This article appeared in the November/December issue of Surgical Products.

The selection of proper surgical apparel and how it is worn in the operating room are critical to creating a safe operating room environment for both hospital patients and staff.  Bloodborne pathogens and various microorganisms are a constant presence and threat in the OR. However, despite myriad infection control concerns, proper surgical apparel purchasing choices are not always made. To make matters works, even effective OR apparel can be misused by staff due to lack of education and failure to consider such factors as type of procedure, length of procedure, amount of fluid exposure, or the role in surgical procedure, among others.

“Selecting surgical apparel and products is perhaps the most important decision materials managers and purchasing executives have to make,”  says Laureen Clark, Senior Manager, Medical Science and Clinical Education, Kimberly-Clark Health Care. “While many features and characteristics go into the decision making process, we find that protection, comfort, strength, and durability are often top of mind.”

Getting Comfortable
Because surgical apparel is used on a daily basis, the level to which staff finds it comfortable and usable goes a long way toward ensuring its effectiveness. For example, surgical gowns must be constructed to offer breathability and protect skin from irritation and allergic reactions. Facial masks should have a comfortable breathability index. Compliance with Association of Perioperative Registered Nurses guidelines and other standards and best practice recommendations is threatened if staff members feel uncomfortable while wearing certain surgical apparel.

A Barrier Of Protection
Keeping surgical staff and patients out of harm’s way is of utmost importance to hospitals. Simply stated, economic pressures have transformed the issue of patient and staff safety from a key consideration to a constant concern for many facilities over the course of the last decade or so.

As a result, customers are looking for manufacturers to provide a selection of products that can provide both value and quality solutions in meeting recommended practices and protocols within their facility, says Julie Gorog RN, BSN, CNOR, Cardinal Health.

“One of the most important properties of surgical apparel is the level of barrier protection it provides to the end user,” Gorog adds.

The Centers for Disease Control and Prevention recommends that the sterile team members wear surgical gowns that are effective barriers when wet, resisting liquid penetration. Ideally, gowns that are impermeable to liquids and viruses are preferred.  Furthermore, AORN also recommends that selection of surgical gowns and drapes be based on the planned use and anticipated exposure to blood and body fluids.

“Surgical apparel must protect against bloodborne pathogens,” says Clark. “Features such as cuffs that prevent glove roll-down on surgical gowns or bacterial filtration on face masks provide ultimate barrier protection.  Similarly, surgical apparel that will not tear or let liquids seep through is critical as this plays a role in infection prevention.”

Additional important features include flame-resistance and the ability to resist linting and abrasions that can transfer particulates to the surgical wound, implants, or guide wires.

One of the most common safety concerns related to surgical apparel is glove barrier failure. This is true even with the increased prevalence of double gloving. As a result, AORN recommends that two pairs of surgical gloves, one over the other, should be worn during surgical and other invasive procedures with the potential for exposure to blood, body fluids, or other potentially infectious materials. When double gloves are worn, perforation indicator systems should be used.
When it comes to headwear, the most effective products are clean, low-lint head covers that cover all hair and scalp skin.

“Compliance with surgical attire policy can be challenging, especially with head coverings,” says Gorog. “Fashionable reusable head coverings have grown popular, however, they may not fully contain hair and may be infrequently laundered at home.
Skull caps may fail to contain the side hair above and in front of the ears and hair at the nape of the neck,” she adds.

What To Do
Every hospital and medical facility should conduct regular reviews of their surgical apparel policy and compare it with the most recent facility data related to infection control.

“Have a solid understanding of the various levels of protection as outlined in AAMI PB70 and ensure adequate protection is purchased and assigned appropriately based on the anticipated risk for exposure,” says Shelley Petrovskis, Director of Marketing, Lac-Mac, Inc.

According to Gorog, it is important to use all the data on hand to educate staff on selecting the most appropriate product for each procedure.  After all, what is considered proper attire for one procedure may be far from effective at protecting patients and staff in other scenarios in the OR.

“Manufacturers are required to provide product labeling of barrier protection levels," she continues. “There are several CEU programs available to educate staff on barrier protection and current guidelines. I recommend my customers look to their manufacturer to provide tools that enable them to make educated choices on surgical apparel products that fit their needs.”

Choosing surgical apparel with the above characteristics that meets or exceeds performance standards and guidelines established by organizations such as AORN, OSHA, AAMI, NIOSH, and the FDA for strength, barrier protection, and flame resistance helps maintain patient safety and prevents healthcare-associated infections cannot be overlooked. It is a key component to a hospital’s efforts to ensure staff safety and improve patient outcomes. However, just as important is selecting apparel that mirrors staff preference to ensure it is being worn properly --  and at all times.