FROM JAMA DERMATOLOGY
The use of sterile or nonsterile gloves during outpatient dermatologic and dental procedures resulted in similar rates of postoperative surgical site infections (SSIs), results from a large systematic review and meta-analysis demonstrated.
“During the past few decades, the use of surgical gloves has become standard practice to prevent postoperative wound infections or surgical site infection,” researchers led by Dr. Jerry Brewer wrote in a study published online Aug. 3, 2016 in JAMA Dermatology. “However, whether the use of sterile vs. non-sterile gloves makes a difference in the development of postoperative SSIs in the setting of cutaneous and minor outpatient surgical procedures remains unclear.”
In an effort to examine that question, Dr. Brewer of the division of dermatologic surgery at Mayo Clinic, Rochester, Minn., and his associates conducted a systematic review and meta-analysis of randomized clinical trials and comparative studies with information on sterile vs. non-sterile gloves in outpatient surgical procedures (JAMA Dermatol. 2016 Aug. 3. doi: 10.1001/jamadermatol.2016.1965). Patients in the studies underwent outpatient cutaneous or mucosal surgical procedures, including Mohs micrographic surgery, repair of a laceration, standard excisions, and tooth extractions.
The final meta-analysis included 11,071 patients from 13 studies. Of these, 6,040 underwent procedures with sterile gloves and 5,031 underwent procedures with nonsterile gloves. The researchers reported that a total of 228 patients (2.1%) had a postoperative SSI, including 107 in the nonsterile glove group (2.1%), and 121 in the sterile glove group (2%). The overall relative risk for an SSI with nonsterile glove use was 1.06.
In an interview, Dr. Brewer estimated that sterile gloves cost anywhere from $0.27 to $1.29 per pair, compared with about 8 cents per pair for clean nonsterile gloves. “This cost difference may not seem like much, but if you think about all the surgeries that are done on a regular basis across the country, that’s a huge difference in cost,” he said.
The authors acknowledged certain limitations of the study, including the potential for selection bias, since many of the studies included in the meta-analysis were observational. They also noted that findings from some previous studies on the topic run counter to theirs (see Dermatol. Surg. 2010; 36:1529-36 and J. Hosp. Infect. 2007;65:258-63 ). “Although the broad use of nonsterile clean gloves may be justified, caution is advised in generalizing this justification to more advanced outpatient surgical procedures that may not pertain to the information summarized in this review and meta-analysis,” they concluded. “Future study could include whether duration of surgery and complexity of the repair influence postoperative SSI development in the setting of sterile vs. nonsterile gloves.”
The researchers reported having no financial disclosures.