Factors that influence the effectiveness of surgical gowns in the operating theatre

Abstract

Objective: To compare the barrier function, comfort, and protection afforded by nine types of surgical gowns during use and to identify factors that may influence their effectiveness.

Design: Prospective randomised study.

Setting: Teaching hospital, Greece.

Material: 4 Types of disposable single layer gowns, 1 reusable cloth gown, and 4 types of disposable reinforced gowns used during 250 major operations by the surgeon and first assistant (total n = 500).

Interventions: Direct observation by specially trained nurse and questionnaire to surgeons.

Main outcome measures: Contamination of the outside of the gown, blood strike through, safety, and comfort.

Results: Half of all gowns became contaminated on the outside. The mean total rate of strike through was 90% in reusable gowns (528/586 areas contaminated), 11% in disposable single layer gowns (95/855 areas contaminated), and 3% in disposable reinforced gowns (42/1407 areas contaminated). There were differences in strike through among the disposable gowns depending on the material and design, the reinforced gowns consistently showing less strike through than the single layer ones. The areas most vulnerable to strike through were the cuff, forearm, thigh, chest, and abdomen. From 80% to 99% of surgeons felt comfortable and protected wearing disposable gowns, but only 0 to 4% of surgeons felt comfortable and safe with reusable gowns.

Conclusions: Reusable cloth gowns have a high strike through rate and were rejected by most surgeons. Reinforced disposable gowns provided better protection. The highest strike through was at the cuffs, forearms, and thighs, and this requires new designs for surgical gowns.