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Sterile technique is obviously a key factor in avoiding surgical infections. We go to great lengths to scrub our hands, gown up, glove up and use other equipment (eg. masks, hats, etc.) to minimize the risks of introducing microbial contamination to surgical fields.
But are some of the processes we use for sterility flawed? A recent study () looked at the process of surgical gowning using the “2-person” technique. In the 2-person technique a surgical assistant or other persn assists a surgeon in the gowning process. The researchers applied an ultraviolet (UV) resin powder to the lower portion of technicians’ gowns to simulate contamination. They then observed the gowns of the surgeons under UV light to assess whether “contamination” had taken place.
Overall, there was a 66.67% rate of contamination of the surgeon’s gown sleeves while being gowned by a surgical technician. But, most interestingly, the degree of contamination varied with the height of the surgeon. Median contamination for the short surgeon was 1.3 cm2, 1.4 cm2 for the medium height surgeon, the overall median contamination was 1.4 cm2, and 2.9 cm2 for the tall surgeon.
Note that the technician’s height did not matter, nor did the experience level of the surgeon.
The authors suggest that the two-person method must be highly monitored or that the single-person gowning technique should be used to reduce contamination rate during the gowning process.
The study only involved 3 surgeons (1 short, 1 tall, and 1 medium height) and 3 technicians and only 27 gowning events were observed, so the generalizability of the findings may be limited. We are also unaware of any statistics comparing surgical infection rates by method of gowning (or by physician height!). But the Panas study is most interesting. A retrospective analysis would likely be difficult because the method of gowning is not likely to have been recorded anywhere. But, particularly if 2-person gowning is the standard practice at a facility, it would be of interest to compare surgical infection rates by surgeon height.
This interesting finding needs further study. But sometimes it’s the small things that matter!
Panas K, Wojcik J, Falcon S, et al. Surgical Gowning Technique. Are We Contaminated Before We Cut? Journal of Orthopaedic Trauma 2019; Publish Ahead of Print January 01, 2019