Grand Rounds

Does Changing Gloves Decrease Cesarean Wound Infection?

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

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

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

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

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