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We read with interest the paper by Thomas et al concerning single versus double gloving in protection against intraoperative skin contamination from glove perforation.1 We note that one of the methods used to detect glove perforation was the water leak method. Although we accept that the water leak test is an acceptable method we believe that it is not as sensitive as the electrical conductance test as demonstrated by Sohn et al.2
Interim results from an ongoing study yielded 211 sterile and non-sterile gloves used during venepuncture or wound closure in our emergency department. We identified nine glove perforations with the water leak test and 22 with the electrical conductance test. All water leak positives were also electrical conductance test positive. This study supports the work by Sohn et al. We believe that Thomas, Agarwal, and Metha may have underestimated the incidence of glove perforation in their study group.
The water load test, as per the criteria established by the American Society for Testing and Materials, is one of the methods approved by law for testing integrity of latex gloves. Recent studies have shown that the electrical conductance test has a higher sensitivity than the water load test in detecting smaller glove perforations. The study by Sohn et al cited by McLaughlin and colleagues also shows similar findings,1 although the number of patients testing false negative with the electrical conductance test has not been mentioned.
Both these tests, however, have an inherent disadvantage as they overdistend the gloves, thus negating the viscoelastic, self sealing properties of latex and aggravating the potential permeability to fluid/electrical impulses. It may be more appropriate if these tests are conducted with the gloves distended with liquid only up to the appropriate size; the significance of the glove perforation can then be assessed by the number of bacteria/quantity of water that can pass through the perforation in a fixed period of time.
In the ongoing study described by McLaughlin et al, there were 22 perforations in 211 gloves used in minor surgical procedures, indicating that one in five minor surgical procedures will result in perforated gloves (one pair of gloves for each procedure). This emphasises the point made by our article that even in minor surgical procedures, single gloving alone will not provide adequate protection.
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