Sterile Parts of Operating Gown during Lower Limb Joint Replacement Surgery

Document Type : RESEARCH PAPER

Authors

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

Abstract

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

Keywords

Main Subjects

References

1. Learmonth ID, Young C, Rorabeck C. The operation
of the century: total hip replacement. Lancet. 2007;
370(9597):1508-19.
2. Skou ST, Roos EM, Laursen MB. A randomized,
controlled trial of total knee replacement. N Engl J
Med. 2015; 373(7):692.
3. Rowan FE, Donaldson MJ, Pietrzak JP, Haddad
FS. The role of one-stage exchange for prosthetic
joint infection. Curr Rev Musculoskelet Med. 2018;
11(3):370-9.
4. Bozic KJ, Ong K, Lau E, Berry DJ, Vail TP, Kurtz SM,
et al. Estimating risk in Medicare patients with THA:
an electronic risk calculator for periprosthetic joint
infection and mortality. Clin Orthop Relat Res. 2013;
471(2):574-83.
5. Gulihar A, Taub NA, Taylor GJ. A randomised
prospective comparison of Rotecno versus new Gore
occlusive surgical gowns using bacterial air counts in
ultraclean air. J Hosp Infect. 2009; 73(1):54-7.
6. Del Pozo JL, Patel R. Infection associated with
prosthetic joints. N Engl J Med. 2009; 361(8):787-94.
7. Dowsey MM, Choong PF. Obese diabetic patients are
at substantial risk for deep infection after primary
TKA. Clin Orthop Relat Res. 2009; 467(6):1577-81.
8. Albuhairan B, Hind D, Hutchinson A. Antibiotic
prophylaxis for wound infections in total joint
arthroplasty: a systematic review. J Bone Joint Surg
Br. 2008; 90(7):915-9.
9. Glenny AM, Song F. Antimicrobial prophylaxis in total
hip replacement: a systematic review. Health Technol
Assess. 1999; 3(21):1-57.
10. Darouiche R. Treatment of infections associated
with surgical implants. N Engl J Med. 2004; 350(14):
1422-9.
11. Ong KL, Lau E, Suggs J, Kurtz SM, Manley MT. Shortterm
complication risk following primary and
revision total joint arthroplasty. 55th Annual Meeting
of the Orthopaedic Research Society, Las Vegas, NV;
February 22-25, 2009.
12. Hansen E, Belden K, Silibovsky R, Vogt M, Arnold W,
Bicanic G, et al. Perioperative antibiotics. J Orthop
Res. 2014; 32(Suppl 1):S31-59.
13. Ritter MA. Surgical wound environment. Clin Orthop
Relat Res. 1984; 190(1):11-3.
14. Ritter MA, French ML, Hart JB. Microbiological studies
in a horizontal wall-less laminar air-flow operating
room during actual surgery. Clin Orthop Relat Res.
1973; 97(1):16-8.
15. Ricciardi BF, Bostrom MP, Lidgren L, Ranstam J,
Merollini KM, W-Dahl A. Prevention of surgical site
infection in total joint arthroplasty: an international
tertiary care center survey. HSS J. 2014; 10(1):45-51.
16. Merollini KM, Zheng H, Graves N. Most relevant
strategies for preventing surgical site infection after
total hip arthroplasty: guideline recommendations
and expert opinion. Am J Infect Control. 2013;41(3):221-6.
17. Baldini A, Blevins K, Del Gaizo D, Enke O, Goswami
K, Griffin W, et al. General assembly, prevention,
operating room - personnel: proceedings of
international consensus on orthopedic infections. J
Arthroplasty. 2018; 34(2S):S97-104.
18. Seto WH, Tsang D, Yung RW, Ching TY, Ng TK, Ho
M, et al. Advisors of Expert SARS group of Hospital
Authority. Effectiveness of precautions against
droplets and contact in prevention of nosocomial
transmission of severe acute respiratory syndrome
(SARS). Lancet. 2003; 361(9368):1519-20.
19. Tang JW, Li Y, Eames I, Chan PK, Ridgway GL. Factors
involved in the aerosol transmission of infection and
control of ventilation in healthcare premises. J Hosp
Infect. 2006; 64(2):100-14.
20. Fraser JF, Young SW, Valentine KA, Probst NE,
Spangehl MJ. The gown-glove interface is a source
of contamination: a comparative study. Clin Orthop
Relat Res. 2015; 473(7):2291-7.
21. Ward WG Sr, Cooper JM, Lippert D, Kablawi RO,
Neiberg RH, Sherertz RJ. Glove and gown effects on
intraoperative bacterial contamination. Ann Surg.
2014; 259(3):591-7.
22. Lankester BJ, Bartlett GE, Garneti N, Blom AW, Bowker
KE, Bannister GC. Direct measurement of bacterial
penetration through surgical gowns: a new method.
J Hosp Infect. 2002; 50(4):281-5.
23. Noguchi C, Koseki H, Horiuchi H, Yonekura A, Tomita
M, Higuchi T, et al. Factors contributing to airborne
particle dispersal in the operating room. BMC Surg.
2017; 17(1):78.
24. Bible JE, Biswas D, Whang PG, Simpson AK, Grauer
JN. Which regions of the operating gown should be
considered most sterile? Clin Orthop Relat Res. 2009;
467(3):825-30.
25. Greenough CG. An investigation into contamination
of operative suction. J Bone Joint Surg Br. 1986;
68(1):151-3.
26. Maki D. Lister revisited: surgical antisepsis and
asepsis. N Engl J Med. 1976; 294(23):1286-7.
27. Moylan JA, Kennedy BV. The importance of gown and
drape barriers in the prevention of wound infection.
Surg Gynecol Obstet. 1980; 151(4):465-70.
28. Moylan JA, Fitzpatrick KT, Davenport KE. Reducing
wound infections: improved gown and drape barrier
performance. Arch Surg. 1987; 122(22):152-7.
29. Baldwin BC, Fox IL, Russ C. Affect of disposable
draping on wound infection rate. Va Med. 1981;
108(7):477.
30. Smith JW, Nichols RL. Barrier efficiency of surgical
gowns: are we really protected from our patients’
pathogens? Arch Surg. 1991; 126(6):756-63.
31. Granzow JW, Smith JW, Nichols RL, Waterman
RS, Muzik AC. Evaluation of the protective value
of hospital gowns against blood strike-through 
and methicillin-resistant Staphylococcus aureus
penetration. Am J Infect Control. 1998; 26(2):85-93.
32. Hill J, Howell A, Blowers R. Effect of clothing on
dispersal of Staphylococcus aureus by males and
females. Lancet. 1974; 2(7889):1131-3.
33. Mills SJ, Holland DJ, Hardy AE. Operative field
contamination by the sweating surgeon. Aust N Z J
Surg. 2000; 70(12):837-9.
34. Davies RR, Noble WC. Dispersal of bacteria in
desquamated skin. Lancet. 1962; 2(7269):1295-7.
35. Whyte W, Vesley D, Hodgson R. Bacterial dispersion
in relation to operating room clothing. J Hyg. 1976;
76(3):367-8.
36. Dineen P, Drusin L. Epidemics of postoperative
wound infections associated with hair carriers.
Lancet. 1973; 302(7839):1157-9.
37. Whyte W. The role of clothing and drapes in the
operating room. J Hosp Infection. 1988; 11(Suppl
C):2-17
38. Andersson AE, Bergh I, Karlsson J, Eriksson BI,
Nilsson K. Traffic flow in the operating room: an
explorative and descriptive study on air quality
during orthopedic trauma implant surgery. Am J
Infect Control. 2012; 40(8):750-5.
39. Dharan S, Pittet D. Environmental controls in
operating theatres. J Hosp Infect. 2002; 51(2):79-84.
The Archives of Bone and Joint Surgery
Volume 7, Issue 4
July 2019
Pages 354-359

Files

History

  • Receive Date: 16 August 2018
  • Revise Date: 06 January 2019
  • Accept Date: 10 January 2019

Share

How to cite

Statistics