P157 A national UK clinician survey on surgical glove practices in dermatological surgery

Résumé fourni par la source

Abstract Nonsterile gloves have been shown in international studies to offer comparable surgical-site infection (SSI) rates to sterile gloves in dermatological surgery (Hamam Y, Ayesh H, Asad D et al. Sterile versus nonsterile gloves for the repair of wounds and lacerations: a systematic review and meta-analysis. JAMA Surg 2024; 159: 225–7). They provide significant environmental and cost benefits, making them particularly appealing for resource-limited healthcare systems such as the National Health Service (NHS). Despite this, sterile gloves remain the standard in UK dermatology departments, largely driven by infection control regulations and clinician perceptions of reduced SSI risk. The aim of our study was to evaluate current surgical glove practices in dermatological surgery across the UK, and assess clinician willingness to participate in a randomized controlled trial (RCT) comparing sterile and clean nonsterile gloves. With support from the UK Dermatology Clinical Trials Network, an online questionnaire was distributed to members of the British Society of Dermatological Surgery and Scottish Dermatological Society, and dermatology registrars nationwide. Responses were analysed for clinicians’ experience, glove preferences by procedure type, factors influencing decision making, and willingness to randomize patients in a proposed RCT. In total, 88 clinicians responded, including consultant dermatologists (62%), registrars (25%) and others (13%). Over half (54%) performed advanced skin surgery, such as flaps, grafts or Mohs surgery. Sterile gloves were predominantly used for punch biopsies (73.9%), curettage and cautery (67%), shave biopsies (67%) and small excisions (< 1 cm) on the trunk (88%) and face (90%). Local infection control regulations (51%), glove fit (45%) and perceived SSI risk (43%) were the main factors driving sterile glove use, although 55% of respondents considered incorporating sustainability in their surgical practice. Willingness to randomize patients varied: 70% for biopsies and small excisions on the trunk and limbs, 44% for larger excisions (> 1 cm) and 35% for head and neck excisions. Fewer clinicians were willing to randomize patients for flaps and grafts (16%). Among Mohs surgeons, 50% expressed willingness to randomize for tumour excision stages. In total, 67 patient responses were collected, with 73% comfortable participating in randomization and 64% accepting nonsterile gloves for simple skin procedures. Concerns primarily related to infection risk (57%) and glove cleanliness (36%). Despite the widespread use of sterile gloves in UK dermatology, a majority of clinicians and patients support a randomized study of nonsterile gloves for simple procedures. Multicentre UK-based studies are needed to challenge existing guidelines and address barriers to adoption of nonsterile gloves.

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