The windowed glove: a method for promoting asepsis during emergency hand procedures

Sir, Hand injuries comprise 20 % of emergency department (ED) presentations [1] and a large component of emergency referrals to plastic surgery units. Many are explored or closed within the ED, employing a sterile field created using drapes. These do not, however, naturally follow the hand contours and are difficult to stabilise and are poorly fitted (impeding manipulation of the limb during the procedure), of limited size allowing sutures to fall easily fall onto exposed skin (Fig. 1) and absorbent (losing mechanical and aseptic integrity if soaked with liquids) [2–4]. We have therefore adapted a technique [5], which we term a “windowed glove”, to circumvent these issues. It is inexpensive, rapid, technically easy and utilises materials already located in the ED. Local anaesthetic is administered and the hand prepared. A sterile glove one half-size larger than the patient’s hand is opened out from the cuff by the operator, and the patient’s hand was inserted. The forearm is double-wrapped in sterile crepe, starting by overlapping the cuff of the glove and working up to the mid-forearm (Fig. 2). The hand and distal forearm are placed on the procedure table. Finally, the area of hand required to be within the operative field is identified, and a window is cut with sterile scissors (Fig. 2). The windowed glove provides a versatile, inexpensive, clean and convenient method for performing minor procedures on the hand. It can also be used for multiple injuries on the same hand. Furthermore, it allows easy manipulation during the procedure while maintaining sterile condition. Asepsis is improved by covering the forearm in a sterile material, and the use of glove which is impermeable, unlike many drapes, which lose their mechanical integrity and allow the translocation of bacteria if soaked by liquids [3–5]. Moreover, it is our empirical observation that many hand injuries occur in grossly contaminated hands that even thorough scrubbing cannot completely clean. We feel the application of this technique in the operating room in these cases