From the Guidelines
Sterile gloves are recommended for laceration repair in the Emergency Department. When performing laceration repair, maintaining a sterile field is essential to prevent wound infection, which is a significant complication that can delay healing and lead to worse outcomes, ultimately affecting morbidity, mortality, and quality of life 1. While non-sterile exam gloves are appropriate for initial wound assessment and cleaning, they should be exchanged for sterile gloves before beginning the actual repair procedure. The sterile environment helps reduce the introduction of pathogens into the wound during suturing or stapling.
Some key points to consider when choosing between sterile and exam gloves for laceration repair include:
- The risk of infection and its potential to delay healing and lead to worse outcomes
- The importance of maintaining a sterile field during the repair procedure
- The need to exchange non-sterile exam gloves for sterile gloves before beginning the repair
- The additional cost and time required for sterile gloves is justified by the reduced risk of infection and potential complications, as supported by guidelines for infection control in healthcare settings 1.
It is also important to note that gloves should be worn as single-use items, put on immediately before patient contact, and removed as soon as the activity is completed, with hands washed or decontaminated following glove removal 1. Emergency departments should maintain readily available supplies of sterile gloves in various sizes to ensure proper fit for all providers performing laceration repairs.
From the Research
Sterile vs Exam Gloves for Laceration Repair in ED
- The use of sterile gloves versus exam gloves for laceration repair in the Emergency Department (ED) has been studied in several trials 2, 3, 4.
- A randomized controlled trial published in 2004 found no statistically significant difference in the incidence of infection between the use of sterile gloves and clean nonsterile gloves for uncomplicated lacerations 2.
- A non-inferiority multicentre randomised controlled trial published in 2022 also found no significant difference in wound infection rates between non-sterile gloves and dressings versus sterile gloves, dressings, and drapes for suturing traumatic wounds in the ED 3.
- A systematic review and meta-analysis published in 2023 found no evidence of additional protection against wound infections with the use of sterile gloves for wound repair in the ED compared to clean gloves 4.
Key Findings
- The infection rate in the sterile gloves group was 6.1% (95% CI 3.8% to 8.4%) and was 4.4% in the clean gloves group (95% CI 2.4% to 6.4%) in the 2004 study 2.
- 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 in the 2022 study 3.
- The overall RR was 0.86 (95% CI,0.67-1.10, I2=3.6%) in the 2023 systematic review and meta-analysis 4.
Contrasting Evidence
- A study published in 1986 found increased late purulent infection in sutured hand wounds treated without gloves, recommending the use of sterile gloves for all wound suturing in A&E departments 5.
- However, this study's findings are not consistent with more recent evidence, which suggests that the use of clean nonsterile gloves may be a viable alternative to sterile gloves for laceration repair in the ED 2, 3, 4.
Glove Integrity and Infection Risk
- A study published in 2021 investigated damages to sterile latex gloves in general surgery and found that 18.8% of interventions showed glove damage, highlighting the potential risk of infection with single gloving 6.