Objective: Experiments were performed to determine the risk of bacterial contamination associated with changing outer gloves and using disposable spunlace paper versus reusable cloth gowns.
Background: Despite decades of research, there remains a lack of consensus regarding certain aspects of optimal aseptic technique including outer glove exchange while double-gloving and surgical gown type selection.
Methods: In an initial glove study, 102 surgical team members were randomized to exchange or retain outer gloves 1 hour into clean orthopedic procedures; cultures were obtained 15 minutes later from the palm of the surgeon's dominant gloved hand and from the surgical gown sleeve. Surgical gown type selection was recorded. A laboratory strike-through study investigating bacterial transmission through cloth and paper gowns was performed with coagulase-negative staphylococci. In a follow-up glove study, 251 surgical team members, all wearing paper gowns, were randomized as in the first glove study.
Results: Glove study 1 revealed 4-fold higher levels of baseline bacterial contamination (31% vs 7%) on the sleeve of surgical team members wearing cloth gowns than those using paper gowns [odds ratio (95% confidence interval): 4.64 (1.72–12.53); P = 0.0016]. The bacterial strike-through study revealed that 26 of 27 cloth gowns allowed bacterial transmission through the material compared with 0 of 27 paper gowns (P < 0.001). In glove study 2, surgeons retaining outer gloves 1 hour into the case had a subsequent positive glove contamination rate of 23% compared with 13% among surgeons exchanging their original outer glove [odds ratio (95% confidence interval): 1.97 (1.02–3.80); P = 0.0419].
Conclusions: Paper gowns demonstrated less bacterial transmission in the laboratory and lower rates of contamination in the operating room. Disposable paper gowns are recommended for all surgical cases, especially those involving implants, because of the heightened risk of infection. Outer glove exchange just before handling implant materials is also recommended to minimize intraoperative contamination.
Surgical gown sleeve contamination was 31% with reusable cloth gowns versus 7% with disposable paper gowns. A strike-through study confirmed greater bacterial transmission through cloth gowns (96% vs 0%). Using only paper gowns, outer glove exchange 1 hour into surgery decreased subsequent glove contamination (13%) compared with glove retention (23%).
*Wake Forest University Health Sciences, Winston Salem, NC
†Obstetrics and Gynecology, Wexner Medical Center at The Ohio State University, Columbus
‡Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison
§Resident, Emergency Medicine, Orlando Regional Medical Center, Orlando, FL
¶Department of Biostatistical Sciences, Wake Forest Baptist Health, Winston Salem, NC
‖Infectious Diseases, Wake Forest Baptist Medical Center, Winston Salem, NC. Dr. Ward is now with Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, PA.
Reprints: William G. Ward, Sr, MD, Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, PA 18840. E-mail: Ward_William@Guthrie.org.
All work was performed at Wake Forest Baptist Medical Center, Winston-Salem, NC.
Disclosure: Supported by Harry R. Culp Fund for Medical Research at Wake Forest University and unrestricted research grant monies provided by the Musculoskeletal Transplant Foundation, NIH Medical Student Summer Research Program Grant, and Biomet Incorporated. None of the authors have any conflicts of interest in connection with this article.