On December 8, 2012, The Los Angeles Times reported that the contaminated hands of a heart surgeon were responsible for infecting with a bacterium five patients who underwent heart valve replacement surgeries earlier in the year at a hospital in Los Angeles. The infection is known as endocarditis and the outbreak’s bacterium is Staphylococcus epidermidis. All five of these patients are expected to recover fully.

Briefly, S. epidermidis is a gram positive bacterium that is part of human skin flora. The hands of staff, therefore, would be a suspected reservoir or source of this, like of any, S. epidermidis outbreak. Although this bacterium is not usually pathogenic, immuno-compromised patients are at an increased risk of infection.

To read this newspaper’s article discussing this bacterial outbreak, click here.

As The Los Angeles Times reported, these five infections were a result of tiny tears in the latex surgical gloves worn by this heart surgeon, which reportedly allowed this bacteria from a skin inflammation on his hands to be transmitted into the patients’ hearts during surgery.

While this news report does not definitively rule it out, it appears almost certain that this heart surgeon had not been practicing double gloving (i.e., the policy of wearing two gloves on each hand) during the time of this hospital’s bacterial outbreak, but rather had been wearing instead only one set of gloves, which is not atypical.

In an article entitled ” Double Gloving: Myth Versus Fact” (publication date: April 5, 2011), the trade magazine Infection Control Today found during a review of the medical literature that many professional organizations, including the Centers for Disease Control and Prevention (CDC), The Association of periOperative Registered Nurses (AORN), and The American College of Surgeons (ACS) recommend “double gloving” to further reduce the risk of disease transmission.

This magazine article – which, along with the references associated with its findings, can be read by: clicking here – also reported that perforation rates as high as 61 percent for thoracic surgeons and 40 percent for scrub personnel have been reported. Double gloving decreases the risk of exposure to patient blood by as much as 87 percent when the outer glove is punctured.

More specifically, the CDC’s Guideline for Prevention of Surgical Site Infection, 1999 states that:Sterile gloves are put on after donning sterile gowns. A strong theoretical rationale supports the wearing of sterile gloves by all scrubbed members of the surgical team. Sterile gloves are worn to minimize transmission of microorganisms from the hands of team members to patients and to prevent contamination of team members’ hands with patients’ blood and body fluids. If the integrity of a glove is compromised (e.g., punctured), it should be changed as promptly as safety permits. *Wearing two pairs of gloves (double-gloving) has been shown to reduce hand contact with patients’ blood and body fluids when compared to wearing only a single pair.*” Click here for other CDC discussions about the apparent clinical benefits of double-gloving.

Therefore, in closing, based on this incident of physician-to-patient disease transmission reported last week by The Los Angles Times, as well as many other reports documented in the literature supporting the practice, “double gloving” by all members of the sterile surgical team is recommended to reduce the risk of exposure to patient blood and body fluids. In addition to the CDC’s recommendation, another guideline’s endorsement of this practice may be read by clicking here.

Blog by: Lawrence F Muscarella PhD posted on 12-11-2012

Leave a Reply

Your email address will not be published. Required fields are marked *