Infection Rates of Wound Repairs During Mohs Micrographic Surgery Using Sterile Versus Nonsterile Gloves: A Prospective Randomized Pilot Study

Abstract

BACKGROUND Mohs micrographic surgery (MMS) is a multistep outpatient procedure that has become the treatment of choice for the removal of many cutaneous malignancies. The surgeon initially removes the tumor with nonsterile gloves in MMS. Sterile or nonsterile gloves are then used during the final repairs.OBJECTIVE This prospective patient-blinded single-institution pilot study was performed to evaluate whether there is a difference in infection rate when using clean, nonsterile gloves versus sterile gloves during tumor removal and the wound repair phases of MMS.MATERIALS AND METHODS This study randomized 60 patients undergoing MMS. Data on age, sex, anatomic location, number of Mohs stages, closure type, size of final defect, operative time, number of pairs of gloves used, and type of glove used were recorded and evaluated.RESULTS Three infections were identified. Two infections occurred in the sterile glove arm and one in the clean glove arm. Overall, there was no greater infection rate when using clean, nonsterile gloves than sterile gloves (p = .99).CONCLUSIONS Our study supports the use of clean, nonsterile gloves as a safe alternative to sterile gloves during all steps of MMS, at a significant cost savings. A larger confirmatory study comparing the equivalence in infection rates between clean and sterile gloves is warranted.The authors have indicated no significant interest with commercial supporters.

Endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injection: a comprehensive review

“…Wound infection rates have been shown to be no higher with the use of non-sterile compared with sterile gloves when suturing the skin [59, 60] However, sterile gloves are recommended for the insertion of central venous catheters and spinal anesthesia procedures [51, 61, 62]. Like the CSF, the vitreous is an immune-privileged site and a small inoculum of low virulence bacteria may be sufficient to cause endophthalmitis.…”

Patient safety in dermatologic surgery

“…20 Recent evidence also reveals that infection rates are unaffected by the use of nonsterile compared to sterile gloves during MMS and reconstruction, reinforcing the safety of outpatient dermatologic surgery. [21][22][23] Because electrosurgery is an integral component of dermatologic surgery, it is also important to consider the safety of these methods on an outpatient basis. The primary concern with respect to electrosurgery is its potential interference with implantable electrical devices, namely cardiac pacemakers and defibrillators (ICDs).…”

Comparing non‐sterile to sterile gloves for minor surgery: a prospective randomised controlled non‐inferiority trial

“…A comprehensive Medline search found few studies relating to the use of sterile versus non‐sterile gloves (). Randomised trials looking at lacerations in an emergency department, 7 wisdom tooth extraction in an outpatient setting 8 and Mohs micrographic surgery 9 all showed no significant difference between infection rates. However, these studies looked for superiority of the sterile gloves rather than non‐inferiority of the non‐sterile gloves, resulting in negative trials, and the latter two studies were statistically underpowered.…”