 (41%) were completed and evaluable. Of the respondents, 1,487 (73%) were registered nurses., Results: Sixty-seven percent (n = 1,358) of the respondents routinely used an enzymatic cleaner as a step in the instrument decontamination process; 93% (n = 1,879) chemically disinfected instruments after each case; and 88% (n = 1,779) disinfected endoscopes with an aqueous glutaraldehyde product. Respondents reported that they and a significantly smaller proportion of physicians (p less than .001) employed barrier precautions for all endoscopic cases involving possible contact with blood/body fluids of patients known (66% versus 57%, respectively) and not known (12% versus 8%, respectively) to have a bloodborne infection. Endoscopy-related infections, usually bacterial, were reported to have occurred at their institutions by 6% (n = 116) of respondents., Conclusions: We conclude that cleaning, disinfection, and sterilization procedures for gastrointestinal endoscopic instruments vary, that appropriate protective apparel is not always worn, and that some practices may lead to preventable endoscopy-related infection in patients.

Objective: To investigate compliance with isolation precautions., Design: A prospective observational study carried out during ten weeks of 1989. Participants were unaware of the study., Setting: The isolation bay of a 24-bed surgical intensive care unit in a 900-bed university tertiary care facility., Participants: Study participants included any healthcare worker or visitor entering the patient room during designated 15-minute intervals., Results: We observed 467 subjects entering patient rooms. Compliance with strict isolation (65%) was better than with wound/skin (40%) or excretion/secretion (36%) isolation (p less than .01). Visitors were more compliant than healthcare workers (88% versus 41%; p less than .01). Spending more time in the room was associated with improved compliance (p less than .01). Compliance was higher for subjects entering with a group compared with those entering alone (51% versus 41%; p less than .05). The compliance rate for nurses improved as the nurse/patient ratio improved (p = .14). Compliance was independent of severity of illness. Multivariate analysis revealed that the amount of time spent in the room, being a visitor, and use of strict isolation were independent predictors of compliance., Conclusions: Noncompliance was widespread. When increased demands are placed on the time of physicians and nurses in the name of cost containment, unperceived consequences, such as those resulting from decreased compliance, must be considered.

Glove-wearing attitudes of 375 physicians, representing 56% of all physicians surveyed, were ascertained. Although the majority were comfortable with their current glove use, 33% preferred wearing them more frequently. The most common reasons for not wearing gloves were a low likelihood of disease transmission and fear of offending patients. Many physicians felt that more frequent glove use in examining human immunodeficiency virus- (HIV)-positive patients might reduce rapport and diminish the adequacy of physical examination procedures, but only 11% felt that increased glove use would compromise overall care of HIV-positive patients. With regard to all patients, 33% felt that increased glove use in examinations would compromise care. Additionally, 56% of physicians stated that they were somewhat concerned about HIV infection. Glove-wearing preferences were significantly associated with greater concern about infection, a younger age and more frequent exposure to blood and body secretions. Contact with high-risk patient groups was not associated with glove-wearing preferences.