Abstract
To the Editor:
H
Minor cuts and abrasions such as papercuts are not uncommon among the general population, including surgeons. Such injuries can increase the risk of transmission of blood-borne infections from the patient to the surgeon and vice versa. Sterile gloves help to protect against transmission of infections and are an integral part of the aseptic surgical protocol. However, the rate of micro-perforations present in a pair of gloves increases with operative time, especially after 90 minutes [2]. Such micro-perforations along with an underlying abrasion or cut can further increase the risk of infection transmission. Double gloving and using a color indicator glove can help to reduce this risk.
The National Institute for Health and Care Excellence (NICE) guidelines on prevention and treatment of surgical site infections [1] do not address how to manage minor cuts or abrasions on the hands of the surgeons, first assistants, and scrub nurses. The Association of Peri-Operative Practice (AfPP) advocates covering wounds with a waterproof dressing prior to gloving. This can be a time-consuming process because of the need for tailoring the dressing to the correct size, ensuring it adheres properly, and making certain it fits under the glove. It also requires redressing the wound after each scrub. In addition to this, the extra layer might limit movement and dexterity, especially if the dressing is applied around a joint. Dressings on the fingertip can also reduce critical tactile feedback.
Our simple solution to overcome the bulkiness of plasters is to use a skin adhesive such as Dermabond® (Ethicon, Somerville, NJ, USA) or SurgiSeal® (Adhezion Biomedical, Wyomissing, PA, USA). Skin adhesives have been used for many decades and provide a waterproof barrier over surgical wounds and minor abrasions [3,4]. Skin adhesives are not prescription-only medications and are increasingly available in many first aid boxes.
After the initial scrub, the surgeon applies a layer of skin adhesive over the abrasion or cut and allows it to set. Multiple layers are recommended to increase durability. The adhesive needs to be applied only once and provides protection during subsequent hand scrubbing. Although the new 2-octyl-cyanoacrylate products seem to have greater flexibility than older products containing N-butyl-cyanoacrylate, we do not recommend using skin adhesive as a sole barrier over flexor creases because of the risk of failure. Wounds need to be thoroughly cleansed prior to application, and skin adhesives are contraindicated on infected wounds.
We recommend using this solution especially in cases where tactile feedback and fine dexterity play a crucial role in the surgical procedure such as performing microsurgery. Skin adhesive can also be used as a waterproof occlusive dressing after a needle-stick injury after local protocols have been followed, including bleeding and irrigating the wound.