- Email: [email protected]
False faith in the surgeon's gown and surgical drape
TheRmerlranQoucnalof
Ahrgecy
Copyright, 1952 by Ihe Ameruan Journal of Surgery, Inc.
A
PRACTICAL
JOURNAL
BUILT
ON
MERIT
VOL. LXXX111
NUMBER
FALSE FAITH
IN THE SURGEON’S GOWN DRAPE*
I
TWO
AND SURGICAL
some waterproof materral such as ceIIophane between the layers of the dressing. This can be confirmed by the simplest bacterioIogic experiments, but it is much more important in the operating theater where we reIy upon cIoth to become a bacteriologic barrier between the aseptic and the non-sterile heIds. Our experiments in vitro have been very simple. An agar Petri pIate was inoculated with a bacterial culture. SeveraI layers of steriIe cotton cIoth and cotton buck toweling were placed upon the plate and a second agar pIate placed against the first one. No growth appeared upon the second plate even after proIonged (several hours) exposure. A second series of plates were prepared in a simiIar manner. The same materiaIs were placed upon these plates and the cloths were moistened with sterile water. Agar plates were then placed against these moistened cloths momentarrly and incubated. Gross contaminatron appeared in each case. An attempt was made to produce a second plate culture to show this photographically. For this purpose the original plate was inoculated in the design of a cross. The “seeding” of the second plate was so great however, that the design did not appear upon the second plate. An attempt at an in two study was made. A surgeon was dressed in a sterile manner, wearing the usuaI operating room suit, cap, mask, gown and gIoves. A cuIture was taken by a moist swab from the front of his gown. The
N recent years there has been much research work on the preparation of the operative field, the aseptic preparation of the surgeons’ hands, surgical masks and of the sterilization of instruments and sutures.l The surgeons’ gowns and the drapes which are used to surround the operative field have, however, been more or Iess taken for granted. Tradrtion has dictated that one or more layers of sterile cotton cloth are an effective aseptic barrier between the undercIothes of the surgeon and the aseptic IieId. One or more layers of cotton sheeting or toweIing are often assumed to be an effective barrier between a non-sterile instrument table and the sterile instruments used m the operation, and between the patient’s body other than in the prepared area and the sterile lieId. Our experiments have indeed proven the validity of these assumptions under the condition that they are dry. If they become wet, all of the Iayers of cIoth become sieves to the passage of bacteria. This applies whether the agent is water, plasma or salt solution. Colebrook and Hood2 have showed that when wet dressings are employed, bacteria from the outermost layer of the dressing wander to the inside immediately. This passage of bacteria is immediately stopped by the interposition of 1L\'ALTEK, C. and CODDING, L&I.B. AseptIc Treatment of Wounds. New York, 1948. Macmillan Co. 2 COLEBROOK, L. and HOOD, A. M. Infection through soaked dressings. Lancet, 2: 682, 1948.
* From the Section on Surgery and Bacteriology,
‘25
Guthrie Chnic, Sayre, Pa.
126
EditoriaI
surgeon then washed his hands in the usual basin of sterile saline, splashing his gown in doing so. Another culture was taken in a similar manner from the moist area of his gown within a matter of a few seconds. The first culture was steriIe while the second was repIete with bacteria. These experiments have been qualitative not quantitative ones. No attempt was made to see whether any certain group or type of bacterium wandered more rapidly through the cIoth. Neither was any specia1 study made of the type of bacterium which appeared upon the surgeon’s gown after it had been wet with spIashed water. It is ampIy evident that wet cloth is not a barrier against bacteria1 contamination. This means that we must adopt certain changes in technic which wiI1 obviate this hazard. It wouId seem simpIest to repIace a11 cIoth with an impermeabIe, waterproof material. This is not the answer, nor is it desirable. If the skin of the patient or of the surgeon is incapable of “breathing,” there will be increased perspiration and intoIerabIe heat. We are at present experimenting with waterproofing materiaIs which preserve the porosity of the cloth. ProbabIy much can be accompIished, how-
ever, mereIy by the recognition that a wet drape is a contaminated drape. The instrument tables should be covered by a waterproof sterile drape or the entire tray shouId be sterile. If moistened packs are necessary at the wound margins, these shouId be we11 wrung out so that they wiI1 not moisten the drapes beyond the prepared heId. They shouId be narrow enough or @sopIaced that they are in contact onIy with the prepared area of skin. IdeaIIy, they shouId aIso be isoIated from this skin by a narrow piece of waterproof material which has been pIaced over the “wound towels.” If the surgeon’s gown has become wet by water, bIood or amniotic ffuid, it shouId be changed. UntiI some method is found to render cIoth either waterproof or bacteria-proof, the aforementioned methods shouId reduce the hazard of bacteria1 permeation of the aseptic barrier. In concIusion, dry cIoth is an aseptic barrier which Ioses all of its properties when it becomes wet. The recognition that any wet drape or gown is contaminated wiI1 prevent most danger from such contamination. A preventive method has been suggested. WM. C. BECK, M.D.AND THOMAS S.~OLLETTE,B.A.
American
Journal
of Surgery
Ahrgecy
Copyright, 1952 by Ihe Ameruan Journal of Surgery, Inc.
A
PRACTICAL
JOURNAL
BUILT
ON
MERIT
VOL. LXXX111
NUMBER
FALSE FAITH
IN THE SURGEON’S GOWN DRAPE*
I
TWO
AND SURGICAL
some waterproof materral such as ceIIophane between the layers of the dressing. This can be confirmed by the simplest bacterioIogic experiments, but it is much more important in the operating theater where we reIy upon cIoth to become a bacteriologic barrier between the aseptic and the non-sterile heIds. Our experiments in vitro have been very simple. An agar Petri pIate was inoculated with a bacterial culture. SeveraI layers of steriIe cotton cIoth and cotton buck toweling were placed upon the plate and a second agar pIate placed against the first one. No growth appeared upon the second plate even after proIonged (several hours) exposure. A second series of plates were prepared in a simiIar manner. The same materiaIs were placed upon these plates and the cloths were moistened with sterile water. Agar plates were then placed against these moistened cloths momentarrly and incubated. Gross contaminatron appeared in each case. An attempt was made to produce a second plate culture to show this photographically. For this purpose the original plate was inoculated in the design of a cross. The “seeding” of the second plate was so great however, that the design did not appear upon the second plate. An attempt at an in two study was made. A surgeon was dressed in a sterile manner, wearing the usuaI operating room suit, cap, mask, gown and gIoves. A cuIture was taken by a moist swab from the front of his gown. The
N recent years there has been much research work on the preparation of the operative field, the aseptic preparation of the surgeons’ hands, surgical masks and of the sterilization of instruments and sutures.l The surgeons’ gowns and the drapes which are used to surround the operative field have, however, been more or Iess taken for granted. Tradrtion has dictated that one or more layers of sterile cotton cloth are an effective aseptic barrier between the undercIothes of the surgeon and the aseptic IieId. One or more layers of cotton sheeting or toweIing are often assumed to be an effective barrier between a non-sterile instrument table and the sterile instruments used m the operation, and between the patient’s body other than in the prepared area and the sterile lieId. Our experiments have indeed proven the validity of these assumptions under the condition that they are dry. If they become wet, all of the Iayers of cIoth become sieves to the passage of bacteria. This applies whether the agent is water, plasma or salt solution. Colebrook and Hood2 have showed that when wet dressings are employed, bacteria from the outermost layer of the dressing wander to the inside immediately. This passage of bacteria is immediately stopped by the interposition of 1L\'ALTEK, C. and CODDING, L&I.B. AseptIc Treatment of Wounds. New York, 1948. Macmillan Co. 2 COLEBROOK, L. and HOOD, A. M. Infection through soaked dressings. Lancet, 2: 682, 1948.
* From the Section on Surgery and Bacteriology,
‘25
Guthrie Chnic, Sayre, Pa.
126
EditoriaI
surgeon then washed his hands in the usual basin of sterile saline, splashing his gown in doing so. Another culture was taken in a similar manner from the moist area of his gown within a matter of a few seconds. The first culture was steriIe while the second was repIete with bacteria. These experiments have been qualitative not quantitative ones. No attempt was made to see whether any certain group or type of bacterium wandered more rapidly through the cIoth. Neither was any specia1 study made of the type of bacterium which appeared upon the surgeon’s gown after it had been wet with spIashed water. It is ampIy evident that wet cloth is not a barrier against bacteria1 contamination. This means that we must adopt certain changes in technic which wiI1 obviate this hazard. It wouId seem simpIest to repIace a11 cIoth with an impermeabIe, waterproof material. This is not the answer, nor is it desirable. If the skin of the patient or of the surgeon is incapable of “breathing,” there will be increased perspiration and intoIerabIe heat. We are at present experimenting with waterproofing materiaIs which preserve the porosity of the cloth. ProbabIy much can be accompIished, how-
ever, mereIy by the recognition that a wet drape is a contaminated drape. The instrument tables should be covered by a waterproof sterile drape or the entire tray shouId be sterile. If moistened packs are necessary at the wound margins, these shouId be we11 wrung out so that they wiI1 not moisten the drapes beyond the prepared heId. They shouId be narrow enough or @sopIaced that they are in contact onIy with the prepared area of skin. IdeaIIy, they shouId aIso be isoIated from this skin by a narrow piece of waterproof material which has been pIaced over the “wound towels.” If the surgeon’s gown has become wet by water, bIood or amniotic ffuid, it shouId be changed. UntiI some method is found to render cIoth either waterproof or bacteria-proof, the aforementioned methods shouId reduce the hazard of bacteria1 permeation of the aseptic barrier. In concIusion, dry cIoth is an aseptic barrier which Ioses all of its properties when it becomes wet. The recognition that any wet drape or gown is contaminated wiI1 prevent most danger from such contamination. A preventive method has been suggested. WM. C. BECK, M.D.AND THOMAS S.~OLLETTE,B.A.
American
Journal
of Surgery