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USA. Surgeons and assistants performing caesarean sections. Closure of all anatomical layers. Number studied: 194 operations. Intervention group n = 204 surgeon‐operations. Control group n = 204 surgeon‐operations. All gloves collected. MH "Health Occupations") OR health occupations or (MH "Health Personnel+") or (MH "Health Facilities+") OR health facilities or TX "health care worker" or TX "health care workers" or (MH "Personnel, Health Facility+") or (MH "Occupational Health Services+") or (MH "Occupational Hazards+") or (MH "Occupational Exposure") or TX "health care personnel" or (MH "Health Personnel+") or (MH "HIV Infections+") All studies used blunt or tapered needles as the intervention and compared them to sharp or conventional suture needles. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. surgeon nor assistant blinded to randomisation outcome; blinding to type of needle is impossible for surgeons
random* OR control* OR trial OR trials OR comparativ* OR evaluation* OR "latin square" OR placebo OR "follow up" OR prospectiv* OR "cross over" OR volunteer*}
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The overall quality of the evidence in the studies was good even though the reporting of the older studies could have been better. Given the technical nature of the intervention and the objective method of ascertaining that the gloves had holes, used in all studies, we believe that there is no reason to assume a high risk of bias. The newer studies that are better reported and thus score better with regard to risk of bias show similar results to the older studies. It was however disturbing to notice that the habit of testing for perforations has changed over time to water tests only, which were originally reported to be less sensitive than the air test and even less so than the combination of the two tests ( Smith 1988; Smith 1990). Everyone who has once repaired a bicycle tyre might know from experience that the air test is very sensitive. Very disturbingly, to support the validity of the water test used most authors referred to an article in which the water test had been described but not validated and stated with great certainty that: "the gloves were tested with a previously validated method". Because all authors tested both study arms with the same test, we don't think that this has influenced the results of this review. A possible effect of detecting fewer perforations could be that the effectiveness of blunt needles has been underestimated.
USA. Physicians performing obstetrical laceration repairs, needle used for whole procedure. Number studied: 438 procedures. Intervention group n = 217 surgeon‐operations. Control group n = 221 surgeon operations. All gloves collected.Information from author:The surgeon called the study nurse while changing his gloves before closure of the laparotomy. Therefore, only elective surgery has been included in this study. Number of perforated glove pairs per total number of procedures. Perforation detection: firstly the gloves were filled with air, immersed in water and perforations were noted as air bubbles. Secondly, the gloves were filled with water and perforations were noted as jet of water. For the second half of the study additional testing was performed with a specifically designed electrical testing device.
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