The use of non-sterile gloves during minor surgery is normal care in general practice. The Dutch College of General Practitioners has issued a guideline for infection prevention based on the regulation of the Dutch Working Party on Infection Prevention.1 Under the section ‘Minor surgery’ it is stated: ‘When a wound is closed with a suture, one has to work under sterile conditions. This means: sterile gloves, sterile working area and sterile material.’ There is no evidence in the guideline to support this recommendation.
A retrospective study of the records of patients undergoing minor surgical procedures was performed. Records were searched for surgical site infection (SSI). SSI is defined according to the guideline for the prevention of SSI.2
All surgical procedures were performed in an examination room in a general practice. After washing the hands with a disinfecting soap the gloves were put on. The skin was disinfected. A sterile dressing, steam-heated sterilised instruments and pre-packaged sterilised gauzes were used. The wound was closed using nylon or resolvable sutures which were removed after 7–14 days.
One hundred and sixty-eight minor surgical procedures were performed on 133 patients. Sutures were used in 131 procedures. Five procedures were excluded from this analysis because sterile gloves were used. In the remaining 126 procedures there were four complications of which three (2.4%) were a SSI. None of these patients had diabetes or used anticoagulant or antiplatelet medication. In the group in whom no sutures were used there were no complications.
Cultures on blood agar plates were taken of clean examination gloves after opening a new box and 1 week later. They showed no bacterial growth. It might be concluded that bacterial contamination of the gloves occurs after they are put on. This corresponds with earlier findings.3
Randomised controlled trial's on this subject are scarce because of ethical constraints.4 One study showed that the risk for wound infection in dermatological surgery after using clean gloves is not significantly greater than after using sterile gloves; that is, 1.7% versus 1.6%.5 This corresponds with our results showing that the use of clean gloves has a low incidence of SSI.
Despite the retrospective nature of our study, our results question the recommended routine use of sterile gloves for minor surgery in general practice but further research is needed. Based on earlier reports and the results of our study, the ethical considerations preventing a randomised controlled trial might be overcome.
REFERENCES
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