Sterile Parts of Operating Gown during Lower Limb Joint Replacement Surgery



1 Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Bone Joint and Related Tissues Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran


Background: The prevention of surgical site infection is one of the most concerning issues in operating rooms. Surgical
gowns are worn as one of the intraoperative strategies for infection prevention. The present study investigated whether
the gowns remained sterile during the surgical procedure. Furthermore, this study examined which parts of the surgical
gown were more prone to contamination.
Methods: The sterility of the gowns was investigated during eight total joint arthroplasties all of which were performed
by four surgeons. The samples were taken from the arms and frontal part of the sterile gowns pre- and postoperatively.
In the anterior surface of the gown, the sampling was initiated at a strip with 50 cm height from the ground followed
by the strips with 15 cm distances from caudal to cephalad. Furthermore, the frontal part of the gown was divided
into three parts in relation to the operating room table. Finally, the contamination rate was evaluated in each part. A
semiquantitative method was used for the analysis of bacterial culture.
Results: Before the operation, there were four samples tested positive for bacterial culture (1.06%). All of these samples
were taken from the most proximal strip near the neckline. After the surgery, the rate of contamination in the strips on
the frontal part of the gown was reported as 3.1% to 53%. Based on the operating table, the contamination rate was
35.9%, 8.9%, and 47.3% in the distal, middle, and proximal parts of the gown, respectively. The contamination rate at
the elbow crease was 23%, and at 5 and 10 cm above the creases were 24% and 36%, respectively.
Conclusion: The high rate of gown contamination during the operation is concerning. However, part of the gown that
was in contact with the operating room table remained clean most of the time. More safe strategies should be used for
infection prevention in operating rooms.
Level of evidence: IV


Main Subjects