Sterile or Clean Gloves for Laceration Repair?
/Perelman VS, Francis GJ, Rutledge T, Foote J, Martino F, Dranitsaris G. Sterile versus nonsterile gloves for repair of uncomplicated lacerations in the emergency department A randomized controlled trial. Ann Emerg Med 2004;43(3):362–70. 10.1016/j.annemergmed.2003.09.008
This was a multicenter, prospective, and single blinded randomized control trial designed to determine whether rates of infection after repair of uncomplicated lacerations in immunocompetent patients is comparable using clean nonsterile gloves versus sterile gloves.
The study was completed at 3 large community hospitals in the Toronto, ON area. Over 9,000 patients were eligible for participation and about 1,100 were approached. Patients were excluded from eligibility for a wide range of reasons including presence of diabetes, renal failure, asplenia, acquired or congenital immunodeficiency, cirrhosis, and current use of or need for prophylactic antibiotics such as artificial heart valves or wounds sustained via bites.
816 patients were randomized using block randomization in blocks of 60 as well as in strata according to the site of laceration (head and neck, trunk and buttocks, extremities). Physicians performing the laceration repair were provided an algorithm suggesting ideal repair including obligatory pressure irrigation and the use of appropriate suture material. The use of antiseptic cleansing solution and final choice of suture material was left to the provider's discretion. Providers put on gloves out of sight of the patients to blind them to the type of gloves used (although this would easily be noted by any patient with background knowledge of glove material). Patients were then given a data sheet to be used by a follow-up physician to determine infection, as the presence/absence of a significant wound infection was the primary endpoint of the study.
Of the 816 patients randomized, 73% were men and 62% were to the extremities with 37% to the head or neck. Lacerations were typically repaired 3 hours after the event, and pressure irrigation was used in 84.1% of patients. The observed infection rate was 6.1%, CI 3.8-8.4% in the sterile glove group and 4.4%, CI 2.4-6.4% in the clean nonsterile group. Although the RR (Relative Risk) of infections was 1.37, the difference of infection rate was insignificant (CI 0.75-2.52, P=.295).
During the follow up assessments, physician discretion was used to determine the presence or absence of infection. If, however, uncertainties or discrepancies were noted on the follow up data sheet (e.g., reported no infection but recorded purulent discharge) the wound was assumed to be infected. This increased the number of reported infections above the true number, although infection rates were comparable to previous studies. As no significant increase in infection rates was noted by the study, it is reasonable to propose the use of non-sterile clean gloves for all simple laceration repair (provider preference allowing) due to the significantly decreased cost of these gloves compared to individually packaged sterile gloves.
This study has several limitations including only partial blinding as the provider was very aware of the type of glove used which may have influenced their practice (Hawthorne Effect). Additionally, laceration repair could not be standardized among providers nor could the infection assessments of the follow up physicians.
In summary, this prospective, single-blinded, multicenter study provides evidence that clean, nonsterile, boxed gloves can be safely used for repairing uncomplicated traumatic lacerations without increasing the risk of wound infections.
Authorship
Written by Cole Davis, PGY-3 University of Cincinnati Deparment of Emergency Medicine
Audio Editing, Posting by Jeffery Hill, MD MEd, Associate Professor, University of Cincinnati Department of Emergency Medicine.
Cite As: Davis, C. Hill, J. Sterile or Clean Gloves for Laceration Repair? TamingtheSRU. www.tamingthesru.com/blog/journal-club/clean-gloves. June 12, 2024.
