surgeons not blinded to randomisation outcome; blinding to type of needle is impossible for surgeons High quality: Further research is very unlikely to change our confidence in the estimate of effect. Ireland. Surgeons performing deep wound closure in primary total hip replacement surgery: fascia, fat and muscle not skin. Number studied: 68 operations. Intervention group n = 34 surgeon‐operations (number of gloves not reported). Control group n = 34 surgeon operations (128 gloves). Fresh outer gloves put on before wound closure and changed again before skin closure.

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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. random* OR control* OR trial OR trials OR comparativ* OR evaluation* OR ((singl* OR doubl* OR tripl* OR trebl*) AND (blind* OR mask*)) OR "latin square" OR placebo* OR "follow up" OR prospectiv* OR "cross over" OR volunteer* Blunt filter needles , which are filler needles with an extra filter attachment. This filter keeps out any solid particles from the liquid solution, especially if it’s been mixed from a powdered form. Italy. Attending surgeons, 3rd to 4th year residents and medical students performing abdominal procedures: muscle and fascia. Number studied: 100 operations (1560 gloves). Intervention group n = 300 surgeon operations (780 gloves). Control group n = 300 surgeon‐operations (780 gloves). Gloves changed before closure. The studies were located in the UK ( Ablett 1998; Hartley 1996; Thomas 1995; Wright 1993), the US ( Sullivan 2009; Wilson 2008), Ireland ( Rice 1996), the Netherlands ( Nordkam 2005 ), Italy ( Mingoli 1996) and Germany ( Meyer 1996).

surgeon nor assistant blinded to randomisation outcome; blinding to type of needle is impossible for surgeons Perforation detection: The gloves were filled with water and perforations were noted as jets of water. Secondary outcome: Ease of use of the needles. Once your item has been returned, we will inspect it and take the necessary action as soon as possible. Blunt fill needles are used to draw medications out of a sealed container. Blunt filter needles have an extra filter, which filters out solid particles from the liquid.

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For studies with multiple study arms that belonged to the same comparison, we intended to divide the number of events and participants equally over the study arms to prevent double counting of study participants in the meta‐analysis, but no such studies were found. We pooled studies with sufficient data, and judged to be clinically homogeneous, with RevMan software ( RevMan 2011). Blunt fill needles , which function as filling or extraction needles. They can draw medicine out of any sealed medical container and transfer their contents to the desired container. Use of suture needles with blunted end. Control group used conventional sharp pointed suture needles. Study design: randomised controlled trial according to operation date and time. Object of randomisation: operations

The person, who assessed the globes, identified the procedure by participant´s name + OP‐book number. Surgeon´s opinion was evaluated separately. (information from author) Four studies focused on the risk during abdominal closure ( Hartley 1996; Meyer 1996; Mingoli 1996; Nordkam 2005), two studies on vaginal repair ( Ablett 1998; Wilson 2008), two studies on caesarean section ( Sullivan 2009; Thomas 1995) and two on hip replacement operations ( Rice 1996; Wright 1993). Randomized Controlled Trial"[pt] OR "Controlled Clinical Trial"[pt] OR "Randomized Controlled Trials as Topic"[mh] OR "Random Allocation"[mh] OR "Double‐Blind Method"[mh] OR "Single‐Blind Method"[mh] OR "Clinical Trial"[pt] OR "Clinical Trials as Topic"[mh] OR "clinical trial"[tw] OR ((singl*[tw] OR doubl*[tw] OR trebl*[tw] OR tripl*[tw]) AND (mask*[tw] OR blind*[tw])) OR "latin square"[tw] OR Placebos[mh] OR placebo*[tw] OR random*[tw] OR "Research Design"[mh:noexp] OR "Comparative Study"[pt] OR "Evaluation Studies as Topic"[mh] OR "Follow‐up Studies"[mh] OR "Prospective Studies"[mh] OR "Cross‐over Studies"[mh] OR control[tw] OR controls*[tw] OR controla*[tw] OR controle*[tw] OR controli*[tw] OR controll*[tw] OR control'*[tw] OR prospectiv*[tw] OR volunteer*[tw]) NOT (Animals[mh] NOT Humans[mh) The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). TS=("health care worker" OR "health care workers" OR "health occupations" OR "health personnel" OR physician* OR nurse* OR hospital* OR clinic OR clinics)UK. Surgeons performing caesarean sections, closing the uterine wound. Number studied: 80 procedures. Sizes of intervention or control group not reported but assumed to be 40 and 40 surgeon‐operations. Glove change not reported.

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. Search effect*[tw] OR control[tw] OR controls*[tw] OR controla*[tw] OR controle*[tw] OR controli*[tw] OR controll*[tw] OR control'*[tw] OR evaluation*[tw] OR program*[tw] EXP Health Occupations (MeSH) OR EXP Health Personnel (MeSH) OR EXP Health Facilities (MeSH) OR "health care worker" OR "health care workers" OR Disease Transmission, patient‐to‐Professional (MeSH) 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.

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While they aren’t sharp, blunt needles are still medical devices and require careful attention. 1. Keepinga Blunt Needle Sterile We assumed that the number of glove pairs in experimental group was the same as the number of procedures, and used outer glove perforations as outcome. All studies used blunt or tapered needles as the intervention and compared them to sharp or conventional suture needles. 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+")