A study of operating gowns infection

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1 Vol.72 (Healthcare and ursing 2014), pp A study of operating gowns infection Hee Jeong Kim 1*, Eui Chan Jang 2 1* amseoul University, ursing, 91 aehak-ro,seongwan-eup, Sebuk-gu Chonan-si, Chungcheongnam-do, Korea yshbb@nsu,.ac.kr 2 Chung-Ang University, Orthopedic Surgery, 84 Heukseok-ro, ongjak-gu, Korea osguy123@unitel.co.kr Abstract. There are various recommendations about keeping operating gowns sterile, but the validity of these recommendations has not been definitively established. The purpose of this study was to use bacterial cultures to identify which areas of operating gowns are vulnerable to infection and which are safe against infection, as well as to find ways to improve bacterial identification and to prevent contamination. There were statistically significant differences according to year, as follows: F1, F4, B1, and B3. Based on 2009 s results, when assisting with putting on OR gowns, we wore sterile gloves, sterile vests, and helmet-shaped hats which cover the entire head area to prevent rear area infections. Also, we performed bacterial identification immediately after finishing operations in The results showed that in this study, the areas of F1, F4, B1, B3, and B4 exhibited significant differences in bacterial identification. Keywords: operation, infection, operating room, operating gowns 1 Introduction There is always a risk of post-operative infection with every surgical intervention [1], and it can have a great effect on patient outcomes. In addition, post-operative infections increase the length of stay and the use of antibiotics, and they induce an increase in medical costs, causing legal, ethical, and other problems. Therefore, while many precautionary measures are being undertaken to prevent infections, there are still many infections which are acquired in hospital operating rooms due to environmental factors and the carelessness of medical personnel. Ritter et al. reported a 35-fold increase in colony-forming units per hour in operating rooms with five people present over the colony-forming rate in an empty operating rooms. In addition, contaminants were found on surgical knives, suction tips, and gloves. In particular, the probability of damage to gloves was reported to be between 9 and 37% [5-6]. Several others, citing empirical recommendations [2-4], stipulate that the areas near the axillae or the neckline may represent the upper limits of the sterile zone. In order to perform sterile surgeries, it is important to determine the exact boundaries of the sterile areas of the surgical gowns and those areas which could lead to infection. ISS: ASTL Copyright 2014 SERSC

Vol.72 (Healthcare and ursing 2014) Although J.

The purpose of this study was to use bacterial cultures to identify which areas of operating gowns are vulnerable to infection and which are safe against infection, as well as to find ways to improve

2 Methodology The general characteristics of the bacterial identification results were analyzed using descriptive statistics, and differences in homogeneity were accounted for by t-test.

2 Vol.72 (Healthcare and ursing 2014) Although J.. Grauer has reported that the areas from the surgical field to chest area and the elbow region are relatively sterile sites, no domestic reports on this yet exist. The purpose of this study was to use bacterial cultures to identify which areas of operating gowns are vulnerable to infection and which are safe against infection, as well as to find ways to improve bacterial identification and to prevent contamination. 2 Methodology The general characteristics of the bacterial identification results were analyzed using descriptive statistics, and differences in homogeneity were accounted for by t-test. Operative times were as follows: in 2009, 2 surgeries took 1-2 hours; 3 surgeries took 2-3 hours; and 15 surgeries took 3-4 hours. In 2010, 4 surgeries took 1-2 hours; 4 surgeries took 2-3 hours; and 12 surgeries took 3-4 hours. We identified the bacteria on the front and back areas of the doctor s operating gowns and and the scrub nurse s operating gowns. We thereafter evaluated gown sterility to assess the legitimacy of these guidelines. We used sterile culture swabs to obtain samples from the gown fronts in 6-inch increments starting from a location 15 inches above the ground, for a total of 7 times. The samples from the rear were obtained four times in 8 inch by 30 inch intervals from the bottom. The culturing and identification process was carried out by one person. The cultures in 2010 were taken using the same basic method that we used in However, the 2010 method included some improvements we made after analyzing the results from We used disposable operating gowns made by Yuhan-Kimberly; tests were performed using one gown per person. We assigned names to different regions as follows: F1 (front of the clavicle); F2 (chest); F3 (abdominal area); F4 (groin area); F5 (proximal femur area); F7 (knee area); B1 (rear of the proximal scalp area); B2 (distal scalp area); B3 (iliac crest area); and B4 (buttock area) <Figure 1>. Bacterial identification was performed using Rodac plates; 24 hours after the cultures were taken, we compared colony growth rates per plate <Figure 2>. Cultured bacteria were identified using Gram stain and bacterial processes. Fig.1. Operating gown areas of bacterial identification Fig. 2. Rodac plate Copyright 2014 SERSC 69

3 Vol.72 (Healthcare and ursing 2014) 3 Result <Table 1> shows as follow. In 2009, among operations lasting 1-2 hours, there were 3 cases of bacterial growth in the surgeon s F1, the scrub nurse s B1, and the scrub nurse s B3. Among operations lasting 2-3 hours, there were: 15 cases of bacterial growth in the surgeon s F1 and F6; 9 cases in the scrub nurse s B1; 2 cases in B2; and 1 case in B4. Among the 15 operations lasting 3-4 hours, there were 30 cases of bacterial growth in F1 of the surgeon s operating gown. Additionally, 9 cases showed growth in F4; F5, 3 cases; F6, 9 cases; and F7, 3 cases. On the front of the scrub nurse s OR gown, bacterial growth was identified in F1 in 50 cases; F4, 6 cases; F5, 4 cases; F6, 6 cases; and F7, 8 cases. In the rear of the surgeon s OR gown, bacterial growth was identified in B1 in 41 cases; B2, 6 cases; B3, 12 cases; and B4, 16 cases. On the scrub nurse s OR gown, growth in B1 was identified in 62 cases; B2, 3 cases; B3, 5 cases; and B4, 7 cases. Based on 2009 s results, when assisting with putting on OR gowns, we wore sterile gloves, sterile vests, and helmet-shaped hats which cover the entire head area to prevent rear area infections <Figure 3>. Also, we performed bacterial identification immediately after finishing operations in In 2010, among operations lasting 1-2 hours, bacterial growth was observed on the front of scrub nurse s operating gowns in F1 in 2 cases and in F3 in 10 cases. For operations lasting 2-3 hours, bacterial growth was observed in F1 in 2 cases. For operations lasting 3-4 hours, there were several cases of bacterial growth: in F1, 21 cases; F5, 2 cases; F6, 6 cases; and F7, 6 cases. There were statistically significant differences according to year, as follows: F1 (t=2.133, p=.034); F4 (t=2.341, p=.020); B1 (t=3.495, p<.001); and B3(t=2.315, p=.022) <Table 2>. Table 1: umber of colonies of isolated bacteria Year OP Categories umber of OP F1 F2 F3 F4 F5 F6 F7 B1 B2 B3 B ~2 2~3 3~4 1~2 2~3 Front Back Front Back Front Back Front Back Front Back Front Back Front Front Front Front Back Copyright 2014 SERSC

Vol.72 (Healthcare and ursing 2014) 3~4 Front 12 20 0 0 2 3 8 3 - - - - Back 12 - - - - - - - 18 2 4 6 Front 12 21 0 0 0 2 6 6 - - - - Back 12 - - - - - - - 19 1 1 6 OP: Operation; : octor s Gown; :

. Grauer et al [5], the region from the surgical field to the chest area, the elbow, and the area below elbow are relatively sterile sites, so we should always be careful not to contaminate these

4 Vol.72 (Healthcare and ursing 2014) 3~4 Front Back Front Back OP: Operation; : octor s Gown; : urse s Gown Figure 3: Operation vest and hat 4 iscussion According to J.. Grauer et al [5], the region from the surgical field to the chest area, the elbow, and the area below elbow are relatively sterile sites, so we should always be careful not to contaminate these areas by touching other areas. In this present study conducted in 2009, among surgeries lasting less than three hours, there were hardly any bacterial cultures. But in surgeries lasting more than three hours, we found many bacterial cultures in areas such as the front of the shoulder, groin, knee, and the back of the shoulder bacterial identification. To reduce infection rates in operating rooms, it is necessary to correctly wear gowns, hats, and masks and to keep one's hair neatly trimmed.. Additionally, it is very important to maintain correct neck posture because over flexion or overextension of the neck can cause contamination if the chin, occipital area, or operation hat touches the gown. Table 2: ifferences in bacterial identification with respect to operation year This was supported by several studies [6-8], indicating that operation times cause differences in Variables M±S M±S t/f p F1 1.01± ± F2.01± ± F3.01±.11.00± F4.17±.54.00± F5.07±.26.08± F6.12±.46.14± F7 3.44± ± B1 1.41± ± B2.12±.37.04± B3.26±.70.06± B4.30±.83.16± Copyright 2014 SERSC 71

5 Vol.72 (Healthcare and ursing 2014) Acknowledgments. We acknowledge certain limitations of this study. We did not obtain negative control swabs immediately before each operation, and the data was small. Also, we didn t know the severity of contamination among several bacterial identifications. References 1. Jesse, E., Bible B. S., ebdut Biswas, B. A.,Peter, G. W., Andrew K. S., Jonathan,. G., Which regions of the operating gown should be considered most sterile? Clin Orthop Relat Res. 467, pp (2009) 2. Boess-Lott, R., Stecik,, S.: The Ophthalmic Surgical Assistant. 1 st Ed. Thorofare, J: Slack Inc; (1999). 3. Spry C. Essentials of Perioperative ursing. 2nd Ed. Gaithersburg, M: Aspen Publishers; (1997). 4. Whalan, C.: Assisting at Surgical Operations: A Practical Guide. Cambridge, UK: Cambridge University Press; (2006) 5. Grauer, J.., Bible, J. E., Biswas,., Whang, P. G., Simpson, A. K.: Which Regions of the Operating Gown Should be Considered Most Sterile?. Clin Orthop Relat Res. 467, (2009) 6. Baird, R.A., ickel, F,R., Thrupp,,L., Rucker, S., Hawkins, B.: Splash basin contamination in orthopedic surgery. Clin Orthop Relat Res. 187, (1984) 7. Andersson, B.M., Lidgren, L., Schal en, C., Steen, A.: Contamination of irrigation solutions in an operating theatre. Infect Control. 7, (1984) 8. Greenough, C.G.: An investigation into contamination of operative suction. J Bone Joint Surg Br. 68, (1986) 72 Copyright 2014 SERSC

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