Minor surgery in general practice: are sterilised gloves necessary?

Bruens, Marco; Berg, Pieter J van den; Keijman, Jeroen

doi:10.3399/bjgp08x279797

Cited by 4 publications

(6 citation statements)

References 5 publications

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“…One reason could be that there is no consensus in the literature on the definition of wound infection. The boundaries between normal wound healing, inflammation and actual infection seem hard to discern and various criteria are used throughout the literature to define wound infection 1–17. Although almost all study patients (93%) were followed up in the treating ED, interclinician variety in wound judgement could have contributed to the higher overall incidence of infection in this study.…”

Section: Discussionmentioning

confidence: 96%

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

et al. 2022

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BackgroundPatients with traumatic wounds frequently present to the ED. Literature on whether to treat these wounds sterile or non-sterile is sparse. Non-sterile treatment has the advantage of saving resources and costs, and could be of value in health settings where sterile materials are not readily available. Our objective was to compare the rate of wound infection after suturing traumatic lacerations with non-sterile gloves and dressings versus sterile gloves, dressings and drapes in the ED. We hypothesised that non-sterile gloves and dressings would be non-inferior to sterile gloves, dressings and drapes. The non-inferiority margin was set at 2%.MethodsA multicentre single-blinded randomised controlled trial testing for non-inferiority of non-sterile gloves and dressings versus sterile gloves, dressings and drapes for suturing of traumatic wounds was performed in 3 EDs in The Netherlands. Adults with uncomplicated wounds were included from July 2012 to December 2016. At the time of treatment, patient and wound characteristics and management were documented. The outcome was wound infection, which was identified during follow-up in the treating ED at 5–14 days postprocedure.ResultsFrom 2468 eligible patients, 1480 were randomised in a sterile (n=747) or non-sterile (n=733) protocol. Baseline characteristics were similar in both study arms. The observed wound infection rate in the non-sterile group was 5.7% (95% CI 4.0% to 7.5%) vs 6.8% (95% CI 5.1% to 8.8%) in the sterile group. The mean difference of the wound infection rate of the two groups was −1.1% (95% CI −3.7% to 1.5%).ConclusionAlthough recruitment ceased prior to reaching our planned sample size, the findings suggest that there is unlikely to be a large difference between the non-sterile gloves and dressings for suturing of traumatic wounds and sterile gloves, dressings and drapes for suturing of traumatic wounds in the ED.Trial registration numberNL 34798.078.11, NTR3541.

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Section: Discussionmentioning

confidence: 96%

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

et al. 2022

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“…Six doctors recruited between one and 100 patients. The GPs and practice were purposively selected as they had previously successfully participated in wound management projects 12 , 15 . Consecutive patients presenting for minor skin excisions were invited to take part in the trial.…”

Section: Methodsmentioning

confidence: 99%

“…The GPs and practice were purposively selected as they had previously successfully participated in wound management projects. 12,15 Consecutive patients presenting for minor skin excisions were invited to take part in the trial. Practice nurses were responsible for recruiting patients and collecting data.…”

Section: Setting and Participantsmentioning

confidence: 99%

“…11 The only study conducted in a general practice setting was an audit of 126 patients where non-sterile gloves had been used for minor surgery, which showed an infection rate of 2.4%. 12 Prior studies of wound infection after minor surgery involving GPs in Mackay, Queensland, showed overall incidences of wound infection of 8.6% and 8.9%. [13][14][15][16] This incidence was higher than expected based on published results of a similar Australian general practice cohort (1.9%), 17 a skin cancer clinic cohort (1.5%) 18 and a European dermatology clinic cohort (2%).…”

mentioning

confidence: 99%

“…Another observational study of Mohs surgery showed no statistical difference in infection rates 11 . The only study conducted in a general practice setting was an audit of 126 patients where non‐sterile gloves had been used for minor surgery, which showed an infection rate of 2.4% 12 …”

mentioning

confidence: 99%

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