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Tan YY, Chua ZX, Loo GH, Ong JSP, Lim JH, Siddiqui FJ, Graves N, Ho AFW. Risk of wound infection with use of sterile versus clean gloves in wound repair at the Emergency Department: A systematic review and meta-analysis. Injury 2023; 54:111020. [PMID: 37713965 DOI: 10.1016/j.injury.2023.111020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/02/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023]
Abstract
STUDY OBJECTIVE Sterile gloves are widely used during wound repair procedures in Emergency Departments (ED) worldwide. It is unclear whether sterile gloves protect against postoperative wound infections. We conducted a systematic review and meta-analysis to determine if sterile gloves offer significant protection against wound infections compared to clean gloves for wound repair in the ED. METHODS Ovid MEDLINE, Ovid Embase, Cochrane Library and Web Of Science were searched for randomised controlled trials (RCTs) or non-randomized studies of intervention (NRSIs) from their dates of inception to January 2023. RCTs or NRSIs comparing sterile (control) vs. clean/no (intervention) glove use for wound repair procedures in the ED and reporting postoperative wound infections were included. Two investigators independently extracted data and assessed risk-of-bias of each report on a standardised form. Wound infection incidence was pooled using a random effects model. Subgroup analysis was performed to explore heterogeneity. RESULTS 7 studies were included in the review, with 6 included in the meta-analysis. Of 3227 patients, 115/1608 (7.2%) patients in the intervention group and 135/1619 (8.3%) patients in the control group had postoperative wound infections. Overall RR was 0.86 (95% CI,0.67-1.10, I2=3.6%), and of high evidence certainty (GRADE). Absence of a protective effect was invariant in sensitivity analyses, leave-one-out analysis and subgroup analyses. CONCLUSION No evidence of additional protection against wound infections with the use of sterile gloves for wound repair in the ED compared to clean gloves was found. However, the review was limited by nonreporting of antibiotic history and time between wound repair and follow-up amongst included studies. Considering the ergonomics, potential cost-savings and environmental impact, clean gloves are a viable alternative to sterile gloves, without compromising wound infection risk in this setting.
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Affiliation(s)
- Yong Yi Tan
- Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore
| | - Zhuo Xun Chua
- Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore
| | - Guan Hin Loo
- Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore
| | - Jamie Si Pin Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jia Hao Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Fahad Javaid Siddiqui
- International Development Coordinating Group, Campbell Collaboration, United States; Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore
| | - Nicholas Graves
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore; Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore.
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Taub PJ, Oleru O, Mandelbaum MG, Seyidova N. Application of Field Sterility to Safely Reduce Cost and Waste in Cleft Surgery. J Craniofac Surg 2023; 34:2008-2011. [PMID: 37590005 DOI: 10.1097/scs.0000000000009579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/03/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Healthcare spending in the United States remains a major concern, requiring reforms to control spending and curtail costs. Medical supply is one of the largest expenses for hospitals and strategies should be utilized to reduce nonbeneficial service delivery, which increases cost without concomitant increase in value. Introduction of field sterility is one of the potential strategies that has been applied in several surgical disciplines to improve cost-efficiency by reducing overuse of resources and decreasing enormous medical waste. Of course, this must be applied without a diminution in safety. METHODS The PubMed, Medline, and Cochrane databases from 1980 to 2022 were used to review literature. Key words included "cleft surgery and field sterility," "sterile gloves and oral surgery," "oral surgery and field sterility," "sterile techniques and cleft palate surgery," "sterile versus nonsterile gloves," "sterile and non-sterile gloves and minor surgery," "skin laceration repair and sterile techniques," "sterile gloves and wound suture," "surgical site infection and field sterility," "operating room versus clinical setting," "operating rooms economics and hand surgery," and "main operating room versus ambulatory." RESULTS The literature search yielded 827 articles. Following evaluation of titles, abstracts, and manuscript contents, 23 articles were ultimately included, of which 10 discussed field sterility and cost-efficiency for cutaneous procedures, 9 hand surgery, and 4 oral surgery. There was no study evaluating field sterility application in cleft surgery. In the reviewed studies, no statistical significance was observed in surgical site infection (SSI) with substantial cost savings and medical waste reduction when hand procedures were performed in ambulatory settings with field sterility compared to the main operating room (OR). Furthermore, no difference was observed for SSI in wound closure, excision of skin lesions, or Mohs micrographic surgery when nonsterile gloves were used. CONCLUSION The incidence of infection following most cleft-related procedures remains low. As such, the application of field sterility may be ideal for this setting. The cost and waste associated with standard operating protocols are not warranted for many cleft procedures.
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Affiliation(s)
- Peter J Taub
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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Malik OA, Khan AS. Do we use antibiotics judiciously enough? A study in Accident & Emergency Department of tertiary care hospital in Pakistan. Pak J Med Sci 2018; 34:1498-1501. [PMID: 30559811 PMCID: PMC6290189 DOI: 10.12669/pjms.346.15542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine whether antibiotics are necessary for all minor wounds presenting to the Accident and Emergency Department at a tertiary care Centre in Pakistan. Methods: One hundred and five patients presenting to the Accident & Emergency Department, Jinnah Postgraduate Medical Centre, Karachi, with open wounds were included in the study and divided into two: Groups A (study) and B (control), with Group-A receiving conservative therapy. Eighty-four patients were included in the final analysis as the rest were lost to follow up. Follow up was done after one week to see how many patients had developed infection. Results: The average age of patients was 27.3 +/-9.7 years with similar baseline characteristics. From these, 51% had superficial wounds; average number of wounds was 1.63 +/-0.99, with an average length of 2.7 +/-1.6 cm. A total of 10 out of 84 patients developed infection at 7-10 days after presentation to the A&E. From these, 3 patients receiving conservative treatment (A, 10%, OR=0.107), and seven patients receiving prophylactic antibiotics (B, 12.96%, OR=0.149) developed an infection. Calculated odds ratio for increased risk of infection in Group-A = 0.72. Conclusion: A conservative approach to antibiotic prescription for minor trauma may be appropriate despite absence of strict asepsis during emergency wound care.
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Affiliation(s)
- Omar Abbas Malik
- Omar Abbas Ahmed Malik, Student, MBBS, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Asim Saeed Khan
- Asim Saeed Khan, MBBS (SMC), House Officer (2015-16 during the period of the study), Jinnah Post Graduate Medical Centre, Karachi, Pakistan
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Ghafouri HB, Zoofaghari SJ, Kasnavieh MH, Ramim T, Modirian E. A Pilot Study on the Repair of Contaminated Traumatic Wounds in the Emergency Department Using Sterile versus Non-Sterile Gloves. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791402100303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Although the use of sterile gloves for minor and major surgical repairs is the current standard of care, use of non-sterile and clean gloves has been shown to be safe in certain procedures. In this study, we compared the infection rates of contaminated lacerations repaired with sterile versus non-sterile gloves. Materials and methods A prospective, randomised, two-centre pilot trial included patients that attended the emergency department with any type of visible contaminated soft tissue lacerations. The patients were selected according to convenience sampling technique and divided into two groups using random number table. Age, sex, and characteristics of the wound were assessed by a physician. According to that, the physician used sterile gloves or non-sterile, clean gloves for wound repair. Clinical data were analysed by chi-square test and paired-t test where appropriate. A p value =/< 0.05 was considered as statistically significant. Results Two hundred and twenty two recruited subjects with visible contaminated simple wounds were randomised to 2 groups. Males constituted 89.2% of the patients. The sites of lacerations were extremities in 50.5% of patients, head or neck in 48.4% of patients, and trunk in 1.1% of patients. Overall infection rate was 3.2%. The infection rates in the sterile gloves group and the clean gloves group were 2.02% and 4.6%, respectively (relative risk=2; odds ratio=2.3). Incidence of infection was not significantly different between two groups (p=0.322). Conclusion It seems that uses of clean gloves rather than sterile gloves do not increase the risk of infection in the repair of contaminated simple wounds in emergency department setting. (Hong Kong j. emerg.med. 2014;21:148-152)
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Affiliation(s)
- HB Ghafouri
- 7-tir Hospital, Emergency Medicine Department, Iran University of Medical Sciences, Tehran, Iran
| | - SJ Zoofaghari
- Hazrat Rasoul Akram Hospital, Emergency Medicine Department, Iran University of Medical Sciences, Tehran, Iran
| | - MH Kasnavieh
- 7-tir Hospital, Emergency Medicine Department, Iran University of Medical Sciences, Tehran, Iran
| | - T Ramim
- Tehran University of Medical Sciences, Sina Trauma and Surgery Research Centre, Tehran, Iran
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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. Ann Emerg Med 2004; 43:362-70. [PMID: 14985664 DOI: 10.1016/j.annemergmed.2003.09.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE Although sterile technique for laceration management continues to be recommended, studies supporting this practice are lacking. Using clean nonsterile gloves rather than individually packaged sterile gloves for uncomplicated wound repair in the emergency department may result in cost and time savings. This study is designed to determine whether the rate of infection after repair of uncomplicated lacerations in immunocompetent patients is comparable using clean nonsterile gloves versus sterile gloves. METHODS A prospective multicenter trial enrolled 816 individuals who were randomized to have their wounds repaired by using sterile or clean nonsterile gloves. The attending physician or resident completed a checklist describing patient, wound, and management characteristics. The patients were provided with a questionnaire to be completed by the physician who removed their sutures at the prescribed time and indicated the presence or absence of infection. When follow-up forms were not returned, a telephone call was made to the patient to determine whether he or she had experienced any wound complications. RESULTS Follow-up was obtained for 98% of the sterile gloves group and 96.6% of the clean gloves group. There was no statistically significant difference in the incidence of infection between the 2 groups. The infection rate in the sterile gloves group was 6.1% (95% confidence interval [CI] 3.8% to 8.4%) and was 4.4% in the clean gloves group (95% CI 2.4% to 6.4%). The relative risk of infection was 1.37 (95% CI 0.75 to 2.52). CONCLUSION This study demonstrated that there is no clinically important difference in infection rates between using clean nonsterile gloves and sterile gloves during the repair of uncomplicated traumatic lacerations.
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Affiliation(s)
- Vsevolod S Perelman
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
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Abstract
This study was designed to compare the infection rates of simple lacerations irrigated with tap water versus sterile normal saline before repair. Patients with simple lacerations to an extremity that were less than 8 hours from injury were prospectively enrolled. Exclusions from the study were: dog bites, hand lacerations, immunocompromised patients, and those on antibiotics at the time of injury. Patients who qualified were randomized to receive tap water or normal saline for wound irrigation. Before and after irrigation, wound cultures were obtained. After the procedure was complete, patients were scheduled for a 48 hour follow-up wound check. A total of 46 patients were enrolled in the study. Twenty-four patients were randomized to the normal saline group and 21 were assigned to receive tap water irrigation. There were 2 infected lacerations in both the tap water and normal saline groups. The organisms cultured from the wounds in both groups were similar and there was no difference in colony counts when tap water was used. The use of tap water for the irrigation of lacerations does not result in the growth of unusual organisms or increase the colony counts of organisms. Wound infection rates were the same in both groups. This pilot study suggests that the use of tap water for irrigation of wounds may be safe. Further validation is necessary.
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Are sterile conditions essential for all forms of cutaneous surgery? The case of ritual neonatal circumcision. J Cutan Med Surg 2000; 4:177-80. [PMID: 11231194 DOI: 10.1177/120347540000400401] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/1999] [Accepted: 03/02/2000] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many aspects of cutaneous surgical interventions have been perfected, employed, and then scientifically examined. Conversely, ubiquitous, indiscriminate demand for sterile conditions while performing an invasive procedure remains a field devoid of satisfactory critical appraisal. OBJECTIVE Ritual neonatal circumcision served as a prototype to assess scientifically the safety of performing a dermatologic intervention under clean, uncontaminated, but nonsterile conditions. METHODS Two hundred subjects, mostly neonates, who were unselectively referred for ritual circumcision, served as the study group. The guillotine excisional technique was employed in the community setting under clean, uncontaminated, nonsterile conditions, in line with traditional practice. Follow-up was continued until full recovery. RESULTS No wound infections or septic complications were observed in any of the babies at either early (24-36 hours after the procedure) or late follow-up. Many subjects had an exudative discharge at the healing site several days after the procedure. This is a common finding associated with circumcision and was found to be nonindicative of infection. CONCLUSIONS This preliminary study suggests that strict sterile conditions are superfluous for ritual neonatal circumcision, and the effort and expense invested in maintaining an aseptic environment for this sort of intervention may not be justified. Further large-scale investigations are warranted to validate these findings and to determine if they can be extrapolated to other patient populations and other types of cutaneous surgery.
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Abstract
In 1996, almost 11 million lacerations were treated in emergency departments throughout the United States. Although most lacerations heal without sequelae regardless of management, mismanagement may result in wound infections, prolonged convalescence, unsightly and dysfunctional scars, and, rarely, mortality. The goals of wound management are simple: avoid infection and achieve a functional and aesthetically pleasing scar. Recent US Food and Drug Administration approval of tissue adhesives has significantly expanded clinicians' wound closure options and improved patient care. We review the general principles of wound care and expand on the use of tissue adhesives for laceration repair.
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Affiliation(s)
- J E Hollander
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, USA.
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Kanegaye JT. A rational approach to the outpatient management of lacerations in pediatric patients. CURRENT PROBLEMS IN PEDIATRICS 1998; 28:205-34. [PMID: 9740986 DOI: 10.1016/s0045-9380(98)80048-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Lacerations are a frequent reason for pediatric health care visits. Many are referred to EDs or to surgical specialists but may be treated by the pediatrician who has the time and interest in maintaining wound care skills. Although skin closure is often viewed as the primary event in wound care, local anesthesia and wound toilet are equally important aspects in which expertise is often undervalued. On occasion, patient anxiety and resistance complicates wound care, and a variety of sedative techniques facilitates completion of procedures that otherwise would require general anesthesia. Adherence to basic principles and the occasional use of innovations in wound care enable the clinician to bring about optimal outcomes.
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Affiliation(s)
- J T Kanegaye
- Division of Emergency Medicine, Children's Hospital and Health Center, San Diego, California, USA
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Affiliation(s)
- A J Singer
- Department of Emergency Medicine, State University of New York, Stony Brook 11794-8350, USA
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Abstract
We prospectively studied the management and outcome of 2,834 children, aged 1 month to 18 years, who presented to the emergency department of the Children's Hospital of Philadelphia for laceration repair. Patients with bite wounds were excluded from the study. Eight percent (239) of all patients had complications on initial evaluation; the most common was the presence of a foreign body (55). Infection on presentation was diagnosed in 22 cases (0.8%). All of these patients had delayed their initial care beyond 18 hours (range, 18 to 288 hours; mean, 18 hours). Other factors significantly associated with infection on presentation included occurrence of the injury outdoors (16; P less than .001), injury due to broken "street" glass (seven; P less than .02), and injury of an extremity (18; P less than .01). The rate of prerepair infection was not influenced by the size of the wound. Infections developed subsequent to initial repair in 34 cases (1.2%). Factors associated with development of subsequent infection included use of prophylactic antibiotics, use of subcutaneous sutures, laceration length of more than 5.0 cm, glass or ice as a causative agent, and upper- or lower-extremity involvement. The majority of injuries were repaired by ED personnel without surgical consultation. Postrepair infection rates were not influenced by the specialty of the physician managing the case. Although our study was not designed to specifically test the issue, prophylactic antibiotics were of no proven benefit in reducing infection rates in any group of patients analyzed.
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Affiliation(s)
- M D Baker
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia
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Abstract
In a study to investigate the incidence and significance of surgical glove perforation, bacterial contamination of surgeons' hands and gloves before and after operation was measured and the gloves tested for damage. Perforations were found in 74 of 582 gloves (12.7 per cent) and occurred in 34.5 per cent of operations. Glove perforation did not influence bacterial counts on the surgeons' hands or on the outside of their gloves. A separate clinical study of 100 adult hernia repairs gave no evidence that perforation increased wound sepsis. After standard pre-operative hand preparation, glove perforations are of no clinical significance to the patient, but their high incidence should alert surgeons to the need for protection against pathogens transmissible during surgery, such as hepatitis B and the human immunodeficiency virus. Protection of the surgeon is the main indication for preoperative change of damaged gloves.
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Affiliation(s)
- R D Dodds
- Department of Surgery, St. Peter's Hospital, Chertsey, Surrey
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Spirer Z, Hauser GJ. Gloves for lumbar puncture in children? Lancet 1982; 2:1221. [PMID: 6128528 DOI: 10.1016/s0140-6736(82)91240-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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