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. 2025 Aug 12;25(1):835.
doi: 10.1186/s12884-025-08002-3.

Surgical glove perforation in caesarean section and its association with surgical site infections: a prospective cohort study

Volkan Özgür Akbulut  1 , Dinçer Sümer  2 , Aziz Kından  2 , Ahmet Kurt  3 , Aykut Kından  3 , Recep Taha Ağaoğlu  2 , Ahmet Arif Filiz  2 , Kubilay Canga  2 , Hatice Ayhan  3 , Ali Turhan Çağlar  2
Affiliations

Surgical glove perforation in caesarean section and its association with surgical site infections: a prospective cohort study

Volkan Özgür Akbulut et al. BMC Pregnancy Childbirth. .

Abstract

Objective: Infectious complications at the surgical site complicates 1-4% of cesarean deliveries. Strict aseptic technique, hand hygiene and the use of sterile surgical gloves are essential to reduce the risk of surgical site contamination. Glove perforations are observed in almost 30% of all procedures and represent an underestimated potential risk factor for postoperative infections. The aim of this prospective study was to investigate glove perforation rates in cesarean deliveries and to analyze the impact of unrecognized glove perforations during surgery on surgical site infection rates after cesarean delivery.

Method: Surgical gloves from cesarean section were collected prospectively. All gloves were inspected for perforation holes. Cases in which surgical gloves had visible (macro) perforations were excluded from the study. Remaining gloves were examined using a water-fill test. Gloves with a positive water filling test were defined as the study group and negative gloves as the control group. Superficial Surgical Site Infections (SSI) were analyzed for the groups.

Results: A total of 1,779 pairs of used surgical gloves were collected and examined for perforations across 593 cesarean operations. Macro perforation were observed in 56 (9.4%) operations. The remaining 1,611 pairs of gloves underwent water-fill testing. Of these, 505 operations had completely intact gloves, while in 32 (5.4%) cases, micro-perforations were identified. SSI occurred in 18 women (3.3%): 7 in the perforation group (21.8%) and 11 in the control group (2.2%) (p < 0.001). In multivariable logistic regression analysis, glove micro-perforation was found to be a significant independent predictor of SSI (adjusted odds ratio: 12.705; 95% CI: 4.244-38.039; p < 0.001), even after adjusting for potential confounders including diabetes, obesity, emergency cesarean, operative duration, and intraoperative blood loss.

Conclusion: Our data show that glove perforation is unexpectedly common and underestimated in terms of unfavorable surgical outcomes. The rate of surgical site infections is increasing and we suggest that unrecognized glove perforation must be considered as a risk factor for surgical site infection after cesarean section.

Keywords: Cesarean Section; Surgical Site Infection; Surgical glove perforation.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All patients gave informed consent to be enrolled in this project and the study was approved by the local ethics committee of the institution (May 22, 2024; No. AEŞH-BADEK-2024-448) and was conducted in accordance with the Declaration of Helsinki. The data were anonymized and handled in compliance with ethical guidelines to ensure participant confidentiality. Consent for publication: Not applicable. This study does not contain any individual person’s data in any form (including any individual details, images, or videos) that would require consent for publication. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Water Fill Test Method for Detecting Glove Perforations
Fig. 2
Fig. 2
Glove Perforation Demonstrated by Water Fill Test in a Clinical Setting
See this image and copyright information in PMC

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