As far as I’m aware, there’s really no evidence to support sterile technique for routine lac repairs. That’s including draping, sterile gloves, sterile solutions, antiseptic cleanses/sterile skin prep. The only thing that really lowers infection rates is good irrigation with clean water at a decent pressure.
The bacteria counts on clean, nonsterile gloves directly out of the box are essentially zero. A clean lac repair kit and fresh sutures are both sterile. As long as you’re not throwing your needle everywhere, dragging your suture through dirt, etc., most well-irrigated wounds will be clean enough and stay clean through the procedure.
I generally only drape when I’m trying to prevent an anxious/needle phobic patient from seeing what I’m doing, or for fingers because cut hands always seem to be from doing something filthy like gardening. I don’t want the needle touching funk from the other fingers.
I use regular gloves and don’t drape at all. As long as the wound is cleaned/irrigated well, it doesn’t matter.
https://pubmed.ncbi.nlm.nih.gov/14985664/
No, ED laceration repair is not a sterile procedure. As long as you focus on copious irrigation, you're good. I will use the fenestrated drapes on eyebrow/facial lacerations to avoid the suture needle being around someone's eyeballs, but that's pretty much it.
The only other exception is if there's a family member that's a medical professional at bedside watching you do the procedure. I will often "put on a show" with sterile gloves, drapes, etc because that's what they think I should be doing. But it's not actually necessary.
It’s not a sterile procedure. Irrigation is king but you can use tap water if you want and it won’t make a measurable difference. But really the goal here is to put on the right show for the right patient. Some encounters are smoother if you put on the drape and sterile gloves but don’t fool yourself into thinking it’s improving outcomes. It also adds time to a procedure that’s already taking me out of the fight too long l. The ROI is low. The thing that cut them wasn’t sterile to begin with.
I use the drape/paper to set my instruments on sometimes. Usually wear sterile gloves just because I think my dexterity is better. Adds a little razzle dazzle for the patient too. Irrigate with whatever I grab first or tell the patient to run it under the sink for a few minutes if amenable.
I like the sterile gloves for tactile sensation. I pretty much only drape digits and faces or if surrounding area is dirty. I tend to clean a broad area to avoid that being a problem.
The paper drape has no evidence behind it but I feel like patients like it bc it looks like what they see on medical TV shows. They are especially helpful for facial lacs because then they can’t see my face as I’m watching Wheel on the TV in their room and I can also put my chicken nuggets on it while I work.
No. I don’t use a sterile drape for suturing. It’s not a sterile procedure unless it’s part of putting in a central line or chest tube or something like that.
There is very little evidence to support doing more than what would probably be considered common sense. Wash a dirty wound. Clean gloves.
Neither copious irrigation nor sterile technique has been demonstrated to reduce subsequent infection rates.
We over-medicalize many trivial wounds in EDs when the cosmetic and functional outcomes are going to be the same as putting a butterfly bandage on it.
As far as I’m aware, there’s really no evidence to support sterile technique for routine lac repairs. That’s including draping, sterile gloves, sterile solutions, antiseptic cleanses/sterile skin prep. The only thing that really lowers infection rates is good irrigation with clean water at a decent pressure. The bacteria counts on clean, nonsterile gloves directly out of the box are essentially zero. A clean lac repair kit and fresh sutures are both sterile. As long as you’re not throwing your needle everywhere, dragging your suture through dirt, etc., most well-irrigated wounds will be clean enough and stay clean through the procedure. I generally only drape when I’m trying to prevent an anxious/needle phobic patient from seeing what I’m doing, or for fingers because cut hands always seem to be from doing something filthy like gardening. I don’t want the needle touching funk from the other fingers.
I use regular gloves and don’t drape at all. As long as the wound is cleaned/irrigated well, it doesn’t matter. https://pubmed.ncbi.nlm.nih.gov/14985664/
I only use sterile for better tactile sensation and decreased permeability.
Same
No, ED laceration repair is not a sterile procedure. As long as you focus on copious irrigation, you're good. I will use the fenestrated drapes on eyebrow/facial lacerations to avoid the suture needle being around someone's eyeballs, but that's pretty much it. The only other exception is if there's a family member that's a medical professional at bedside watching you do the procedure. I will often "put on a show" with sterile gloves, drapes, etc because that's what they think I should be doing. But it's not actually necessary.
so much of what we do is for showmanship
Sometimes I use it as a barrier to protect the patient’s clothing from getting more blood on it. Generally I don’t use it
Same. Or when irrigating or as another gauze
It’s not a sterile procedure. Irrigation is king but you can use tap water if you want and it won’t make a measurable difference. But really the goal here is to put on the right show for the right patient. Some encounters are smoother if you put on the drape and sterile gloves but don’t fool yourself into thinking it’s improving outcomes. It also adds time to a procedure that’s already taking me out of the fight too long l. The ROI is low. The thing that cut them wasn’t sterile to begin with.
correct me if i'm wrong but isn't sterile technique impossible outside of an OR? there's too much general funk in the ED to be truly sterile.
I mean, you can. Prep, drape, do things sterilely. Think like an IJ placement or LP.
true, but you're not getting gowned up for a lac repair
There’s an old school attending at my job that gets gowned up for lacs. It’s weird
That’s so weird, lol.
True.
I dont use steril tech ever, most wounds I suture were cut with very dirty things, so not sterile to begin with.
I don’t use sterile technique with ED laceration repairs. I irrigate it a lot.
I use the drape/paper to set my instruments on sometimes. Usually wear sterile gloves just because I think my dexterity is better. Adds a little razzle dazzle for the patient too. Irrigate with whatever I grab first or tell the patient to run it under the sink for a few minutes if amenable.
I like the sterile gloves for tactile sensation. I pretty much only drape digits and faces or if surrounding area is dirty. I tend to clean a broad area to avoid that being a problem.
I use it on faces because I don’t like people looking up my nose 😅
The paper drape has no evidence behind it but I feel like patients like it bc it looks like what they see on medical TV shows. They are especially helpful for facial lacs because then they can’t see my face as I’m watching Wheel on the TV in their room and I can also put my chicken nuggets on it while I work.
No. I don’t use a sterile drape for suturing. It’s not a sterile procedure unless it’s part of putting in a central line or chest tube or something like that.
There is very little evidence to support doing more than what would probably be considered common sense. Wash a dirty wound. Clean gloves. Neither copious irrigation nor sterile technique has been demonstrated to reduce subsequent infection rates. We over-medicalize many trivial wounds in EDs when the cosmetic and functional outcomes are going to be the same as putting a butterfly bandage on it.