Discussion

We undertook a retrospective cross-sectional study to determine the cost of reprocessing of surgical gloves in the central sterile supply department of a tertiary care teaching hospital in India so as to understand the economics of reprocessing.

During the study period, 18,850 pairs of gloves were procured and reprocessed. While reprocessing, gloves were checked by air insufflation for integrity and the gloves with leaks were rejected. It has been the experience of the authors that gloves do not last beyond three cycles and some even less. The cost of one pair of reprocessed gloves came out to be INR 14.33, and the cost of reprocessing came out to be INR 10.97. Interestingly, the institute was also procuring sterile disposable surgical gloves at INR 9.90 per pair. It is pertinent to mention that besides these pairs of gloves which were reprocessed, the hospital was also procuring disposable surgical gloves as per the sanctioned hospital budget for surgical stores at that point in time. The gloves procured by the patients from outside the hospital for various reasons also contributed to the pool of gloves. Gloves have been known to be one of the important components of PPE and, along with hand hygiene, play a significant role in the prevention of HAI. Intact surgical gloves are an important barrier for transmission of infection to and from the patients [3]. Esteban et al. demonstrated the possibility of transmission of hepatitis C from surgeon to the patients due to intraoperative perforation of the gloves [4]. Another study by Harpaz et al. also concluded that a surgeon may have transmitted hepatitis B to patients with perforated gloves as a probable cause [5]. Misteli et al. found that the risk of surgical site infection (SSI) increases significantly in procedures in which gloves are perforated and microbial prophylaxis has not been administered [6]. It can be safely assumed that if reprocessed gloves with micro perforations are used, it may result in increasing the opportunity for transmission of infections from the patient to the treating team and vice versa.

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Reprocessing is done in the health-care establishments to reduce the cost and to attempt its uninterrupted availability.

The costing exercise and the comparison of the cost of reprocessed gloves with disposable surgical gloves have shown that the reprocessing is not economical which is the only reason the process is undertaken. Additionally, numerous studies have proved that perforations occur in the surgical gloves during use. Laine and Aarnio [7] calculated the perforation rate to be 18.5 % during orthopaedic procedures. Solda et al. [8] used water leak method to check the integrity of used gloves and found that punctures were found in 16.3 % of gloves used in emergency surgical procedures with a larger percentage occurring in traumatic emergencies. Kojima and Ohashi [9] reported perforation rate to be 12 and 41 % in gloves used in thoracoscopic and open thoracotomy procedures, respectively. Hagos et al. [10] not only raised the issue of physical integrity in reprocessed gloves but also pointed out that such gloves failed sterility tests in 41 % of cases. Damage to the physical integrity of gloves being recycled was also noticed during the study, and such gloves were removed from the circulation. Air insufflation or air leak test was used to detect perforations. However, Gunasekera et al. [11] have averred that air leak test is not a very sensitive test to detect perforations and autoclaving would increase the friability of such gloves. Hence, the chances of glove perforations being missed in the study setting were there and, if detected and removed, would increase the cost of reprocessing further.

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