Sterile Versus Nonsterile Gloves: Infection Risk and Cost Comparison in Corticosteroid Shoulder Injections.

Abstract

Corticosteroid injection into the shoulder is a common treatment used for various orthopaedic pathologies. However, it remains unclear if using nonsterile gloves correlate with higher infection risk compared with sterile gloves for such procedures. Although literature in other fields supports the noninferiority of nonsterile gloves toward infection risk, similar studies have not been conducted in orthopaedics. This study seeks to identify if there is an increased infection risk and difference in costs with using nonsterile gloves compared with sterile gloves for shoulder injections. A retrospective review of medical records identified patients who received shoulder injections from a single surgeon from February 2023 to July 2024. The surgeon transitioned from using sterile gloves to nonsterile gloves during this period, and a proportionate number of patients were assigned to nonsterile and sterile glove groups. Post hoc power analysis was completed through calculating confidence intervals and minimal detectable effect size through Cohen h. Records were reviewed for demographic information, body mass index, Charlson comorbidity index, follow-up length, and postinjection infection as identified through ICD-10 code T80.29XA. Rate of infection was evaluated at 1, 3, and 6 months following injections. Glove prices were obtained through our institution. Percentages were obtained for categorical variables, and means were calculated for continuous variables. Descriptive statistics were done using Chi-squared tests for percentages and Student t tests for means for any baseline differences between the patient groups. A total of 641 patients were evaluated with a minimal follow-up period of 6 months. Three hundred seventeen injections were performed using sterile gloves, and 323 injections were performed using nonsterile gloves. No shoulder joint infections were recorded following any injection performed with either glove type, with the study being sufficiently powered to detect within 0.012 infection rate difference. Sterile gloves were 36 times more expensive than nonsterile gloves per injection. Although sterile gloves are substantially more expensive than nonsterile gloves, no difference was found in infection risk outcomes for corticosteroid shoulder injections in clinical practice.