So, it’s time to glove up for your laceration repair. What gloves do you choose?
I’ve mentioned it here before in one of my earliest posts on wound preparation: at least one ED-based study on laceration repair showed that for selected lacerations, the use of clean (but non-sterile) gloves seems reasonable.
More recently, a 2016 meta-analysis from JAMA Dermatology called the practice of sterile gloves across a variety of medical and dental procedures in to question. This meta-analysis included 14 discrete studies and 12,275 patients and gave us the same conclusion: no difference in rates of infection were found whether sterile or non-sterile gloves were used.
In a subgroup analysis, this proved true with respect to dental procedures, dermatological procedures, and other cutaneous procedures.
This meta-analysis isn’t specific to the emergency medicine literature, but in my opinion blows the roof off of any previous perception that absolute sterility should be maintained for soft tissue procedures in the ED (laceration or abscess, on any part of the body). Think about it: some of the procedures considered in this meta-analysis have traditionally been held to even stricter sterile policies than anything we do.
What I do
With all this said, I still feel a pair of size 7 sterile gloves fits me, well…like a glove. And so I stick to these in procedures where I feel dexterity is paramount (such as, detailed laceration repair around the eye where I might employ an inverting horizontal mattress suture).
What I don’t do is get uppity about it if my hand brushes something off of the sterile field, or if I need to open a new suture mid-way through and “break” my field. For non-precision procedures, like placing the incision in a large abscess, I forget the sterile gloves. Medium nitrile all the way.
This is part of the evidence-based wound preparation series. Previously covered topics include: anesthetic delivery, injectable anesthetics, and topical anesthetics. To follow: what type of antiseptic agent is best prior to initiating laceration repair?