Uso de guantes no esteriles noafecta riesgo de infección, durante Cirugia de Mohs

TAKE-HOME MESSAGE

• This systematic review and meta-analysis evaluated post–Mohs micrographic surgery (MMS) local infection rates associated with the use of sterile versus non-sterile gloves during the surgery. The analysis included data from 10,644 MMS across four studies. The results showed no significant difference in postoperative surgical site infection rates between the groups using sterile and non-sterile gloves during MMS. Based on two studies, the rates of postoperative surgical site infection during the reconstruction phase were comparable between the two groups. Notably, primary closure was associated with the highest surgical-site infection rate in both groups.
• This study showed that using non-sterile gloves is as effective as using sterile gloves for preventing infections in patients undergoing MMS.

–  Lillian Sun, MD

Désirée Ratner MD

There has been an ongoing debate regarding the use of sterile versus non-sterile gloves during Mohs micrographic surgery (MMS) — specifically whether using non-sterile gloves leads to increased rates of postoperative surgical-site infection. This updated systematic review and meta-analysis evaluated data from studies published up to August 2023 that assessed the use of sterile versus non-sterile gloves during MMS and reported postoperative wound infection rates. The surgical-site infection rates did not significantly differ between the two groups, with similar results noted in the excision and repair group subanalyses. These results support the effectiveness of non-sterile gloves in preventing surgical-site infection in patients undergoing MMS and providing significant cost savings without compromising outcomes. In an era of increasing overhead costs, this comes as welcome news.

Abstract

BACKGROUND

Mohs micrographic surgery (MMS) is a well-established technique for the removal of various types of skin cancers. While sterile gloves (SG) are commonly used in skin surgeries such as MMS, additional understanding of their effectiveness compared to nonsterile gloves (NSG) in preventing local infection is required.

OBJECTIVE

We aimed to perform an updated systematic review and meta-analysis comparing the use of SG with NSG for local infection rate post-MMS and point out cost discrepancies between these 2 scenarios.

METHODS

We searched MEDLINE, Embase, and Cochrane for studies published up to August 2023 comparing the use of SG with NSG during MMS that reported the outcome of wound infection.

RESULTS

A total of 4 studies with 10,644 MMS were included, of which 7512 (70.6%) were performed with SG and 3132 (29.4%) were done with NSG. In the SG group, 232 out of 7512 cases (3.1%) developed infection compared to 64 out of 3132 (2.0%) in the NSG group [odds ratio (OR) 1.14; 95% confidence interval (CI) 0.85-1.52; P = .39; I2 = 0%]. Therefore, the post-MMS infection rates were not significantly different between SG and NSG groups, including in the excision (OR 0.92; 95% CI 0.48-1.79; P = .81; I2 = 0%) and reconstruction (OR 1.17; 95% CI 0.85-1.60; P = .34; I2 = 0%) subanalysis. Regarding the mean cost of the gloves, the NSG pair was $0.24, approximately 10% of the price of the SG pair ($2.27).

CONCLUSION

The results support that, compared to SG, NSG are equally effective in preventing infections during MMS while offering significant cost savings without compromising patient outcomes.Protocol registration: PROSPERO, CRD42023458525.

Journal of Cutaneous Medicine and Surgery

Comparison of Infection Rate Between Sterile and Nonsterile Gloves During Mohs Micrographic Surgery: An Updated Systematic Review and Meta-Analysis

J Cutan Med Surg 2024 Sep 10;[EPub Ahead of Print], R Sarto, LF Pereira, Y Mesquita, RC Chater, I Lapenda, L Moury, R Moraes-Souza

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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