POSADAS, Kristina Grace NPR-2

DO SURGICAL PERSONNEL REALLY NEED TO DOUBLE GLOVE?

One century ago surgical gloves were introduced to practice as part of the new antiseptic technique and originally to protect the hands of the surgeon and his assistants from the harmful dermatologic effects of powerful antiseptics (e.g., carbolic acid) in use at that time. Since then, the wearing of gloves during surgery has been standard practice. Furthermore, the protection value of surgical gloves in preventing cross-infection has stood the test of time. Nevertheless, materials used in glove manufacturing have caused a succession of iatrogenic problems in surgical patients over the years. More recently, emergence of transmissible viruses, such as hepatitis B and C and human immunodeficiency virus, has led surgeons to consider their own safety with the frequent possibility of perforation of surgical gloves by sharp instruments. In this context now comes in the idea of double gloving. Double gloving- another protocol that aims to protect both the client and the surgical team-sounds great and it would seem that there should be no questions asked when it comes to such safety issues. However, certain points are still to be addressed before everyone becomes keen on complying with such. First is on the impact on finances. True, that healthcare costs will surely sky rocket if crossinfection occurs but let s face it, we would initially be doubling the budget allocated for surgical gloves. This is not much of a problem in first world countries, but with second and third world countries such expenses are way too much. In the Philippine healthcare setting alone, most rural hospitals already make it a point to recycle gloves just so expenditures would not shoot up. A second concern is regarding the decreased sensitivity and dexterity of the double-gloved hands. The What ifs are initially asked- What if I can t tie the knot securely? , What if I can t feel for that tumor or that bullet or that stone? , What if I can t feel that the instrument or supply or equipment has already been handed to me? -most seem exaggerated but we do get the point. Though studies have shown that double gloving does not affect or significantly reduce tactile sensitivity and dexterity, still some subjects (mostly surgeons) complain of such. I do believe that such complaints may be addressed only if there is first an acceptance that such technique is best for everyone s safety, and second if they do take time in adopting or practicing such maybe initially outside the OR. The third concern is, which is a better option: larger-sized glove inside and smaller-sized glove outside or vice-versa? Studies revealed that both work great; it is but the discretion of the user to explore which one suits his/her needs more. For me, taking extra measures to ensure the safety of all parties involved is a great investment. But what s even greater is that single glove or double glove, we recognize our vital role in the provision of a safe yet quality healthcare to our clients.

POSADAS, Kristina Grace NPR-2

ON TOP OF ANYTHING ELSE...LET S DO THE TIME OUT!

We have heard it time and time again- a case of mistaken identity, a procedure done at the wrong site, or a wrong procedure done altogether. This is the scenario that usually puts healthcare professionals and institutions in jeopardy, and the anxious public questioning their safety at the OR table. To address this problem, an international protocol has been developed and is now gradually being integrated in our very own healthcare system-the Time Out Process (TOP). To me, the TOP seems to scream out these words- GO BACK TO THE BASICS! For it is true that preoperatively we do have to verify who the patient is, what is the procedure and site, what is the purpose of the procedure, what special equipment and/or imaging studies are needed, and what other concerns or considerations need to be addressed first (e.g. allergies, implants, etc.). In my opinion, although most surgical teams do check on these items, there are more intrinsic factors involved which may be evident in the following: most do the verification process in passing or without thought, just out of protocol; other members of the surgical team are already busy doing other functions, or worse starting with the procedure already rather than listening to the actual endorsement first; other members of the surgical team are not yet present during the said endorsement; some members of the surgical team tend to recite the items simply from memory instead of ticking them off from a uniform checklist. In all these, I do think that two major reasons are evident. First is that the surgical team, upon entering the theater, already have an assumption that This will be another one of those typical procedures, having typical outcomes. Such assumption then leads to a mental note that Everything s functioning just fine and there s no need to check for this and that and before we know it, the errors have already occurred, the negligence quite evident. The second reason, I believe is more of the ego-centric type where members of the surgical team seem too confident on themselves that such confidence sometimes overshadows the safety of the client. Such was the majority of reported cases in the U.S. wherein the highly-experienced surgeon hurriedly reaches for the scalpel and starts the procedure, all the while not verifying anything from the patient to the site to the condition of the client. TOP is not something new not even in our own healthcare setting, it is simply a reinforcement of what we should really do preoperatively. It is a reminder of whose advocate we are. It is a wakeup call that lives are at stake everyday and we can t just commit such errors. It serves as a note to dig deep into our surgical conscience. I for one plead guilty of such negligence even as a student but I do hope that we would be able to overcome the barriers/hindrances that we have, whether extrinsic or intrinsic in nature to bring the best possible care to our clients.

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