Written by Nickolas Srica
This trial suggests that there is unlikely to be a large difference in wound infection rates between non-sterile gloves and dressings and sterile gloves, dressings, and drapes for suturing of traumatic wounds in the ED.
Why does this matter?
Traumatic wounds requiring closure are a frequent reason patients present to the ED. These wounds occur out in the non-sterile world with non-sterile objects, and non-sterile treatment of these injuries could potentially save time, resources, and costs, particularly in resource limited areas. Is a non-sterile suturing method non-inferior to a sterile method regarding infection rates?
If the gloves aren’t clean, you mustn’t intervene?
This was a multicenter, single-blinded, randomized controlled trial which took place at three hospitals in The Netherlands assessing for non-inferiority of non-sterile gloves and dressings in comparison to sterile materials. All included patients were randomized into one of these two groups, and all patients regardless of study group underwent removal of large contamination and thorough rinsing of their wounds. They also agreed to return to the ED for wound inspection and suture removal and were educated on wound care and signs of infection.
Follow-up information was able to be obtained for 91% of the 1,480 participants, with 93% returning to the ED for follow up and 7% being followed up by telephone. The wound infection rate in the sterile group was 6.8% (95%CI 4.0%-7.5%) versus 5.7% in the non-sterile group (95%CI 5.1%-8.8%), which met non-inferiority criteria.
It is worth noting that the study was discontinued early due to a decline in patient inclusions, so the trial was ultimately statistically underpowered. However, this study further supports other recent trials showing there probably is no major difference between sterile and non-sterile gloves and drapes for traumatic wound closure, but further investigation is needed to more definitively state this. For now, I will personally elect to err on the side of sterile materials to provide some reassurance to my patients, if nothing else, though either method is likely acceptable.
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. Emerg Med J. 2022 Jul 26;emermed-2021-211540. doi: 10.1136/emermed-2021-211540. Online ahead of print.