A review of single-use and reusable gowns and drapes in health care

A comparison of reusable and disposable perioperative textiles: sustainability state-of-the-art 2012

Contemporary comparisons of reusable and single-use perioperative textiles (surgical gowns and drapes) reflect major changes in the technologies to produce and reuse these products. Reusable and disposable gowns and drapes meet new standards for medical workers and patient protection, use synthetic lightweight fabrics, and are competitively priced. In multiple science-based life cycle environmental studies, reusable surgical gowns and drapes demonstrate substantial sustainability benefits over the same disposable product in natural resource energy (200%-300%), water (250%-330%), carbon footprint (200%-300%), volatile organics, solid wastes (750%), and instrument recovery. Because all other factors (cost, protection, and comfort) are reasonably similar, the environmental benefits of reusable surgical gowns and drapes to health care sustainability programs are important for this industry. Thus, it is no longer valid to indicate that reusables are better in some environmental impacts and disposables are better in other environmental impacts. It is also important to recognize that large-scale studies of comfort, protection, or economics have not been actively pursued in the last 5 to 10 years, and thus the factors to improve both reusables and disposable systems are difficult to assess. In addition, the comparison related to jobs is not well studied, but may further support reusables. In summary, currently available perioperative textiles are similar in comfort, safety, and cost, but reusable textiles offer substantial opportunities for nurses, physicians, and hospitals to reduce environmental footprints when selected over disposable alternatives. Evidenced-based comparison of environmental factors supports the conclusion that reusable gowns and drapes offer important sustainability improvements. The benefit of reusable systems may be similar for other reusables in anesthesia, such as laryngeal mask airways or suction canisters, but life cycle studies are needed to substantiate these benefits.

Functional separation of septic and aseptic surgical procedures

Current evidence does not favour constructional over functional separation of septic and aseptic surgical procedures in terms of overall hygiene maintenance and incidence of skin and soft tissue infections. In both laminar and turbulent flow air operating theatres, air is not a relevant source of pathogens if surface disinfection is carried out properly.Final cleaning after a septic procedure includes a thorough wipe-disinfection of all potentially contaminated near and distant surfaces, including maintaining the necessary and effective exposure time of the chosen surface disinfectant. Cleaning utensils and clothes of all team members must be disposed of before leaving the theatre, and a complete change of gowns is mandatory before re-entering the operating room area. Strict adherence to this code of behaviour will allow for efficient functional separation of clean and contaminated surgical procedures without compromising patient safety.

Determination of antiseptic efficacy of rubs on the forearm and consequences for surgical hand disinfection

While hands are acknowledged to be the most important source of pathogens from the skin of the surgical team, the transmission of pathogens from the forearms may also be relevant. Preoperative hand disinfection is recommended, but evidence-based standards for the forearms are lacking. As neither the European standard EN 12791 nor the American guidelines ASTM 1115 are applicable to the forearms, a new test method based on the European standard EN 12791 and the German Society for Hygiene and Microbiology (DGHM) method for testing for the efficacy of skin antiseptics was developed to address the forearms. The antiseptic efficacy of a commercially available alcohol-based hand rub [76.7% (w/w) ethanol] was assessed on the upper arm after 15s, 2.5 min, and 30 min, and on the lower arm after 2.5 min, 30 min, and 3 h. On the upper arm, application of the product followed the DGHM standard procedure. On the forearm, the product was applied by the participants themselves with the right hand over the left forearm and vice versa as performed during preoperative hand disinfection. Sampling and culture were performed according to the DGHM method for skin antisepsis on the upper arm. Twenty-two volunteers were investigated. The efficacy of the antiseptic treatment on the forearm was not significantly lower than on the upper arm for any of the areas tested (P > 0.05). Reduction factors for all tested areas and times were quite similar, with confidence intervals ranging between 1.43 and 2.31 log₁₀. We suggest that an application time of 10s may be sufficient for the treatment of the forearm as part of preoperative hand disinfection, provided that an appropriate product is used.

Disposable and reusable medical textiles

As infectious diseases circle the globe, medical costs skyrocket and the waste stream continues to grow, it is imperative to look for medical textiles with improved protective performance, low costs, and minimized environmental impacts. Medical textiles include surgical gowns, gloves, drapes, facemasks, dresses, and linens, which could be disposable or reusable based on uses. The selection of reusable and disposable textiles is determined by many factors, such as cost, protective and comfort properties of the textiles, government regulations, and possibly social and psychological perceptions of both types of textile. This chapter intends to provide a broad view on both disposable and reusable textiles, as well as suggestions on improved protection against transmission of infectious diseases by textile materials.

Face masks to prevent transmission of influenza virus: a systematic review

Influenza viruses circulate around the world every year. From time to time new strains emerge and cause global pandemics. Many national and international health agencies recommended the use of face masks during the 2009 influenza A (H1N1) pandemic. We reviewed the English-language literature on this subject to inform public health preparedness. There is some evidence to support the wearing of masks or respirators during illness to protect others, and public health emphasis on mask wearing during illness may help to reduce influenza virus transmission. There are fewer data to support the use of masks or respirators to prevent becoming infected. Further studies in controlled settings and studies of natural infections in healthcare and community settings are required to better define the effectiveness of face masks and respirators in preventing influenza virus transmission.

Barrier precautions, isolation protocols, and personal hygiene in veterinary hospitals

Because nosocomial and zoonotic diseases are inherent and ever-present risks in veterinary hospitals, proactive policies should be in place to reduce the risk of sporadic cases and outbreaks. Policies should ideally be put in place before disease issues arise, and policies should be effectively conveyed to all relevant personnel. Written policies are required for practical and liability reasons and should be reviewed regularly. Although no infection control program can eliminate disease concerns, proper implementation of barrier precautions and isolation can reduce the exposure of hospitalized animals and hospital personnel to infectious agents. Appropriate personal hygiene, particularly hand hygiene, can assist in the prevention of disease transmission when pathogens bypass barriers and are able to contact personnel. Veterinary hospitals have moral, professional, and legal requirements to provide a safe workplace and to reduce the risks to hospitalized patients. Based on experience in the human medical field and on the continual emergence of new infectious diseases, infection control challenges can only be expected to increase in the future. Regular reassessment of protocols based on ongoing research and clinical experiences is required.

[IKOP-Infection control in the operating theatreConsensus on the theme "Barrier measures during operations and invasive procedures"]

Postoperative surgical site infections remain frequent despite intensive control programs. With rising numbers of operations and invasive procedures in the outpatient setting and in immunocompromised patients, the prevention of wound infections presents a rapidly growing challenge to the medical community. Barrier measures including drapes and surgical gowns to prevent wound contamination, have clearly reduced the rate of wound infections. The optimal material characteristics for operating gowns and drapes are well defined, but there is still a long running controversy on the use of single-use versus reusable materials. We review the efficacy and ecological impacts of these different approaches. Currently no superiority of any of these approaches with regard to either efficacy or ecological impact can be found. The European Union has recently published a series of mandatory standards to specify material characteristics of barrier materials used in operating theatres (EN 13795). Their scope include production standards of these materials as well as specific processes in auditing their characteristics. The implementation of these norms will clearly present a challenge to European hospitals but will lead to better material characteristics in the end.

Reprocessing endoscopes: United States perspective

Endoscopes are used frequently for the diagnosis and therapy of medical disorders. For example, greater than 10000000 gastrointestinal endoscopic procedures are performed each year in the United States. Failure to employ appropriate cleaning and disinfection/sterilization of endoscopes has been responsible for multiple nosocomial outbreaks and serious, sometimes life-threatening, infections. Flexible endoscopes, by virtue of the site of use, have a high bioburden of microorganisms after use. The bioburden found on flexible gastrointestinal endoscopes following use has ranged from 10(5) to 10(10)CFU/ml, with the highest levels being found in the suction channels. Cleaning dramatically reduces the bioburden on endoscopes. Several investigators have shown a mean log(10) reduction factor of 4 (99.99%) in the microbial contaminants with cleaning alone. Cleaning should be done promptly following each use of an endoscope to prevent drying of secretions, allow removal of organic material, and decrease the number of microbial pathogens. Because the endoscope comes into intimate contact with mucous membranes, high-level disinfection is the reprocessing standard after each patient use. High-level disinfection refers to the use of a disinfectant (e.g., FDA-cleared chemical sterilant or high-level disinfectant) that inactivates all microorganisms (i.e., bacteria, viruses, fungi, mycobacteria) but not high levels of bacterial spores. The disinfection process requires immersion of the endoscope in the high-level disinfectant and ensuring all channels are perfused for the approved contact time (e.g., for ortho-phthaladehyde this is 12 min in the US). Following disinfection, the endoscope and channels are rinsed with sterile water, filtered water, or tapwater. The channels are then flushed with alcohol and dried using forced air. The endoscope should be stored in a manner that prevents recontamination. A protocol that describes the meticulous manual cleaning process, the appropriate training and evaluation of the reprocessing personnel, and a quality assurance program for endoscopes should be adopted and enforced by each unit performing endoscopic reprocessing.

The role of covering gowns in reducing rates of bacterial contamination of scrub suits

OBJECTIVE

This study was undertaken to determine whether covering gowns reduce the rates of contamination of surgical scrubs.

STUDY DESIGN

Seventy-five clinicians had pieces of fabric from clean scrubs attached to two areas of their scrub suits. Participants wore a covering garment when wearing scrub suits off of designated areas (n = 25), did not wear a covering garment (n = 25), or wore scrub suits outside the hospital (n = 25). Subsequently, the fabric was assessed with culture in enhanced broth media and blood agar.

RESULTS

Although there was a trend toward lower rates of contamination in the group that did not wear a covering garment, the difference was not significant. At no point, and at neither site of fabric attachment, did those who wore a covering garment demonstrate any advantage in regard to levels or frequency of contamination.

CONCLUSION

Wearing covering garments over scrub suits does not reduce rates of contamination.