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Non-sterile gloves and dressing versus sterile gloves, dressings and drapes for suturing of traumatic wounds in the emergency department: a non-inferiority multicentre randomised controlled trial
  1. Juliette J M Zwaans1,
  2. Wouter Raven1,2,
  3. Arthur V Rosendaal3,
  4. Esther M M Van Lieshout4,
  5. Geesje Van Woerden5,
  6. Peter Patka1,
  7. Juanita A Haagsma1,6,
  8. Pleunie P M Rood1
  1. 1Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  2. 2Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands
  3. 3Department of Emergency Medicine, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
  4. 4Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  5. 5Department of Emergency Medicine, Haaglanden Medisch Centrum, Den Haag, The Netherlands
  6. 6Public Health, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to Dr Juliette J M Zwaans, Emergency Medicine, Erasmus Medical Center, Rotterdam 3015 GD, The Netherlands; jjm.zwaans{at}gmail.com

Abstract

Background Patients with traumatic wounds frequently present to the ED. Literature on whether to treat these wounds sterile or non-sterile is sparse. Non-sterile treatment has the advantage of saving resources and costs, and could be of value in health settings where sterile materials are not readily available. Our objective was to compare the rate of wound infection after suturing traumatic lacerations with non-sterile gloves and dressings versus sterile gloves, dressings and drapes in the ED. We hypothesised that non-sterile gloves and dressings would be non-inferior to sterile gloves, dressings and drapes. The non-inferiority margin was set at 2%.

Methods A multicentre single-blinded randomised controlled trial testing for non-inferiority of non-sterile gloves and dressings versus sterile gloves, dressings and drapes for suturing of traumatic wounds was performed in 3 EDs in The Netherlands. Adults with uncomplicated wounds were included from July 2012 to December 2016. At the time of treatment, patient and wound characteristics and management were documented. The outcome was wound infection, which was identified during follow-up in the treating ED at 5–14 days postprocedure.

Results From 2468 eligible patients, 1480 were randomised in a sterile (n=747) or non-sterile (n=733) protocol. Baseline characteristics were similar in both study arms. The observed wound infection rate in the non-sterile group was 5.7% (95% CI 4.0% to 7.5%) vs 6.8% (95% CI 5.1% to 8.8%) in the sterile group. The mean difference of the wound infection rate of the two groups was −1.1% (95% CI −3.7% to 1.5%).

Conclusion Although recruitment ceased prior to reaching our planned sample size, the findings suggest that there is unlikely to be a large difference between the non-sterile gloves and dressings for suturing of traumatic wounds and sterile gloves, dressings and drapes for suturing of traumatic wounds in the ED.

Trial registration number NL 34798.078.11, NTR3541.

  • emergency department
  • wounds and injuries

Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Handling editor David Metcalfe

  • JJMZ and WR contributed equally.

  • Contributors JJMZ: initiation and design of the study, writing of the protocol and the manuscript. Contributed to supervised data collection and analysis. WR: supervised data collection of all participating centres. Contributed to initiation and design of the study, analysis of the data and to the writing, critical revision and final approval of the manuscript. AVR: contributed to initiation of the study and supervised data collection in SFVG and revision of the manuscript. EMMvL: contributed to the study design, data analysis and critical revision and final approval of the manuscript. GVW: contributed to initiation of the study and supervised data collection in HMC and revision of the manuscript. PP: contributed to the design of the study, supervised the conduction of the study and the critical revision and final approval of the manuscript. JAH: contributed to analysis of the data and writing, critical revision and final approval of the manuscript. PPMR: contributed to the initiation and design of the study, writing and revision of the protocol, supervised data collection and analysis and to the writing, critical revision and final approval of the manuscript. PPMR is acting as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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