Comparison of Infection Rate Between Sterile and Nonsterile Gloves During Mohs Micrographic Surgery: An Updated Systematic Review and Meta-Analysis

Abstract

Background: Mohs micrographic surgery (MMS) is a well-established technique for the removal of various types of skin cancers. While sterile gloves (SG) are commonly used in skin surgeries such as MMS, additional understanding of their effectiveness compared to nonsterile gloves (NSG) in preventing local infection is required. Objective: We aimed to perform an updated systematic review and meta-analysis comparing the use of SG with NSG for local infection rate post-MMS and point out cost discrepancies between these 2 scenarios. Methods: We searched MEDLINE, Embase, and Cochrane for studies published up to August 2023 comparing the use of SG with NSG during MMS that reported the outcome of wound infection. Results: A total of 4 studies with 10,644 MMS were included, of which 7512 (70.6%) were performed with SG and 3132 (29.4%) were done with NSG. In the SG group, 232 out of 7512 cases (3.1%) developed infection compared to 64 out of 3132 (2.0%) in the NSG group [odds ratio (OR) 1.14; 95% confidence interval (CI) 0.85-1.52; P = .39; I2 = 0%]. Therefore, the post-MMS infection rates were not significantly different between SG and NSG groups, including in the excision (OR 0.92; 95% CI 0.48-1.79; P = .81; I2 = 0%) and reconstruction (OR 1.17; 95% CI 0.85-1.60; P = .34; I2 = 0%) subanalysis. Regarding the mean cost of the gloves, the NSG pair was $0.24, approximately 10% of the price of the SG pair ($2.27). Conclusion: The results support that, compared to SG, NSG are equally effective in preventing infections during MMS while offering significant cost savings without compromising patient outcomes. Protocol registration: PROSPERO, CRD42023458525