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Surgical Gowning Technique

Are We Contaminated Before We Cut?

Panas, Kenton, MD*; Wojcik, Jonathan, MD*; Falcon, Spencer, MD*; Hollabaugh, Kimberly, MS; Hickerson, Lindsay E., MD*

doi: 10.1097/BOT.0000000000001357
Original Article

Objectives: To assess possible breaches of sterility during the initial gowning step.

Design: Observational study. Twenty-seven gowning events were monitored for contamination during a simulated two-person gowning process in which a surgical technician assists a surgeon in the gowning process at the beginning of a surgical procedure. The lower portion of the technician's gown was coated with resin powder before the gowning process to simulate contamination.

Setting: Single-institution Level 1 trauma center.

Participants: Three physicians and 3 tenured surgical technicians.

Intervention: Observed contaminated areas represented by ultraviolet resin powder under ultraviolet light on the gown of the surgeon after the two-person gowning step.

Main Outcome Measurement: Number and surface area of contamination events.

Results: There was a 66.67% rate of contamination of the surgeon's gown sleeves while being gowned by a surgical technician. The overall median contamination for the short surgeon was 1.3 cm2. For the medium height surgeon, the overall median contamination was 1.4 cm2. The tall surgeon had an overall median contamination of 2.9 cm2. Of the short, medium, and tall surgeons, the number of contamination events was 6, 5, and 7, respectively. The study suggested that the surgeon's height was a significant source of variation (P = 0.046).

Conclusion: We present an observational pilot study that suggests that to reduce contamination in the operating room, the two-person method must be highly monitored. This study also proposes that the single-person gowning technique should be used to reduce contamination rate during the gowning process.

Departments of *Orthopedic Surgery and Rehabilitation, and

Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK.

Reprints: Kenton Panas, MD, Department of Orthopedic Surgery and Rehabilitation, The University of Oklahoma Health Sciences Center, 800 Stanton L Young Boulevard, Suite 3400, Oklahoma City, OK 73104 (e-mail:

The authors report no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Accepted September 28, 2018

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