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What Should We Use? Recommendations on Appropriate Gloves for Dermatologic Surgery
¿Qué tipo de guantes debemos utilizar en la cirugía dermatológica? Recomendaciones sobre los guantes a emplear
X. Bosch-Amate, D. Morgado-Carrasco, J. Riera-Monroig, J. Ferrando
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Servicio de Dermatología, Hospital Clínic de Barcelona, Barcelona, España
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Recommendations on Appropriate Gloves for Dermatologic Surgery" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "160" "paginaFinal" => "161" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "X. Bosch-Amate, D. Morgado-Carrasco, J. Riera-Monroig, J. Ferrando" "autores" => array:4 [ 0 => array:2 [ "nombre" => "X." "apellidos" => "Bosch-Amate" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Morgado-Carrasco" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Riera-Monroig" ] 3 => array:4 [ "nombre" => "J." "apellidos" => "Ferrando" "email" => array:1 [ 0 => "juanferrandobarbera@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Clínic de Barcelona, Barcelona, España" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Qué tipo de guantes debemos utilizar en la cirugía dermatológica? Recomendaciones sobre los guantes a emplear" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The frequency of surgical site infection (SSI) in dermatologic surgery ranges from 1% to 2.4%.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> This complication can entail considerable morbidity and must therefore be prevented using cost-effective measures. Since their introduction by William Stewart in 1890, surgical gloves have been used continuously with aim of preventing infections and protecting both patients and health professionals. In recent decades, the use of sterile gloves has become standard practice in the prevention of SSI in dermatologic surgery, despite their greater cost and the lack of evidence on their superiority over nonsterile gloves.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In 2016, Brewer et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> published the results of the first meta-analysis comparing the frequency of SSI with sterile and nonsterile gloves in dermatologic surgery. The procedures covered were Mohs micrographic surgery, repair of lacerations, standard excisions, and tooth extractions. The analysis included 13 studies with 11071 patients, of whom 2741 had participated in randomized clinical trials with sterile gloves (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1360) or nonsterile glove (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1381) and 8330 were from observational studies with sterile gloves (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4680) or nonsterile gloves (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3650). SSI was detected in 2.1% (107/5031) of individuals operated on by surgeons using nonsterile gloves compared with 2.0% (121/6040) whose surgeon wore sterile gloves. Therefore, no significant differences were observed between both types of glove (RR, 1.06; 95% CI, 0.81-1.39).</p><p id="par0015" class="elsevierStylePara elsevierViewall">A specific analysis of patients who underwent Mohs micrographic surgery (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4899) revealed similar results (RR, 1.15; 95% CI, 0.68-1.97). Sterile gloves were used in 2139 patients and nonsterile gloves in 2760. SSI was detected in 23 cases (1.07%) and 35 cases (1.27%), respectively, with no significant differences between the groups (RR, 1.15; 95% CI, 0.68-1.97). The meta-analysis excluded a prospective study of Mohs micrographic surgery (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1204) with nonsterile gloves because there was no control group. In the study, 11 cases of SSI (0.9%) were reported. When these patients were included in the total cohort of the meta-analysis, the frequency of SSI with nonsterile gloves fell to only 1.9% (vs 2.0% with sterile gloves).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Since January 2017, the United States Food and Drug Administration (FDA) has banned the use of powdered gloves of any type, whether sterile or not. This is the second time in history that the FDA has prohibited the use of a medical device. Their decision was based on the numerous adverse reactions caused by the gloves, namely, allergic and/or inflammatory respiratory conditions, inflammation of the surgical site, formation of foreign body granulomas, and postsurgical adhesions.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Prevention of these adverse effects would save approximately $30 million per year in the USA.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> As an alternative, powder-free nitrile or neoprene gloves provide a similar level of protection as powdered gloves with an acceptable degree of comfort.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Cost-effective measures that do not compromise the safety of patients or health professionals must be used to ensure the sustainability of the health system. In the light of new evidence, it seems reasonable to recommend the use of nonsterile and powder-free gloves in dermatologic surgery.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1085830" "palabras" => array:5 [ 0 => "Sterile gloves" 1 => "Powdered gloves" 2 => "Dermatologic surgery" 3 => "Mohs surgery" 4 => "Infections" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Bosch-Amate X, Morgado-Carrasco D, Riera-Monroig J, Ferrando J. ¿Qué tipo de guantes debemos utilizar en la cirugía dermatológica? Recomendaciones sobre los guantes a emplear. Actas Dermosifiliogr. 2019;110:160–161.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Références" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prospective evaluation of surgical site infection rate among patients with Mohs micrographic surgery without the use of prophylactic antibiotics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.L.H. Maragh" 1 => "M.D. Brown" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2008.03.042" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2008" "volumen" => "59" "paginaInicial" => "275" "paginaFinal" => "278" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18638628" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of Sterile vs Nonsterile Gloves in Cutaneous Surgery and Common Outpatient Dental Procedures: A Systematic Review and Meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.D. Brewer" 1 => "A.B. Gonzalez" 2 => "C.L. Baum" 3 => "C.J. Arpey" 4 => "R.K. Roenigk" 5 => "C.C. 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Federal Register. 2016 [Accessed 28 Oct 2017] Available at: https://www.federalregister.gov/documents/2016/12/19/2016-30382/banned-devices-powdered-surgeons-gloves-powdered-patient-examination-gloves-and-absorbable-powder" ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Performance of latex and nonlatex medical examination gloves during simulated use" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D.M. Korniewicz" 1 => "M. El-Masri" 2 => "J.M. Broyles" 3 => "C.D. Martin" 4 => "K.P. O’connell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Infect Control" "fecha" => "2002" "volumen" => "30" "paginaInicial" => "133" "paginaFinal" => "138" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11944004" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparing the level of dexterity offered by latex and nitrile SafeSkin gloves" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Sawyer" 1 => "A. 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