A review of some of the latest low-resourcs emergency medicine evidence
Use of non-sterile gloves for suturing
Non-sterile gloves and dressing versus sterile gloves, dressings and drapes for suturing of traumatic wounds in the emergency department: a non-inferiority multicentre randomised controlled trial
Juliette J M Zwaans ,Wouter Raven , Arthur V Rosendaal, Esther M M Van Lieshout, Geesje Van Woerden ,Peter Patka ,Juanita A Haagsma , Pleunie P M Rood
To assess if the use of non-sterile gloves gives equally as few wound infections for traumatic wounds as sterile gloves.
Previous systematic reviews and one observational study in the emergency department have shown no difference in infection rates. The use of non-sterile gloves would save time and resources.
Single label multi-centre randomised non-inferiority controlled trial
Three Dutch Emergency departments
Inclusion criteria; Adult, traumatic wound requiring suturing
Exclusion criteria; Complex wound (bone, vascular, nerve, cartilage involvement), >24 hours old, needing theatre closure or bite wounds.
1480 patients enrolled.
All patient’s had wound washed out, chlorhexidine, 1 % lidocaine used and sterile instruments
Standard group; sterile gloves, gauze and drapes.
Intervention group; Non-sterile gloves, gauze and drapes.
Wound infection (composite of various markers). Patient returned to ED for suture removal and blinded physician review.
The wound infection rate was non statistically significant (6.8 % in sterile vs 5.7 % in non sterile).
It is likely than non-sterile gloves are non-inferior to sterile gloves in causing wound infections.
Useful clinical question
Simple intervention, easily applied in most low resource settings.
Sensible patient-orientated outcome
Good use of non-inferiority trial design.
Sensible inclusion criteria.
Did not reach pre-targeted sample size for statistical power
Practitioner undertaking procedure not blinded.
Generalisability to immunosuppressed patients (e.g. those with diabetes) questionable
External validity in low-resource settings who have a very different cohort of wounds
My humble opinion
This well run trial demonstrates there is likely little benefit to certain aspects of the sterility process. This is useful in situations when you need to save resources or time. However it should be remembered in this settings you tend to have a much expanded practice (undertaking wound closure or complex wounds or heavily contaminated wound more often). This is a reminder that the more important aspect of prevent infection is good anaesthetic to allow thorough wound washout rather than the gloves you are wearing.