Routine Change of Surgical Gloves/Instruments Significantly Lowers SSIs

Could changing gloves and instruments prevent SSIs?

Because surgical site infections (SSIs) remain the most common complication of surgery globally and affect patients in both low- and middle-income countries, investigators continue to find ways of reducing SSIs anywhere they can. One of the main issues is that SSI causes widely vary and few interventions work well or at all.

However, authors of a new study published in The Lancet explain that a simple routine change of surgical gloves and instruments can prevent 1 in 8 SSIs from striking. One specific surgery that often has an SSI associated with it is abdominal surgery.

“SSIs are one of the major health challenges for surgery today. The simple and cost-effective intervention of clean gloves and instruments for wound closure is appropriate for implementation across the world and can mark an important step towards the future minimizing of SSIs and so improve patient outcomes,” Dion Morton, MD, MBchB, FRCS (Eng), OBE, Barling Chair of Surgery, The University of Birmingham told Infection Control Today®.

The paper, “Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh): a pragmatic, cluster-randomized trial in seven low-income and middle-income countries,” was published in The Lancet.

A total of 13,301 patients were recruited for the trial (ChEETAh, a multicentre, cluster randomized trial), which took place between June 2020 and March 2022 across a total of 7 hospitals, both large hospitals with advanced perioperative services to small, rural hospitals with as few as 20 beds. These hospitals are in Benin, Ghana, India, Mexico, Nigeria, Rwanda, and South Africa. Morton and his colleagues found that a routine change of gloves and instruments before abdominal wound closure reduced SSIs rates by 13% at 30 days post-surgery compared with the trial control group. This reduction in SSI was seen across the trial.

Of the 13,301 participants, 11,825 (88.9%) were adults and 1476 (11.1%) were children. Gender balance was 54.8% female participants and 45.2% male.

The paper concludes that, “this trial showed a robust benefit to routinely changing gloves and instruments before abdominal wound closure. We suggest that it should be widely implemented into surgical practice around the world.”

Weaknesses of the study noted in the study include “small imbalances in patient characteristics across groups, which are inevitable in a clustered design, particularly with such a broad and heterogenous hospital network.” Also, the investigators note that selection bias and residual bias could exist. Also, some clusters included fewer patients than the investigators anticipated because of low volume or the site opening towards the end of the trial. And the investigators did not collect data around single or double gloving.

This recommendation despite the World Health Organization not making recommendations for changing gloves and instruments before wound closure because of lack of evidence.

Mölnlycke, a medical solutions company, donated sterile Biogel surgical gloves to participating sites to help support this study.