To the Editor—Surgical gloves act as a barrier to the bidirectional transmission of pathogens between surgeon and patient.Reference Daeschlein, Kramer and Arnold ¹ Nevertheless, glove defects are common and increase with the duration of glove wear.Reference Kojima and Ohashi ^{2 ,} Reference Partecke, Goerdt and Langer ³ Preoperative surgical hand disinfection may well reduce the risk of germ transmission in the event of a glove breach. However, original levels of skin flora can be re-established during surgery.Reference Peterson, Rosenberg and Alatary ^{4 ,} Reference Rotter, Kampf and Suchomel ⁵ Therefore, we analyzed the ability of a novel antimicrobial surgical glove to disinfect contaminated glove fluid passing through a hole in the glove in vitro.

The bacteria used in our study included a methicillin-susceptible strain of Staphylococcus aureus (ATCC 29213 [American Type Culture Collection, Manassas, VA]), Klebsiella oxytoca (ATCC 700324), Escherichia coli (ATCC 25922), Enterococcus faecium (ATCC 6057), and Staphylococcus epidermidis (ATCC 12228). Five contaminated solutions were prepared to simulate glove fluid; each contained 1 of the aforementioned pathogens. All strains were recovered from frozen stock. After determination of purity, enrichment broth was cultured overnight and adjusted to a concentration of approximately 10⁵ colony-forming units (CFU)/mL.

Two different surgical gloves were tested: an antimicrobial trilayer glove containing liquid droplets of antiseptic (G-Bact, Hutchinson-Santé, SNC, Paris, France) in its core and a conventional sterile glove of the same thickness (G-Derm, Hutchinson-Santé) as a control. The test conditions were designed to simulate an injury resulting from the penetration of a sharp instrument with high reproducibility. The test site consisted of a chamber supporting a mount for the finger of the glove tested. In-glove pressure was regulated by a barometer controlling the volume of fluid transmitted, the velocity of passage (ie, time of contact with the antimicrobial layer), and the stretch of the glove. The sample gloves were prepared by separating the fingers with a sterile knife, filling them with the simulated glove fluid, and affixing them to the mount. Care was taken to maintain the sterility of the external surface of the glove finger. After manual perforation using a 20-gauge needle (Microlance 3, Becton Dickinson, Heidelberg, Germany), 5 µL of the passed fluid was collected for examination.

The samples were processed immediately. Each was vortexed for 30 seconds in 3 mL of sterile saline (0.9%) diluted with inhibitor ([NaClPeptone + LTHTh, Haipha GmbH, Eppelheim, Germany]; the appropriate concentration was determined in prior experiments (data not shown). Next, 100 µL of the suspension was streaked onto Columbia agar (5% sheep blood; Oxoid, Wedel, Germany) and incubated for 48 hours at 36°C. Colonies were counted and differentiated using the VITEK 2 Compact system (Biomérieux Deutschland GmbH, Nürtingen, Germany). Microbial growth was measured in CFUs. Each experiment was repeated 6 times with 6 replications. The mean reduction factors (RFs) were calculated for the different sample gloves and pathogens as follows: RF=log(total CFUs before passage) − log(total CFUs after passage).

The mean RF_[G-Bact] results were as follows: against methicillin-susceptible S. aureus, RF_[G-Bact]=4.22; against E. coli, RF_[G-Bact]=1.58; against E. faecium, RF_[G-Bact]=3.56; against K. oxytoca, RF_[G-Bact]=3.68; and against S. epidermidis, RF_[G-Bact]=3.40. Conventional sterile gloves resulted in lower RFs; the mean RF_[G-Derm] results were as follows: 0.2 against S. aureus, RF_[G-Derm]=0.2; against E. coli, RF_[G-Derm]=0.33; against E. faecium, RF_[G-Derm]=0.04; against K. oxytoca, RF_[G-Derm]=0.01; and against S. epidermidis, RF_[G-Derm]=0.04. The mean reduction factors against all species (RF_[All]) were RF_[All]=3.29 for G-Bact and RF_[All]=0.1 for G-Derm. Thus, G-Bact was more antibacterially efficaceous.

The skin flora of the surgical team members were identified as a possible source of surgical site infection (SSI), mainly in the case of glove breach.Reference Daeschlein, Kramer and Arnold ^{1 –} Reference Partecke, Goerdt and Langer ^{3 ,} Reference Harnoss, Partecke and Heidecke ⁶ Misteli et alReference Misteli, Weber and Reck ⁷ identified “perforation of surgical glove” as a risk factor for SSI when a single antibiotic shot was not administered. Therefore, antimicrobial surgical gloves may be useful to overcome the risk of glove perforation.

However, it must be emphasized that several antimicrobial gloves using different techniques and based on different concepts are currently being examined. Assadian et alReference Assadian, Kramer and Ouriel ⁸ examined a sterile surgical glove featuring a chlorhexidine-coated inner surface and reported significant suppression of surgeon hand flora. This study design targeted inadequate hand hygiene and bacterial regrowth. Examination gloves with external antimicrobial coating are being tested in experimental settings and focus on preventing transmission of pathogens via the outer surface (not yet available as certified medical products).Reference Leitgeb, Schuster and Eng ⁹ Prevention of bloodborne viral infections due to sharp instrument injuries is the aim of another antiviral trilayer glove (G-Vir, Hutchinson-Santé) that has also shown reduced transmission of bacteria.Reference Daeschlein, Kramer and Arnold ^{1 ,} Reference Edmiston, Zhou and Hoerner ¹⁰

In the present experiment, we demonstrated that the G-Bact antimicrobial surgical glove disinfected glove fluid in a simulated glove breach in vitro. Thus, its use may prevent bacterial contamination of the surgical site under real surgical conditions and may increase patient safety. However, this can only be confirmed by clinical studies of sufficient power with SSI as the direct endpoint.

1. 1. Concurrent transmission of pathogens in cases of glove breach can highly probably be reduced by an antimicrobial glove technology at the site of perforation.

2. 2. The ideal antimicrobial glove protects its wearer from bloodborne infections via antiviral efficacy and protects the patient from surgical site contamination via suppression of the bacterial flora from surgeons’ hands or reduction of pathogen passage. The ideal antimicrobial glove prevents externally contaminated gloves from functioning as vectors of pathogenic transmission from one location to another.