Mohs Infection Rates Equal With Sterile Versus Clean Gloves

NEW YORK - Clean, nonsterile gloves are just as effective in preventing infection in Mohs surgery as their more expensive sterile counterparts.

These findings from two studies add to a growing body of data that support the use of clean technique and could translate into significant cost savings for Mohs surgeons - up to several thousand dollars a year, by one estimate.

In the first study presented at the annual meeting of the American College of Mohs Surgery, researchers led by Dr. Heather D. Rogers of the University of Washington, Seattle, sought to evaluate the rate of surgical site infection (SSI) in Mohs surgery patients using clean surgical technique versus sterile technique for "all steps of MMS [Mohs micrographic surgery], including wound reconstruction, in the absence of prophylactic antibiotics."

The researchers evaluated 1,000 patients undergoing MMS using clean technique, which included the use of clean (vs. sterile) gloves, clean (vs. sterile) towels, and a "single pack" of sterile instruments for the entire wound reconstruction.

Infection was classified according to the Centers for Disease Control and Prevention parameters: A site was considered infected if it expressed purulent discharge, if it displayed edema or erythema, and if the patient complained of pain or tenderness at the site.

"There were 11 infections in 1,000 patients with 1,204 tumors," said Dr. Rogers, for an infection rate of 0.91%. Three of the infections were complications of hematomas.

"Our SSI rate of 0.91% is extremely low," she said, "underscoring the overall safety of MMS and its performance in the outpatient setting without the use of antibiotic prophylaxis or sterile technique."

The second study was presented by Dr. Yang Xia of the division of Mohs surgery at the Scripps Clinic, La Jolla, Calif. Dr. Xia conducted a prospective, subject-blinded pilot study of 60 patients at the clinic to assess the difference in infection rate between clean, nonsterile gloves and sterile gloves for the repair of surgical defects in MMS.

"Clean gloves were used for all patients in the tumor removal phase," said Dr. Xia.

After tumors were removed, patients were randomized to repair with either clean or sterile gloves. A total of 30 patients were enrolled in each arm. Sterile paper and trays were used during all repairs. The mean age of the clean group was 69 years (26 men); the mean age of the sterile group was 74 years (28 men). Patients were excluded from the study if they were taking antibiotics at the time of the procedure or if they had any serious comorbidities, such as HIV.

After surgery, patients were followed up for 5-21 days, and the wounds were assessed by a nurse or assistant who was not affiliated with the study.
In the clean group, there was one SSI, in a 67-year-old man who cultured positive for methicillin-susceptible Staphylococcus aureus (MSSA). He was prescribed cephalexin.

In the sterile group, there were two SSIs: one case of MSSA, which was treated with cephalexin and resolved, and one case of methicillin-resistant Staphylococcus aureus (MRSA), which resolved with administration of Septra (trimethoprim and sulfamethoxazole) twice a day for 14 days.

Given the equally low rates of infection in the two study arms, the potential cost-savings of switching from sterile to clean gloves for these procedures could be tremendous, Dr. Xia said. One online search put the cost of a box of 100 clean gloves at $4-$9, although Dr. Xia gave a figure of $4-$29 for a box of 150 gloves. In contrast, a box of 100 sterile surgical gloves costs $74-$250, according to Dr. Xia. (A separate online search found a box of 100 sterile gloves available for $45-$275.)

Depending on the annual volume of a surgeon's cases, switching from sterile to clean gloves could save $6,000 to $20,000 a year, Dr. Xia estimated.

Dr. Rogers and Dr. Xia said they had no disclosures to make in relation to their presentations.

NEW YORK - Clean, nonsterile gloves are just as effective in preventing infection in Mohs surgery as their more expensive sterile counterparts.

These findings from two studies add to a growing body of data that support the use of clean technique and could translate into significant cost savings for Mohs surgeons - up to several thousand dollars a year, by one estimate.

In the first study presented at the annual meeting of the American College of Mohs Surgery, researchers led by Dr. Heather D. Rogers of the University of Washington, Seattle, sought to evaluate the rate of surgical site infection (SSI) in Mohs surgery patients using clean surgical technique versus sterile technique for "all steps of MMS [Mohs micrographic surgery], including wound reconstruction, in the absence of prophylactic antibiotics."

The researchers evaluated 1,000 patients undergoing MMS using clean technique, which included the use of clean (vs. sterile) gloves, clean (vs. sterile) towels, and a "single pack" of sterile instruments for the entire wound reconstruction.

Infection was classified according to the Centers for Disease Control and Prevention parameters: A site was considered infected if it expressed purulent discharge, if it displayed edema or erythema, and if the patient complained of pain or tenderness at the site.

"There were 11 infections in 1,000 patients with 1,204 tumors," said Dr. Rogers, for an infection rate of 0.91%. Three of the infections were complications of hematomas.

"Our SSI rate of 0.91% is extremely low," she said, "underscoring the overall safety of MMS and its performance in the outpatient setting without the use of antibiotic prophylaxis or sterile technique."

The second study was presented by Dr. Yang Xia of the division of Mohs surgery at the Scripps Clinic, La Jolla, Calif. Dr. Xia conducted a prospective, subject-blinded pilot study of 60 patients at the clinic to assess the difference in infection rate between clean, nonsterile gloves and sterile gloves for the repair of surgical defects in MMS.

"Clean gloves were used for all patients in the tumor removal phase," said Dr. Xia.

After tumors were removed, patients were randomized to repair with either clean or sterile gloves. A total of 30 patients were enrolled in each arm. Sterile paper and trays were used during all repairs. The mean age of the clean group was 69 years (26 men); the mean age of the sterile group was 74 years (28 men). Patients were excluded from the study if they were taking antibiotics at the time of the procedure or if they had any serious comorbidities, such as HIV.

After surgery, patients were followed up for 5-21 days, and the wounds were assessed by a nurse or assistant who was not affiliated with the study.
In the clean group, there was one SSI, in a 67-year-old man who cultured positive for methicillin-susceptible Staphylococcus aureus (MSSA). He was prescribed cephalexin.

In the sterile group, there were two SSIs: one case of MSSA, which was treated with cephalexin and resolved, and one case of methicillin-resistant Staphylococcus aureus (MRSA), which resolved with administration of Septra (trimethoprim and sulfamethoxazole) twice a day for 14 days.

Given the equally low rates of infection in the two study arms, the potential cost-savings of switching from sterile to clean gloves for these procedures could be tremendous, Dr. Xia said. One online search put the cost of a box of 100 clean gloves at $4-$9, although Dr. Xia gave a figure of $4-$29 for a box of 150 gloves. In contrast, a box of 100 sterile surgical gloves costs $74-$250, according to Dr. Xia. (A separate online search found a box of 100 sterile gloves available for $45-$275.)

Depending on the annual volume of a surgeon's cases, switching from sterile to clean gloves could save $6,000 to $20,000 a year, Dr. Xia estimated.

Dr. Rogers and Dr. Xia said they had no disclosures to make in relation to their presentations.

NEW YORK - Clean, nonsterile gloves are just as effective in preventing infection in Mohs surgery as their more expensive sterile counterparts.

These findings from two studies add to a growing body of data that support the use of clean technique and could translate into significant cost savings for Mohs surgeons - up to several thousand dollars a year, by one estimate.

In the first study presented at the annual meeting of the American College of Mohs Surgery, researchers led by Dr. Heather D. Rogers of the University of Washington, Seattle, sought to evaluate the rate of surgical site infection (SSI) in Mohs surgery patients using clean surgical technique versus sterile technique for "all steps of MMS [Mohs micrographic surgery], including wound reconstruction, in the absence of prophylactic antibiotics."

The researchers evaluated 1,000 patients undergoing MMS using clean technique, which included the use of clean (vs. sterile) gloves, clean (vs. sterile) towels, and a "single pack" of sterile instruments for the entire wound reconstruction.

Infection was classified according to the Centers for Disease Control and Prevention parameters: A site was considered infected if it expressed purulent discharge, if it displayed edema or erythema, and if the patient complained of pain or tenderness at the site.

"There were 11 infections in 1,000 patients with 1,204 tumors," said Dr. Rogers, for an infection rate of 0.91%. Three of the infections were complications of hematomas.

"Our SSI rate of 0.91% is extremely low," she said, "underscoring the overall safety of MMS and its performance in the outpatient setting without the use of antibiotic prophylaxis or sterile technique."

The second study was presented by Dr. Yang Xia of the division of Mohs surgery at the Scripps Clinic, La Jolla, Calif. Dr. Xia conducted a prospective, subject-blinded pilot study of 60 patients at the clinic to assess the difference in infection rate between clean, nonsterile gloves and sterile gloves for the repair of surgical defects in MMS.

"Clean gloves were used for all patients in the tumor removal phase," said Dr. Xia.

After tumors were removed, patients were randomized to repair with either clean or sterile gloves. A total of 30 patients were enrolled in each arm. Sterile paper and trays were used during all repairs. The mean age of the clean group was 69 years (26 men); the mean age of the sterile group was 74 years (28 men). Patients were excluded from the study if they were taking antibiotics at the time of the procedure or if they had any serious comorbidities, such as HIV.

After surgery, patients were followed up for 5-21 days, and the wounds were assessed by a nurse or assistant who was not affiliated with the study.
In the clean group, there was one SSI, in a 67-year-old man who cultured positive for methicillin-susceptible Staphylococcus aureus (MSSA). He was prescribed cephalexin.

In the sterile group, there were two SSIs: one case of MSSA, which was treated with cephalexin and resolved, and one case of methicillin-resistant Staphylococcus aureus (MRSA), which resolved with administration of Septra (trimethoprim and sulfamethoxazole) twice a day for 14 days.

Given the equally low rates of infection in the two study arms, the potential cost-savings of switching from sterile to clean gloves for these procedures could be tremendous, Dr. Xia said. One online search put the cost of a box of 100 clean gloves at $4-$9, although Dr. Xia gave a figure of $4-$29 for a box of 150 gloves. In contrast, a box of 100 sterile surgical gloves costs $74-$250, according to Dr. Xia. (A separate online search found a box of 100 sterile gloves available for $45-$275.)

Depending on the annual volume of a surgeon's cases, switching from sterile to clean gloves could save $6,000 to $20,000 a year, Dr. Xia estimated.

Dr. Rogers and Dr. Xia said they had no disclosures to make in relation to their presentations.