#2 Lacerations: Sterile Gloves & Water?

CLINICAL QUESTION

In the management of simple lacerations, are sterile gloves and sterile saline required to reduce infection?

BOTTOM LINE

The present evidence indicates that simple lacerations can be cleaned with tap water and repaired with clean non-sterile gloves without an increased risk of infection.

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EVIDENCE

Gloves:

Randomized-controlled trial (RCT)¹ of 816 immunocompetent patients (age ≥1) in Canadian emergency departments compared sterile vs. non-sterile gloves (both latex-free) in suture repair of lacerations.
- Infection rates by day 23: Sterile gloves 6% vs. non-sterile 4.3% (not statistically different).

Irrigation:

One meta-analysis² of three RCTs (1328 patients) comparing tap water to saline for irrigation of lacerations.
- Infection rates: Tap water 4.4% vs. saline 6.7% (not statistically different, p=0.16).
  - Though there is a suggestion that saline increases the risk of infection, this is mainly driven by a small study of non-sterile saline and one study of questionable randomization.
  - If we focus on the best study—a high-quality RCT of 713 patients comparing tap water and sterile saline with no difference in infections—it appears that sterile saline offers no advantage over tap water.³

Context:

The study of non-sterile gloves is the only RCT that we have, but it is of high quality and of reasonable size.
Two older studies (with 50 and 408 patients)^4,5 with questionable randomization surprisingly compared no gloves at all to sterile gloves, and infections did not differ:
- These two studies have significant limitations, and suturing without any gloves is clearly not appropriate for a host of reasons including blood-borne infectious diseases.
- However, these do lend support to the idea that sterile gloves likely offer little advantage in the repair of simple lacerations.