Monday, June 22, 2015

Gloves for minor skin procedures: sterile or not?

- Jennifer Middleton, MD, MPH

When I ask my medical assistant to gather supplies for a simple skin lesion excision, I often hear this question in return: "Sterile gloves or not?" The decision of which type of gloves to wear has potential implications for both individual patients and overall healthcare costs. A POEM in the June 15 AFP asserts that, for most uncomplicated minor skin surgeries, sterile gloves are no better at preventing infection than clean, non-sterile gloves.

The authors randomized 493 patients who were receiving minor skin excisions in a primary care office to either a sterile glove or regular glove group. They had very broad inclusion criteria but did exclude patients taking antibiotics or immunosuppressives, and they did not include patients undergoing sebaceous cyst removal. They found no difference in post-procedure infection rates (-0.6%, 95th CI [-4.0%, 2.9%]) and noted that the use of non-sterile gloves saved an average of AUD $1 (USD $0.78) per procedure. These findings are consistent with a 2011 AFP article on shave and punch biopsies that lists non-sterile gloves on its "materials" table.

78 cents less for a pair of gloves may not seem like much, but The Institute of Medicine estimates that 30% of health care spending in the US is on waste. We could potentially save $53 billion a year by decreasing the costs of episodes of care. If every family doctor used non-sterile gloves for these procedures, how much might we save?

We have a finite healthcare resource pool, and every dollar spent unnecessarily is a lost opportunity. The small decisions we make every day in our offices - whether to order a CT scan, prescribe an antibiotic, or use sterile gloves for a simple excision - add up. Being a good financial steward doesn't have to equal substandard care. The Choosing Wisely campaign's primary aim is to prevent patient harm, yet avoiding unnecessary care also allows those healthcare dollars to be allocated elsewhere. True, bigger gains in healthcare cost savings require system initiatives, but we should not feel that we, as individual physicians, are powerless to make a difference. Even a simple decision about which pair of gloves to don can help.

You can read more about the Choosing Wisely campaign here, and the AFP website also has a handy Choosing Wisely search tool if you'd like to learn more about a particular initiative.