A Glove Tear at Closing

In practice

Near the end of a long orthopedic case, Kim, the scrub person, loads a needle holder and notices a small tear in the outer glove of the left hand, near the index finger. Kim cannot remember when it happened; the case involved bone fragments and wires. Kim stops passing and says that the left outer glove is torn. The surgeon pauses. Kim steps back from the field and checks the inner glove: it looks intact, but Kim cannot be sure, and there is a faint mark on the skin of the finger beneath. Kim tells the circulating nurse that there may also have been a puncture. Following the facility's procedure, both gloves on that hand are replaced with sterile gloves, with the circulator's help. Kim looks at the skin under good light: a small scratch, without obvious bleeding. After the case, Kim reports a possible sharps exposure to the charge nurse, and the facility's exposure procedure begins, including a confidential evaluation. In the meantime, the surgeon examines the closure site, and the team notes the glove change in the record. At the debrief, the team agrees to change outer gloves at set points during long bone cases, as the facility's policy permits.