Advertisement

Wearing long sleeves while prepping a patient in the operating room decreases airborne contaminants

Published:November 30, 2017DOI:https://doi.org/10.1016/j.ajic.2017.10.016

      Highlights

      • Data used to support many practices in the operating room environment are supported by anecdotal data.
      • Certain regulatory agencies have suggested that nonscrubbed operating room personnel wear long sleeves while in the room.
      • Wearing long sleeves and gloves while prepping a mock patient led to decreased large-particle and microbial shedding compared with prepping with bare arms.
      • Wearing of long sleeves and gloves should be considered when applying the skin prep to patients before surgery.

      Background

      The use of long sleeves by nonscrubbed personnel in the operating room has been called into question. We hypothesized that wearing long sleeves and gloves, compared with having bare arms without gloves, while applying the skin preparation solution would decrease particulate and microbial contamination.

      Methods

      A mock patient skin prep was performed in 3 different operating rooms. A long-sleeved gown and gloves, or bare arms, were used to perform the procedure. Particle counters were used to assess airborne particulate contamination, and active and passive microbial assessment was achieved through air samplers and settle plate analysis. Data were compared with Student's t-test or Mann-Whitney U, and P < .05 was considered to be significant.

      Results

      Operating room B demonstrated decreased 5.0- µm particle sizes with the use of sleeves, while operating rooms A and C showed decreased total microbes only with the use of sleeves. Despite there being no difference in the average number of total microbes for all operating rooms assessed, the use of sleeves specifically appeared to decrease the shed of Micrococcus.

      Conclusion

      The use of long sleeves and gloves while applying the skin preparation solution decreased particulate and microbial shedding in several of the operating rooms tested. Although long sleeves may not be necessary for all operating room personnel, they may decrease airborne contamination while the skin prep is applied, which may lead to decreased surgical site infections.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hubble M.J.
        • Weale A.E.
        • Perez J.V.
        • Bowker K.E.
        • MacGowan A.P.
        • Bannister G.C.
        Clothing in laminar-flow operating theatres.
        J Hosp Infect. 1996; 32: 1-7
        • Tammelin A.
        • Blomfeldt A.M.
        Comparison of two single-use scrub suits in terms of effect on air-borne bacteria in the operating room.
        J Hosp Infect. 2017; 95: 324-326
        • Nordstrom J.M.
        • Reynolds K.A.
        • Gerba C.P.
        Comparison of bacteria on new, disposable, laundered, and unlaundered hospital scrubs.
        Am J Infect Control. 2012; 40: 539-543
        • Al-Benna S.
        Laundering of theatre scrubs at home.
        J Perioper Pract. 2010; 20: 392-396
        • Salassa T.E.
        • Swiontkowski M.F.
        Surgical attire and the operating room: role in infection prevention.
        J Bone Joint Surg Am. 2014; 96: 1485-1492
        • Moylan J.A.
        • Fitzpatrick K.T.
        • Davenport K.E.
        Reducing wound infections. Improved gown and drape barrier performance.
        Arch Surg. 1987; 122: 152-157
        • Garibaldi R.A.
        • Maglio S.
        • Lerer T.
        • Becker D.
        • Lyons R.
        Comparison of nonwoven and woven gown and drape fabric to prevent intraoperative wound contamination and postoperative infection.
        Am J Surg. 1986; 152: 505-509
        • Sanders R.
        • Fortin P.
        • Ross E.
        • Helfet D.
        Outer gloves in orthopaedic procedures. Cloth compared with latex.
        J Bone Joint Surg Am. 1990; 72: 914-917
        • Sebold E.J.
        • Jordan L.R.
        Intraoperative glove perforation. A comparative analysis.
        Clin Orthop Relat Res. 1993; 297: 242-244
        • Gormley T.
        • Markel T.A.
        • Jones H.
        • Greeley D.
        • Ostojic J.
        • Clarke J.H.
        • et al.
        Cost-benefit analysis of different air change rates in an operating room environment.
        Am J Infect Control. 2017; (pii: S0196-6553:30911-2)
        • Bischoff P.
        • Kubilay N.Z.
        • Allegranzi B.
        • Egger M.
        • Gastmeier P.
        Effect of laminar airflow ventilation on surgical site infections: a systematic review and meta-analysis.
        Lancet Infect Dis. 2017; 17: 553-561
        • Noguchi C.
        • Koseki H.
        • Horiuchi H.
        • Yonekura A.
        • Tomita M.
        • Higuchi T.
        • et al.
        Factors contributing to airborne particle dispersal in the operating room.
        BMC Surg. 2017; 17: 78
        • Andersen B.M.
        • Solheim N.
        Occlusive scrub suits in operating theaters during cataract surgery: effect on airborne contamination.
        Infect Control Hosp Epidemiol. 2002; 23: 218-220
        • AORN
        Guidelines for surgical attire.
        in: Guidelines for perioperative practice. 2015: 97-120
        • Benediktsdottir E.
        • Hambraeus A.
        Dispersal of non-sporeforming anaerobic bacteria from the skin.
        J Hyg (Lond). 1982; 88: 487-500
        • AORN Recommended Practices Committee
        Recommended practices for surgical attire.
        AORN J. 2005; 81: 413-420
        • Tammelin A.
        • Hambraeus A.
        • Stahle E.
        Routes and sources of Staphylococcus aureus transmitted to the surgical wound during cardiothoracic surgery: possibility of preventing wound contamination by use of special scrub suits.
        Infect Control Hosp Epidemiol. 2001; 22: 338-346
        • Alexiou K.
        • Drikos I.
        • Terzopoulou M.
        • Sikalias N.
        • Ioannidis A.
        • Economou N.
        A prospective randomised trial of isolated pathogens of surgical site infections (SSI).
        Ann Med Surg (Lond). 2017; 21: 25-29
        • Dapunt U.
        • Burkle C.
        • Gunther F.
        • Pepke W.
        • Hemmer S.
        • Akbar M.
        Surgical site infections following instrumented stabilization of the spine.
        Ther Clin Risk Manag. 2017; 13: 1239-1245
        • Kozon I.
        • Riahi S.
        • Lundbye-Christensen S.
        • Thogersen A.M.
        • Ejlertsen T.
        • Aaen D.
        • et al.
        Risk factors of cardiac device infection: glove contamination during device procedures.
        Am J Infect Control. 2017; 45: 866-871
        • Pineda M.
        • Burnett A.L.
        Penile prosthesis infections—a review of risk factors, prevention, and treatment.
        Sex Med Rev. 2016; 4: 389-398
        • Faulkner W.
        • Memarzadeh F.
        • Riskowski G.
        • Kalbasi-Ashtari A.
        • Ching-Zu Chang A.
        Effects of air exchange rate, particle size and injection place on particle concentrations within a reduced-scale room.
        Build Environ. 2015; 92: 246-255
        • Memarzadeh F.
        • Olmsted R.N.
        • Bartley J.M.
        Applications of ultraviolet germicidal irradiation disinfection in health care facilities: effective adjunct, but not stand-alone technology.
        Am J Infect Control. 2010; 38: S13-S24
        • Gormley T.
        • Markel T.A.
        • Jones 3rd, H.W.
        • Wagner J.
        • Greeley D.
        • Clarke J.H.
        • et al.
        Methodology for analyzing environmental quality indicators in a dynamic operating room environment.
        Am J Infect Control. 2017; 45: 354-359