Results of a
randomized controlled trial presented at the ACOG 2017 showed that changing the
outer gloves before closing the abdomen decreases the wound complication of infection,
cellulitis and dehiscence.
Wound
infection after a cesarean section (CS) is a major cause of maternal
morbidity, lengthy hospital stay and increased medical cost. The rate of
surgical site infection after cesarean section range from 3% to 15%.
The nature
of the procedure is such that surgeon’s and assistant’s gloves are contaminated
by lower genital tract bacteria and seed an otherwise sterile operative field. Previous
studies have not shown that a change of gloves decreases the rate of post-operative
wound infection.
The study was
led by Dr. Buvana Reddy from Woodbury, Minnesota but the results were presented
at the conference by coauthor Jonathan Scrafford, MD from University of
Minnesota–Minneapolis.
A review of
literature showed that only one small similar study of 92 patients was
published in 2004 in Journal of Reproductive Medicine in 2004. The study
concluded that “Obstetricians may decrease the number of postcesarean wound
infections by having the entire team change surgical gloves after delivery of
the placenta.” But, the study lacked power and the timing of change of gloves after
the delivery of placenta was not very practical during the course of surgery.
The present
study is larger, and focuses on a composite wound outcome score instead of just
evaluating the surgical site infection and the timing of change of gloves was
at the time of abdominal closure.
This single
center study recruited 553 women who had a planned cesarean section at the
center across a period of 15 months. Out of this cohort, data is available for a
total of 250 patients in the control arm and 236 patients in the study arm who received
the glove-changing intervention.
The patients
were matched on demographics, total surgical time and the amount of blood loss.
After statistical analysis 15 patients in the study arm suffered from wound
infection as compared to 34 patients in the control group (P = .008).
Statistical significant difference was also observed in wound dehiscence in the
two group (5 in glove changing arm vs 14 in the control arm; P = .01)
Pre-operative
vaginal preparation with antiseptic solution did not alter the results of the
study.
The number
need to treat for achieving the benefit of gloves changing was 14 and the added
cost per procedure was just $5.
