Time to switch to nonsterile gloves for these procedures?
Are sterile gloves worth the extra cost for common cutaneous surgeries? This systematic review and meta-analysis provides answers.
PRACTICE CHANGER
Using nonsterile gloves for common primary care skin procedures causes no more infections than using sterile gloves.1
STRENGTH OF RECOMMENDATION
A: Based on a systematic review and meta-analysis of 13 randomized controlled trials.
Brewer JD, Gonzalez AB, Baum CL, et al. Comparison of sterile vs nonsterile gloves in cutaneous surgery and common outpatient dental procedures: a systematic review and meta-analysis. JAMA Dermatol. 2016;152:1008-1014.
WHAT’S NEW
Highest-quality evidence shows no difference in SSIs
This systematic review found no difference in SSI rates when using sterile vs nonsterile gloves. Given that the analysis represents the highest-quality level of evidence (a systematic review of RCTs) and that sterile gloves are several times more expensive per pair than nonsterile gloves, the findings should impact future practice.
CAVEATS
A risk of bias and limited applicability
Not every trial in this meta-analysis was an RCT, and the inclusion of observational studies increases the risk of bias. However, the results of the observational studies were similar to those of the RCTs, somewhat alleviating this potential threat to validity.
It is worth noting that more extensive surgeries and more complicated repairs were not included in the trials, meaning that the findings are limited to oral surgery, Mohs micrographic surgery, standard incisions, and laceration repairs.
CHALLENGES TO IMPLEMENTATION
Inertia, medicolegal concerns, and personal preference
Clinical inertia may lead to slow adoption of these recommendations. Physicians may worry about potential medicolegal ramifications from this change.1 Lastly, some physicians may prefer the fit and feel of sterile gloves for their procedures.
ACKNOWLEDGEMENT
The PURLs Surveillance System was supported in part by Grant Number UL1RR024999 from the National Center For Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center For Research Resources or the National Institutes of Health.
