For surgeons getting ready to enter the operating theatre,
the chances of contamination may be lower if they put their gowns on by
themselves – without the assistance of a surgical technician, according to an
experimental study in the Journal of
Orthopaedic Trauma
published by Wolters Kluwer.

Contamination occurs in most two-person assisted gowning
procedures, suggests the study by Kenton Panas, MD, and colleagues of The University
of Oklahoma Health Sciences Center, Oklahoma City. The researchers write,
“We suggest a single-person gowning step to help optimise sterile
technique in the OR.”.

The researchers designed an experiment to assess possible
breaches of sterility during the gowning step before surgery. The study
simulated a two-person gowning procedure in which a surgical technician unfolds
the gown and holds it open for the surgeon to slide his/her arms through.

The potential for contamination was monitored by coating the
surgical technician’s gown with a special resin that glows under ultraviolet
light. If any of the glowing resin was detected on the surgeon’s gown after the
procedure, it was considered a contamination event. Three orthopaedic surgeons
and three experienced technicians performed a total of 27 gowning procedures.

The results showed evidence of cross-contamination in 67% of
gowning procedures. All areas of contamination, as shown by glowing of the resin
under ultraviolet light, were on the sleeves of the surgical gown.

The surgeons and technicians were selected based on
variations in height: in both groups, one participant was tall, one medium
height, and one short. The surgeon’s height was a significant source of
variation, with the tallest surgeon having the greatest amount of contamination
of the gown of the sleeve.

The contamination rate was unaffected by technician’s
height, nor by the surgeon’s experience. In fact, the least-experienced surgeon
participating in the study had the lowest rate of gown contamination.

Following sterile technique is critical for everyone working
in the operating theatre. “Any breach of sterile technique can lead to
contamination, which ultimately may lead to infection,” the researchers
write. This is especially important in orthopaedic surgery because of the
frequent use of implantable materials. While several OR procedures have been
studied to assess their impact on contamination rates, this is the first study
to assess the process of putting on surgical gowns.

Cross-contamination of the surgeon’s gown is a common
occurrence during the standard two-person assisted gowning procedure, the new
findings suggest. The risk of contamination appears greater when gowning taller
surgeons – possibly because the longer sleeves are more likely to come into
contact with the technician’s gown.

While acknowledging their study’s small size, Dr Panas and
coauthors write, “this study identifies a common and overlooked pattern of
sterile field contamination.” They suggest that a single-person gowning
procedure – where the gown is handed to the surgeon, who then puts it on
without assistance – can eliminate this source of contamination and help to
optimise sterile technique in the operating theatre.

“Postoperative infections can be life changing in the
critically ill and can lead to permanent disability, loss of limb, or
worse,” Dr Panas comments. “We hope our work gives surgeons of all
specialties one more tool to accomplish our ultimate goal as healthcare
providers, which is the optimisation of patient care.”


Reference: Panas
K, et al. Surgical Gowning Technique: Are We Contaminated Before We
Cut? Journal of Orthopaedic Trauma. Published ahead of print 1 January 2019.