颅脑手术中无菌外科手套忽略性穿孔的发生及其对细菌污染的影响

Occurrence of neglected perforation of sterile surgical gloves and its effect on bacterial contamination during craniocerebral surgery

目的 探讨颅脑手术使用的无菌外科手套忽略性穿孔的发生情况及其对手套细菌污染的影响。方法 选取在颅脑手术中手术参与者佩戴的无菌外科手套996只为研究对象,对可能导致手套发生忽略性穿孔的因素分别进行单因素及多因素Logistic回归分析,对穿孔和未穿孔手套的外表面细菌检出情况进行比较。结果 996只颅脑手术使用的无菌外科手套中,有84只(8.43%)手套检出了忽略性穿孔,有39只(3.92%)手套检出了细菌。忽略性穿孔组的手套外表面细菌检出率显著高于无忽略性穿孔组(P<0.001)。单因素及多因素Logistic分析结果提示开颅手术、急诊手术、手术时间≥150 min、术中使用旋转设备及佩戴手套人员的角色为手术主刀是导致无菌外科手套发生忽略性穿孔的危险因素(OR>1,P<0.05),而术中使用双层手套则是避免发生穿孔的保护性因素(OR<1,P<0.05)。结论 颅脑手术中无菌外科手套的忽略性穿孔发生情况不容乐观,开颅手术、急诊手术、手术时间较长、术中使用旋转设备及手术主刀使用的手套发生忽略性穿孔的概率较高,对于忽略性穿孔发生率较高的手术,术中可以佩戴双层手套,以减少无菌外科手套外表面的细菌污染。

Objective To investigate the incidence of neglected perforation of sterile surgical gloves used in craniocerebral surgery and its effect on bacterial contamination of the gloves.Methods A total of 996 sterile surgical gloves worn by surgical participants during craniocerebral surgery were selected as the study objects.Univariate and multivariate Logistic regression analysis were respectively performed to analyze the factors that might cause the neglected perforation of gloves,and the detection rate of bacteria on the outer surface of perforated and unperforated gloves were compared.Results Among 996 sterile surgical gloves used in craniocerebral surgery,84(8.43%)gloves were found to have neglected perforation,and 39(3.92%)gloves were found to have bacteria.The detection rate of bacteria on the outer surface of the neglected perforation group was significantly higher than that of the non-neglected perforation group(P<0.001).The results of univariate and multivariate Logistic analysis suggested that craniotomy,emergency surgery,surgery time≥150 minutes,the use of rotating equipment during surgery and the role of glove wearing personnel as the main surgeon were the risk factors for neglected perforation of sterile surgical gloves(OR>1,P<0.05),while the use of double-layer gloves during surgery was the protective factor for avoiding perforation(OR<1,P<0.05).Conclusion The occurrence of neglected perforation of sterile surgical gloves during craniocerebral surgery is not optimistic.The probability of neglected perforation of gloves is higher in craniotomy,emergency surgery,long surgery time,the use of rotating equipment during surgery,and gloves used by the main surgeon.For surgeries with a high incidence of neglected perforation,double-layer gloves can be worn during surgery to reduce bacterial contamination on the outer surface of sterile surgical gloves.