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Grand Rounds

Does Changing Gloves Decrease Cesarean Wound Infection?

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BACKGROUND AND PURPOSE: 

  • Previous small randomized trials were inconclusive as to whether changing gloves during cesarean section prevents post-operative wound infections  
  • Scrafford et al. (Archives of Obstetrics and Gynecology, 2018) assessed the impact of intra-operative glove changing on rates of wound-related complications among women undergoing a cesarean section  

METHODS: 

  • Prospective randomized controlled trial 
  • Participants: Women undergoing cesarean section for any indication 
  • All patients received appropriate pre-operative measures to prevent infection  
  • Vaginal preparation and cesarean delivery techniques were at the discretion of the attending surgeon 
  • Participants were randomized into the following groups  
    • Intra-operative glove change where all members of the surgical team (including assistants and scrub technicians) replaced their outer gloves just prior to abdominal closure 
    • Usual care 
  • Abdominal closure was defined as prior to peritoneal closure and not prior to placental delivery due to risk for increased blood loss  
  • Primary outcome: Any wound-related complication including 
    • Wound hematoma 
    • Seroma  
    • Skin separation of at least 1 cm  
    • Wound infection 
    • Incisional abnormality requiring treatment within 8 weeks of surgery 
  • Secondary outcomes included  
    • Other infections complications including endometritis and superficial or deep soft tissue infections 

 RESULTS: 

  • 277 women were included in the usual care group and 276 in the glove changing group 
  • Composite wound complications were significantly lower in the intra-operative glove changing group (6.4%) compared to the non-intervention group (13.6%); p=0.008 
  • Adjusted for vaginal preparation had little impact on the result  
    • Adjusted odds ratio 0.43 (95% CI 0.23, 0.81), p = 0.009  

CONCLUSION: 

  • Intra-operative glove changing prior to abdominal closure during cesarean section reduces the incidence of post-operative wound complication 

Learn More – Primary Sources: 

Effect of intra-operative glove changing during cesarean section on post-operative complications: a randomized controlled trial.

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Related ObG Topics:

Can Evidence-Based Interventions Reduce C-section Complications?
What is the Best Practices Prevention Bundle for Post Cesarean Infection?
Does Vaginal Cleansing Prevent Endometritis Following Cesarean Section?

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