McGovern P D, Albrecht M, Khan S K, Muller S D, Reed M R
Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY, UK.
J Orthop Sci. 2013 Nov;18(6):1027-30. doi: 10.1007/s00776-013-0445-7. Epub 2013 Aug 14.
Arthroplasty surgeons are increasingly using personal protection systems with helmets. It is theoretically possible for the fans in these helmets to blow squames, sweat droplets and orobronchial fomites onto the surgical site. A controlled experiment was set up to investigate the effect of different surgical gowns on counts of airborne particles measuring ≥0.3 μm, using a hand-held particle counter.
The clothing that was sequentially tested included the following: 1. Barrier(®) surgical gown (single use) made from nonwoven polypropylene (Mölnlycke Health Care Ltd, Dunstable, UK) 2. Stryker(®) T5 Helmet (reusable) covered with a disposable Stryker(®) T4/T5 urethane hood worn separate to and enclosed by the Barrier(®) surgical gown both at the front and back 3. Stryker(®) T5 Helmet (reusable) worn within a disposable Stryker(®) T4/T5 urethane zippered toga (Stryker Corporation, Kalamazoo, MI, USA) Six readings were taken for each of the following three setups in a randomised order: 1. Gown: surgeon with surgical gown and face mask 2. Hood: surgeon with surgical gown and hood, maximum fan speed 3. Toga: surgeon with toga, maximum fan speed Wilcoxon rank sum tests were applied to assess equality of means between the three occlusive measures (gown, hood, toga). P values were computed based upon one-sided tests and adjusted for multiple comparisons using the Bonferroni correction.
The mean particle counts (over more than 5 L of air) for the three set-ups were: gown: 1178 (least protective), hood: 328, toga: 42 (most protective). There was a significant reduction in particle counts for the toga versus gown (p = 0.007) and toga versus hood (p = 0.037); differences in particle counts were not significant between the hood and gown (p = 0.140).
The fans in the helmets do not increase contaminants by blowing particles from the head area. A significant reduction in surgeon-originated contaminants was seen with the toga compared to both the hood/gown separate ensemble and gowns alone.
关节置换外科医生越来越多地使用带头盔的个人防护系统。理论上，这些头盔中的风扇可能会将鳞屑、汗滴和口支气管污染物吹到手术部位。我们开展了一项对照实验，使用手持式粒子计数器来研究不同手术衣对直径≥0.3μm的空气中颗粒计数的影响。
依次测试的衣物包括：1. 由聚丙烯无纺布制成的Barrier（®）一次性手术衣（莫林医疗保健有限公司，英国邓斯特布尔）；2. Stryker（®）T5头盔（可重复使用），其覆盖有一次性Stryker（®）T4/T5聚氨酯头罩，该头罩穿在Barrier（®）手术衣外面且前后均被其包裹；3. Stryker（®）T5头盔（可重复使用），穿在一次性Stryker（®）T4/T5聚氨酯拉链长袍内（史赛克公司，美国密歇根州卡拉马祖）。对以下三种设置中的每一种随机进行六次读数：1. 手术衣：穿着手术衣和面罩的外科医生；2. 头罩：穿着手术衣和头罩的外科医生，风扇速度调至最大；3. 长袍：穿着长袍的外科医生，风扇速度调至最大。采用Wilcoxon秩和检验来评估三种封闭措施（手术衣、头罩、长袍）之间均值的相等性。P值基于单侧检验计算，并使用Bonferroni校正对多重比较进行调整。
三种设置下（超过5升空气）的平均颗粒计数分别为：手术衣：1178（防护性最差），头罩：328，长袍：42（防护性最佳）。长袍与手术衣相比（p = 0.007）以及长袍与头罩相比（p = 0.037），颗粒计数均有显著降低；头罩与手术衣之间的颗粒计数差异不显著（p = 0.140）。
头盔中的风扇不会通过将头部区域的颗粒吹起而增加污染物。与头罩/手术衣分开的组合以及单独的手术衣相比，长袍显著减少了外科医生产生的污染物。
