Fraser James F, Young Simon W, Valentine Kimberly A, Probst Nicholas E, Spangehl Mark J
Department of Orthopaedic Surgery, Banner Good Samaritan Hospital, 1320 N 10th Street, Suite A, Phoenix, AZ, 85006, USA,
Clin Orthop Relat Res. 2015 Jul;473(7):2291-7. doi: 10.1007/s11999-014-4094-8.
The original Charnley-type negative-pressure body exhaust suit reduced infection rates in randomized trials of total joint arthroplasty (TJA) decades ago. However, modern positive-pressure surgical helmet systems have not shown similar benefit, and several recent studies have raised the question of whether these gowning systems result in increased wound contamination and infections. The gown-glove interface may be one source of particle contamination.
QUESTIONS/PURPOSES: The purpose of this study was to compare particle contamination at the gown-glove interface in several modern surgical helmet systems and conventional surgical gowns.
A 5-μm fluorescent powder was evenly applied to both hands to the level of the wrist flexion crease. After gowning in the standard fashion, the acting surgeon performed a 20-minute simulated TJA protocol. Each of the five gowning systems was run through five trials. The amount of gown contamination at the gown-glove interface then was measured by three observers under ultraviolet light using a grading scale from 0 (no contamination) to 4 (gross contamination). Statistical analysis was carried out with Minitab 15. Friedman's test was used to compare the levels of contamination across trials for each gown and the Mann-Whitney test was used post hoc to perform a pairwise comparison of each gown.
All gown-glove interfaces showed some contamination. Friedman's test showed that there was a significant difference in contamination between gowns (p = 0.029). The Stryker T5 Zipper Toga system showed more contamination than the other gowns. The median contamination score and range for each gowning setup was 1.8 (range, 1-4; conventional Kimberly-Clark MicroCool gown without helmet), 4 (range, 3-4; Stryker T5 Zipper Toga), 3.6 (range, 0-4; Stryker helmet with conventional gown), 1.6 (range, 0-2; Stryker Flyte Toga), and 3.0 (range, 2-3; DePuy Toga). A Mann-Whitney test found no difference among any of the gowns except for the Stryker T5 Zipper Toga, which showed more contamination compared directly with each of the other four gowns (p < 0.001 for each gown-to-gown comparison).
Particle contamination occurs at the gown-glove interface in most commonly used positive-pressure surgical helmet systems. The Stryker T5 Zipper Toga exhibited more contamination than each of the other gowning systems.
The gown-glove interface is prone to particle contamination and all surgeons should be aware of this area as a potential source of surgical site infection. Although future studies are needed to clarify the link between particle contamination through this route and clinical infection, surgeons should consider using gowning systems that minimize the migration of fomites through the gown-glove interface.
几十年前，在全关节置换术（TJA）的随机试验中，最初的Charnley型负压全身排气服降低了感染率。然而，现代正压手术头盔系统并未显示出类似的益处，最近的几项研究提出了这些着装系统是否会导致伤口污染和感染增加的问题。手术衣与手套的接口可能是颗粒污染的一个来源。
问题/目的：本研究的目的是比较几种现代手术头盔系统和传统手术衣在手术衣与手套接口处的颗粒污染情况。
将一种5微米的荧光粉均匀地涂在双手至腕部屈褶处。按照标准方式穿上手术衣后，主刀医生执行一个20分钟的模拟TJA方案。五种着装系统中的每一种都进行了五次试验。然后，由三名观察者在紫外线下使用从0（无污染）到4（严重污染）的分级量表测量手术衣与手套接口处的手术衣污染量。使用Minitab 15进行统计分析。Friedman检验用于比较每种手术衣在各试验中的污染水平，事后使用Mann-Whitney检验对每种手术衣进行两两比较。
所有手术衣与手套的接口都有一定程度的污染。Friedman检验表明，不同手术衣之间的污染存在显著差异（p = 0.029）。史赛克T5拉链式手术袍系统的污染比其他手术衣更多。每种着装设置的污染评分中位数及范围分别为：1.8（范围，1 - 4；无头盔的传统金佰利微孔凉爽手术衣），4（范围，3 - 4；史赛克T5拉链式手术袍），3.6（范围，0 - 4；配有传统手术衣的史赛克头盔），1.6（范围，0 - 2；史赛克Flyte手术袍），以及3.0（范围，2 - 3；迪普伊手术袍）。Mann-Whitney检验发现，除史赛克T5拉链式手术袍外，其他任何手术衣之间均无差异，与其他四种手术衣直接比较时，史赛克T5拉链式手术袍的污染更多（每种手术衣两两比较的p < 0.001）。
在最常用的正压手术头盔系统中，手术衣与手套的接口处会发生颗粒污染。史赛克T5拉链式手术袍的污染比其他着装系统更多。
手术衣与手套的接口容易出现颗粒污染，所有外科医生都应意识到该区域是手术部位感染的潜在来源。尽管需要未来的研究来阐明通过此途径的颗粒污染与临床感染之间的联系，但外科医生应考虑使用能将污染物通过手术衣与手套接口迁移降至最低的着装系统。
