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Original Investigation |

Comparison of Sterile vs Nonsterile Gloves in Cutaneous Surgery and Common Outpatient Dental Procedures A Systematic Review and Meta-analysis

Jerry D. Brewer, MD1; Alexandra B. Gonzalez, MD2; Christian L. Baum, MD1; Christopher J. Arpey, MD1; Randall K. Roenigk, MD1; Clark C. Otley, MD1; Patricia J. Erwin, MLS3
[+] Author Affiliations
1Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota
2Center for Clinical and Translational Science, Mayo Graduate School, Rochester, Minnesota
3Mayo Medical Library, Mayo Clinic, Rochester, Minnesota
JAMA Dermatol. 2016;152(9):1008-1014. doi:10.1001/jamadermatol.2016.1965.
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Importance  Whether the use of sterile vs nonsterile gloves in outpatient cutaneous procedures affects the rate of postoperative wound infection is unknown.

Objective  To explore rates of surgical site infection (SSI) with the use of sterile vs nonsterile gloves in outpatient cutaneous surgical procedures.

Data Sources  This systematic review and meta-analysis identified studies from Ovid MEDLINE (1946 to present), Ovid Cochrane Central Register of Controlled Trials (1991 to present), Ovid EMBASE (1988 to present), EBSCO Cumulative Index to Nursing and Allied Health Literature (1980 to present), Scopus (1996 to present), and Web of Science (1975 to present).

Study Selection  Studies with information on sterile vs nonsterile gloves in outpatient surgical procedures were retrieved. Only randomized clinical trials and comparative studies were included for final analysis.

Data Extraction  Data of trial design, surgery characteristics, and outcomes from published manuscripts and unpublished data were independently extracted.

Main Outcomes and Measures  Randomized clinical trials were considered high quality if randomization, allocation concealment, blinding, and follow-up completeness were appropriate. Relative risk and 95% CIs were derived for postoperative wound infections.

Results  Fourteen articles met eligibility and inclusion criteria for systematic review; they included 12 275 unique patients who had undergone 12 275 unique outpatient procedures with sterile or nonsterile gloves and had follow-up regarding SSI. With the exclusion of 1 single-arm observational study of 1204 patients, 11 071 patients from 13 studies remained in the meta-analysis. Of these, 228 patients were documented as having postoperative SSI (2.1%), including 107 of 5031 patients in the nonsterile glove group (2.1%) and 121 of 6040 patients in the sterile glove group (2.0%). Overall relative risk for SSI with nonsterile glove use was 1.06 (95% CI, 0.81-1.39).

Conclusions and Relevance  No difference was found in the rate of postoperative SSI between outpatient surgical procedures performed with sterile vs nonsterile gloves.

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Figure 1.
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The prospective single-arm observational study included in the systematic review was excluded from the meta-analysis.

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Figure 2.
Meta-analysis

Meta-analysis includes findings of studies of surgical site infections with sterile vs nonsterile gloves after outpatient procedures. RR indicates relative risk. The size of the diamond represents the 95% CI of the overall assessment. If the diamond is wide, there is less confidence that it is accurate; however, if the diamond is narrow and small, then there is a higher confidence that the final analysis is accurately representing the truth.

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