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#178 All You Need is Glove: Are non-sterile gloves safe for excisions in the office?


CLINICAL QUESTION
QUESTION CLINIQUE
Does the use of non-sterile (clean) gloves for office-based excisions result in more infections when compared to the use of sterile gloves?


BOTTOM LINE
RÉSULTAT FINAL
Using non-sterile gloves does not increase the number of infections when compared to sterile gloves for outpatient minor/uncomplicated skin (not flap) excisions and laceration repair in immune-competent adults. The current standard of care of using sterile gloves in these procedures is likely unnecessary and more costly. Unclear if this applies to sebaceous cyst excision, as these weren’t studied.



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EVIDENCE
DONNÉES PROBANTES
  • Minor skin excision:
    • Australian primary care Randomized Controlled Trial (RCT) of 493 patients (mean age 65) for mean 2 cm excision (33% head/neck).1 Infection rate:
      • 8.7% non-sterile gloves versus 9.3% sterile gloves, not statistically different.
    • Prospective cohort of dermatologic surgery.2 Infection rates:
      • 3,071 simple excisions: 1.7% non-sterile gloves versus 1.6% sterile gloves, not statistically different.
      • 420 reconstructive (flap) procedures: Non-sterile gloves statistically significantly more infections versus sterile gloves (14.7% versus 1.6%).
    • Retrospective primary care chart review (131 minor procedures).3 Infection rate:
      • 2.4% non-sterile gloves (sterile gloves not reported).
  • Mohs dermatological surgery:
    • Small RCT of 60 patients (mean age 73) with mean 2.2 cm excisions (85% head/neck).4 Infection rate:
      • 3% non-sterile gloves versus 7% sterile gloves, not statistically significant.
    • Three observational studies:
      • One cohort (20,821 procedures):5 Sterile gloves reduces infection rate by 0.47% versus non-sterile (p=0.04).
      • Two cohorts (1,400 and 2,025 procedures) found no difference in infection rates.6,7
Context:
  • Important exclusions:
    • Sebaceous cyst excision1,2 (possibly due to existing infection2).
    • Complex procedures (like closure requiring flaps)1 or found may have increased infection risk.2
      • Immuno-compromised patients.1,4
  • Other limitations:
    • Mohs excisions often more complex with potentially multiple glove changes: possibly less primary care relevance.4-7
    • Cohort studies: lower-level evidence.2,3,5-7
  • Research indicates simple lacerations can be repaired/sutured using non-sterile gloves.8
  • Another RCT shows that keeping sutured wounds dry beyond 12 hours did not reduce infection rates.9
  • Sterile gloves cost 3.5-16 times more than non-sterile gloves.1,4,6,7


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Author(s)
Auteur(s)
  • Ezekial Steve MD
  • G. Michael Allan MD CCFP

1. Heal C, Sriharan S, Buttner PG, et al. Med J Aust. 2015;202:27-31.

2. Rogues AM, Lasheras A, Amici JM, et al. J Hosp Infect. 2007; 65:258-63.

3. Bruens ML, van den Berg PJ, Keijman JMG, et al. Br J Gen Pract. 2008; 58: 277-8.

4. Xia Y, Cho S, Greenway HT, et al. Dermatol Surg. 2011; 37:651-6.

5. Alam M, Ibrahim O, Nodzenski M, et al. JAMA Dermatol. 2013; 149:1378-85.

6. Rhinehart MB, Murphy MM, Farley MF, et al. Dermatol Surg. 2006; 32:170-6.

7. Mehta D, Chambers N, Adams B, et al. Dermatol Surg. 2014; 40(3):234-9.

8. Allan GM. Tools for Practice. Available at: https://www.acfp.ca/wp-content/uploads/tools-for-practice/1397745796_20130913_125822.pdf. Last accessed: December 20, 2016.

9. Heal C, Buettner P, Raasch B, et al. BMJ. 2006 May 6; 332(7549):1053-6.

Authors do not have any conflicts of interest to declare.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.