Tools for Practice Outils pour la pratique


#2 Lacerations: Sterile Gloves & Water?


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


BOTTOM LINE
RÉSULTAT FINAL
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. 



CFPCLearn Logo

Reading Tools for Practice Article can earn you MainPro+ Credits

La lecture d'articles d'outils de pratique peut vous permettre de gagner des crédits MainPro+

Join Now S’inscrire maintenant

Already a CFPCLearn Member? Log in

Déjà abonné à CMFCApprendre? Ouvrir une session



EVIDENCE
DONNÉES PROBANTES
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. 
Ricky D Turgeon BSc(Pharm) ACPR PharmD  by july 13, 2106


Latest Tools for Practice
Derniers outils pour la pratique

#365 Shrooms for Glooms: Evidence for psilocybin for depression

What are the benefits and harms of psilocybin for treatment-resistant/recurrent depression?
Read Lire 0.25 credits available Crédits disponibles

#364 Facing the Evidence in Acne, Part II: Oral Antibiotics

How effective are oral antibiotics in treating acne of at least mild-moderate severity?
Read Lire 0.25 credits available Crédits disponibles

#363 Making a difference in indifference? Medications for apathy in dementia

In patients with dementia, how safe and effective are stimulants, antidepressants, and antipsychotics for treating apathy?
Read Lire 0.25 credits available Crédits disponibles

This content is certified for MainPro+ Credits, log in to access

Ce contenu est certifié pour les crédits MainPro+, Ouvrir une session


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

1. Perelman VS, Francis GJ, Rutledge T, et al. Ann Emerg Med. 2004; 43:362-70.

2. Fernandez R, Griffiths R. Cochrane Database Syst Rev. 2012; (2):CD003861.

3. Moscati RM, Mayrose J, Reardon RF, et al. Acad Emerg Med. 2007; 14:404-9.

4. Worrall GJ. Can Fam Physician. 1987; 33:1185-7.

5. Bodiwala GG, George TK. Lancet. 1982; 91-2.

Authors do not have any conflicts of interest to declare.

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