Is it the gown or the precautions in its use?

Amewar,

172

Letters to the editor

INFECTION

The first full data exchange and transmission tween the Joint Commission and al2 hospitals not commence before, at the earliest, 1994. Carole

H. Patterson,

bewill

MN

Associate Director for Interpretation Department of Standards Joint Commission on Accreditation One Renaissance Blvd. Oakbrook Terrace, IL 60181

and Acting of Healthcare

Is it the go-wn or the premwtbns

Director Organizations

in Its use?

To the Editor: In the review of the article by Klein et al., entitled “Reduction of Nosocomial Infection During Pediatric Intensive Care by Protective isolation,” in your June issue,’ the authors cite the investigators’ conclusion “that the use of disposable, high-barrier gowns and gloves for the care of selected high-risk children who require prolonged intensive care significantly reduced the incidence of nosocomial infection. . .)I An examination of the methods used in the study indicates that a total of five different gowns-four disposable and one reuseable-were tested for filtration efficiency.Z Of the four disposable gowns, the brand made of a material that was reinforced with polypropylene proved to be the most effective. What this demonstrated was that bacteria were not able to penetrate the plastic-reinforced material as readily as they did the other disposable materials or the woven material used in the “hospital’s reusable cotton gown.” It was to be expected that a plasticreinforced material would be the least penetrable and confirms the findings reported by several independent clinical researchers.3-6 Their studies indicated that some nonwoven disposable quality materials remained impermeable for limited periods and some were almost immediately permeable. The same was found to be true with woven reusable materials. In those instances in which the nonwoven disposable materials were reinforced with a layer of plastic film or impregnated with plastic, the bacterial suspension accumulated only on the surface of the fabric and did not penetrate. Unfortunately, this latest study gives the impression that only one brand of disposable gown is made of a polypropylene-reinforced material. By the same token, considering today’s technical and complex textile world, to describe a woven material in such nebulous terms as “the hospital’s reusable cotton gown” is not only misleading but confusing. Therefore, neither of these statements should be interpreted to mean that there are no fabrics available from other sources-either disposable or reusable-

Joumai

:,f

CONTROL

that possess comparable filtration capabilities simply because they were not included in the study. What is particularly noteworthy is the reviewers’ comment that “actually, it is possible, even likely, that the same beneficial effects might have been achieved with the use of new clean gowns that were changed between patient contacts to decrease the likelihood of cross-infection.” This observation is not based on the contents of the paper as originally published but, rather, is the result of an exchange between one of your reviewers, Dr. Richard A. Garibaldi, and the study’s authors that subsequently appeared in the publication of record.’ In their response to Dr. Garibaldi’s inquiry, the researchers replied that “the use of a disposable gown increased the likelihood that the gown will be discarded after the patient contact during which it is used” and then continued by saying that “whether a garment with superior barrier properties such as the polypropylene gown we studied, may prove superior to a reusable cloth garment, as long as in either case the garment is not worn for prolonged periods, remains to be demonstrated.” Under these circumstances, the conclusion of the study now takes on a totally new dimension and one that could ultimately focus on how the gowns are used rather than on the barrier capabilities of the materials from which they are made. In the interim, what is lamentable is that the manufacturer of the brand of disposable gown reinforced with the polypropylene is referencing the Klein study in promoting their product as superior to all others. Nathan

I.. Eelkin,

Cleatwater,

PhD

Fla

References Reviews - Literature. Reduction of nosocomiai infection during pediatric intensive care by protective isolation. AM J INFECT CONTROL 1990;18:225-6. 2. Klein BS, Perloff WH, Maki DG. Reduction of nosocomial infection during pediatric intensive care by protective isolation. N Engl J Med 1989;320:4-21. 3. Laufman H, Eudy WW, Vandernoot AM, et al. Strike1.

through of moist contamination by woven and nonwoven surgical materials. Ann Surg 1975;181:857. 4. Laufman H, Siegal JD, Edberg SC. Moist bacterial strikethrough of surgical materials; confirmatory tests. Ann Surg 1979; 189:68. 5. Laufman H, Montefusco C, Siegal JD, et al. Scanning electron microscopy of moist bacterial strike-through of surgical materials. Surg Gynecol Obstet 1980; 150: 165. 6. Schwartz JT, Saunders DE. Microbial penetration of sur-

gical gown materials. 507. 7. Letters

to the

Editor.

Surg Gynecol N Engl

J Med

Obstet 1980;150: 1990;322:553.