M K Yancey1, P Clark, P Duff. 1. Department of Obstetrics and Gynecology, University of Florida, Gainesville.
Abstract
OBJECTIVE: To determine the frequency of glove contamination associated with fetal extraction during cesarean delivery. METHODS: The study was performed in 25 women having scheduled or unscheduled cesarean delivery. Surgeons double-gloved for all procedures. Immediately before and after delivery of the fetus, the dorsal aspect of the fingers and hand of the surgeon's outer glove was swabbed with cotton-tip applicators and cultured for aerobic and anaerobic organisms. Only the glove from the hand that was used to deliver the infant was cultured. RESULTS: Nine of 25 cultures (36%, 95% confidence interval [CI] 17-55) performed immediately before fetal extraction were positive for staphylococci. No other organisms were isolated. Cultures performed following fetal extraction showed non-staphylococcal bacteria in 11 of 14 (79%, 95% CI 58-100) laboring women and one of 11 (9%, 95% CI 0-26) nonlaboring women, a statistically significant difference (P < .01). In the laboring patients, non-staphylococcal bacteria were isolated with similar frequency from the dorsal aspect of the hand (seven of 14, 50%, 95% CI 24-76) and the fingers (ten of 14, 71%, 95% CI 47-95). These cultures yielded mostly bacterial species from the Enterobacteriaceae family. CONCLUSION: In laboring patients with ruptured membranes, delivery of the fetal head frequently results in contamination of the surgeon's glove with pathogenic bacteria. This finding may partially explain the increased frequency of post-cesarean endometritis associated with manual extraction of the placenta.
OBJECTIVE: To determine the frequency of glove contamination associated with fetal extraction during cesarean delivery. METHODS: The study was performed in 25 women having scheduled or unscheduled cesarean delivery. Surgeons double-gloved for all procedures. Immediately before and after delivery of the fetus, the dorsal aspect of the fingers and hand of the surgeon's outer glove was swabbed with cotton-tip applicators and cultured for aerobic and anaerobic organisms. Only the glove from the hand that was used to deliver the infant was cultured. RESULTS: Nine of 25 cultures (36%, 95% confidence interval [CI] 17-55) performed immediately before fetal extraction were positive for staphylococci. No other organisms were isolated. Cultures performed following fetal extraction showed non-staphylococcal bacteria in 11 of 14 (79%, 95% CI 58-100) laboring women and one of 11 (9%, 95% CI 0-26) nonlaboring women, a statistically significant difference (P < .01). In the laboring patients, non-staphylococcal bacteria were isolated with similar frequency from the dorsal aspect of the hand (seven of 14, 50%, 95% CI 24-76) and the fingers (ten of 14, 71%, 95% CI 47-95). These cultures yielded mostly bacterial species from the Enterobacteriaceae family. CONCLUSION: In laboring patients with ruptured membranes, delivery of the fetal head frequently results in contamination of the surgeon's glove with pathogenic bacteria. This finding may partially explain the increased frequency of post-cesarean endometritis associated with manual extraction of the placenta.