Are sterile gloves necessary when repairing lacerations in the emergency department?

From First10EM:

One of the first times I was really introduced to ‘dogma busting’ was when I was told early in residency that sterile gloves were absolutely not needed when repairing lacerations in the emergency department, and there were RCTs to prove it. I have lived by that anti-dogma dogma since, and so I expected this to be a very easy topic to review, with very solid research. 

I imagine that the reason I heard about this evidence so often in residency was that the largest emergency department study was published in Toronto, and the authors are now my friends and colleagues. (Perelman 2004) It was a multicentre RCT including emergency department patients over the age of 1 with uncomplicated lacerations. Patients at high risk for infection were excluded (diabetes, renal failure, immunosuppression, asplenia, cirrhosis). 816 patients were randomly assigned to have their physician wear sterile or just clean gloves. The primary outcome (wound infection) was assessed on a questionnaire provided to the patient to be filled out by their family doctor at the time of suture removal. If this wasn’t received they called the patient. Unsurprisingly, they received less than half of the questionnaires, but based on phone calls, they managed to reach 97% of all patients for follow-up. Infection occurred in 6.1% of the sterile glove group and 4.4% of the clean glove group, a nonsignificant difference (RR 1.37, 95% CI 0.75-2.25, p=0.3). For a study of emergency medicine wound repair, this is a big trial, but it cannot exclude small differences between the groups. (I am reassured that the sterile glove group actually had higher infection rates, as it makes it less likely that there is a real difference, and the trial is simply under-pwoered.) Out of approximately 9,000 eligible patients, they approached 1,110, and included 816, so selection bias is a big concern. They report that to do an equivalency trial, they would have needed 3,000 patients per group.

That is a good study, but there are obviously some weaknesses, such as the heavy reliance on telephone follow-up. More importantly, it is only a single study, and we all know that science requires replication. Given the certainty with which this fact was taught to me, I honestly expected more high quality data. 

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