AORN Recommended Practices Committee. Recommended practices for surgical attire

A Combined Tie-Fastening Method for the Reusable Surgical Gown with Two Neck Tie Belts to Improve Wearing Comfort

The reusable surgical gowns made of slippery materials have the tendency to slip down as they are being worn. The rear neck tie(s) can sometimes loosen, and this causes the surgical gown to slip down somewhat, making the surgical staff members feel uncomfortable. If the gowns have two rear neck ties with a tendency of loosening and allowing the gowns to slip down, the surgical staff members feel more uncomfortable when there is only one tie loosening but the other tie is tethering. To fasten the neck ties of the surgical gown with two neck tie belts, we propose a simplified method of fastening the two sets of tie belts together as one tie, instead of fastening them separately. The object of this study is to evaluate this combined tying method for its ability to secure the gown and its wearing comfort. We enrolled five volunteers to evaluate the tie loosening condition of the reusable surgical gowns with two sets of rear neck tie belts after a series of upper limb motion exercises while wearing and not wearing the X-ray protective apron beneath the gown. The amount of uppermost rear neck cloth edge separation was recorded before and after the exercise. We also evaluated the wearing comfort of five enrolled operating surgeons for comparing the original and this modified tying method while wearing and not wearing the X-ray protective apron. In the results, we found that combined tying tends to have significantly more rear gown separation (0.94 cm) than separate tying (0.27 cm) after vigorous upper extremities exercise. However, during the actual performance of the surgeries, the rear neck tie(s) loosening and wearing discomfort of the combined tying method was significantly less than using the separate tying method (loosening: 0% vs. 30%) (discomfort: 0% vs. 35%) while the X-ray protective apron was not worn. For reusable surgical gowns that have two rear neck ties, we suggest the two sets of rear neck ties could be fastened together as one combined tie in routine surgical practice. With this, tying could be performed easier and faster, and wearing comfort could be improved.

Sterile field contamination from powered air-purifying respirators (PAPRs) versus contamination from surgical masks

BACKGROUND

Currently, powered air-purifying respirators (PAPRs) are not recommended for usage in close proximity to sterile fields owing to concerns that exhaled, unfiltered air potentially may cause contamination; however, this has not been confirmed by experimental study.

METHODS

After establishing background levels of airborne contamination, our team placed settling plates in a sterile field and collected contamination from participants who were performing particulate-generating actions. Participants performed the actions while wearing various forms of respiratory protection, including: (1) a full facepiece PAPR, (2) a full facepiece PAPR with a shoulder-length hood, (3) a surgical mask, and (4) no facial covering (as a positive control to determine contamination-reduction effectiveness). Specimens were collected at the end of a 10-minute sampling time frame. After incubation at 36.5˚C for 72 hours, we tabulated colony forming units as a marker of contamination.

RESULTS

Surgical masks and the 2 PAPR configurations all drastically reduced aerosolized droplet contamination. Surgical masks reduced contamination by 98.48%, and both PAPRs reduced contamination by 100% (compared with the usage of no facial covering). There was no statistical difference between their effectiveness (surgical mask vs both PAPRs, P value = .588 and no hood PAPR vs hood PAPR, P value >.999).

DISCUSSION/CONCLUSIONS

Based on these findings, the tested PAPR configurations are effective at reducing aerosolized droplet contamination into a sterile field, and further testing is warranted to assess other PAPR configurations as well as PAPR suitability in an operating room.

Wearing long sleeves while prepping a patient in the operating room decreases airborne contaminants

BACKGROUND

The use of long sleeves by nonscrubbed personnel in the operating room has been called into question. We hypothesized that wearing long sleeves and gloves, compared with having bare arms without gloves, while applying the skin preparation solution would decrease particulate and microbial contamination.

METHODS

A mock patient skin prep was performed in 3 different operating rooms. A long-sleeved gown and gloves, or bare arms, were used to perform the procedure. Particle counters were used to assess airborne particulate contamination, and active and passive microbial assessment was achieved through air samplers and settle plate analysis. Data were compared with Student's t-test or Mann-Whitney U, and P < .05 was considered to be significant.

RESULTS

Operating room B demonstrated decreased 5.0- µm particle sizes with the use of sleeves, while operating rooms A and C showed decreased total microbes only with the use of sleeves. Despite there being no difference in the average number of total microbes for all operating rooms assessed, the use of sleeves specifically appeared to decrease the shed of Micrococcus.

CONCLUSION

The use of long sleeves and gloves while applying the skin preparation solution decreased particulate and microbial shedding in several of the operating rooms tested. Although long sleeves may not be necessary for all operating room personnel, they may decrease airborne contamination while the skin prep is applied, which may lead to decreased surgical site infections.

Twelve tips for medical students to maximise learning in theatre

BACKGROUND

Introduction into the clinical environment can be a daunting experience for medical students, especially in the operating theatre. Prior knowledge of how to prepare for theatre and cope with surgical placements is advantageous, as learning opportunities can be maximised from the start.

AIM

This article provides medical students with 12 tips devised to help make the most out of their initial theatre placements.

METHODS

Tips were formulated based on the experiences of three senior medical students and a review of the literature.

RESULTS

The 12 tips are (1) Know the patient and procedure, (2) Be familiar with your surgical department, (3) Familiarise yourself with different surgical attire, (4) Revise your clinical skills, (5) Be time-efficient, (6) Learn how to work in a sterile environment, (7) Avoiding syncope, (8) Impress the operating surgeon, (9) Be aware of the professional, ethical, and legal issues in surgery, (10) Use mentors to enhance your learning, (11) Embrace extra-curricular activities to enhance your insight into surgery and (12) Be acquainted with relevant support systems.

CONCLUSIONS

These 12 tips provide guidance and opportunities to maximise learning for new clinical-phase medical students being introduced to the operating theatre for the first time.

Surgical attire and the operating room: role in infection prevention

➤ Although there is some evidence that scrubs, masks, and head coverings reduce bacterial counts in the operating room, there is no evidence that these measures reduce the prevalence of surgical site infection.➤ The use of gloves and impervious surgical gowns in the operating room reduces the prevalence of surgical site infection.➤ Operating-room ventilation plays an unclear role in the prevention of surgical site infection.➤ Exposure of fluids and surgical instruments to the operating-room environment can lead to contamination. Room traffic increases levels of bacteria in the operating room, although the role of this contamination in surgical site infection is unclear.

Surgical attire, practices and their perception in the prevention of surgical site infection

INTRODUCTION

Clean surgical scrubs, surgical gowns and headgear are worn by operative teams to decrease bacterial contamination and lower surgical site infection (SSI) rates.

METHODS

A detailed review was undertaken of peer-reviewed publications and other sources of material in the English language over the last 50 years included.

RESULTS

Surgical scrubs should be clean and made of tightly woven material. Studies investigating single-use gowns and drapes versus reusable gowns report conflicting evidence. Double gloving may reduce SSI rates in procedures where no antibiotic prophylaxis was administered. Bacterial contamination of the operative field has been shown to be decreased by the wearing of surgical headgear by the operating team.

CONCLUSIONS

Further consideration and better trials are required to determine the impact of different theatre clothing on SSI rates.

Respiratory and facial protection: a critical review of recent literature

Infectious micro-organisms may be transmitted by a variety of routes. This is dependent on the particular pathogen and includes bloodborne, droplet, airborne, and contact transmission. Some micro-organisms are spread by more than one route. Respiratory and facial protection is required for those organisms which are usually transmitted via the droplet and/or airborne routes or when airborne particles have been created during 'aerosol-generating procedures'. This article presents a critical review of the recently published literature in this area that was undertaken by Health Protection Scotland and the Healthcare Infection Society and which informed the development of guidance on the use of respiratory and facial protection equipment by healthcare workers.

Laundering of theatre scrubs at home

Infections, particularly those caused by antibiotic-resistant gram-positive bacteria, such as methicillin-resistant staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), are a growing concern, particularly in units in which patients are immunosuppressed either intentionally (as for transplantation) or as a result of trauma (severe burns) or disease (such as acquired immunodeficiency disease) (Steinstraesser et al 2009). As more bacteria become resistant to antibiotics, our ability to control the spread of these bacteria with antibiotic treatments decreases (Steinstraesser et al 2009).

Wearing Surgical Attire Outside the Operating Room: A Survey of Habits of Anesthesiologists and Surgeons in Israel

BACKGROUND

Nurses observe regulations restricting the use of uncovered surgical attire outside the operating room (OR), but there are no guidelines for physicians nor data on their habits in this matter. We assessed physicians' attitudes and behavior about OR attire in non-OR areas.

STUDY DESIGN

A multicenter study was conducted among 106 units and departments in 23 university-affiliated, teaching and public hospitals and 2 private hospitals in Israel. Physicians were asked to respond "yes" or "no" to seven questions about their own habits of wearing OR attire outside the OR.

RESULTS

The response rate was 62.3%. More than one-half (53%) reported not observing any policy on wearing surgical attire outside the OR; 86% believed that such a policy is needed. Most (80%) left the OR area still wearing OR attire, 82% did not change to regular clothes later on, 63% responded that wearing covering apparel or a laboratory coat is acceptable, and 38% considered it obligatory to change to regular attire when leaving the OR. Most (71%) of the orthopaedic surgeons reported that they changed to regular clothing, compared with fewer gynecologists, general surgeons, and anesthesiologists. More anesthesiologists than other specialists covered themselves with some garment when leaving the OR area and 67% of them considered covering OR attire mandatory.

CONCLUSIONS

Israeli physicians behave differently with regard to wearing OR attire outside the OR. Orthopaedic surgeons and anesthesiologists are more disciplined, and gynecologists are the least observant. Most physicians recognize the importance of establishing strict guidelines of behavior.