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Three Part Question

In [patients with simple wounds] does the use of [sterile gloves rather than clean non-sterile gloves] produce less [wound infections]?

Clinical Scenario

A patient presents to the emergency department with a laceration to his left hand. The wound needs cleaning and suturing. You wonder whether sterile gloves are really necessary in the treatment of simple wounds.

Search Strategy

Medline 1966-week 2 09/04 using the OVID interface.
[exp "wounds and injuries" OR exp wounds, penetrating OR exp lacerations OR laceration.mp] AND [exp gloves, surgical OR exp gloves, protective OR glove.mp] AND [exp infection OR infection.mp OR exp focal infection OR exp surgical wound infection OR exp wound infection] LIMIT to human AND English.

Search Outcome

Altogether 59 papers found in Medline none of which one directly answered the question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Perelman et al 2004 Canada	816 patients over the age of 1yr old with simple lacerations	prospective randomised controlled trial	Infection post repair	Infection rate for sterile vs non-sterile gloves was 6.1% and 4.4% respectively with no significant statistical difference	partially blind follow up looking for signs of infection was not standardized

Comment(s)

There seems to be no available evidence for the use of sterile gloves over clean non-sterile gloves in the treatment of simple traumatic wounds.

Editor Comment

Udated 09/04 by Sadaf Khan - Emergency Medicine resident, MERC / MSU Program in Emergency Medicine. 1 paper found in table. Comment:Thousands of simple uncomplicated lacerations are repaired daily. Traditionally only sterile gloves have been used without any substantial evidence to support decreased rates of infection. Time and money could be saved by the use of clean, non-sterile gloves. The evidence from this trial shows no significant difference in the rates of infection post repair using sterile and non-sterile gloves. Bottom Line: Although not shown to increase post repair wound infections - use of non-sterile gloves may be dependant on an individual level of comfort. Further trials with larger numbers and more standardized follow up may be required. Cost effectiveness may be of more relevance and importance in countries with underfunded healthcare systems.

Clinical Bottom Line

It is arguably unethical to start using non-sterile gloves where the tradition has been to use sterile gloves but this is an area for potential research.

References

1. 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. Annals of Emergency Medicine Mar 2004; 43(3):362-70.