Abstract
Introduction
The original Charnley-type negative pressure body exhaust suit reduced infection rates in randomized trials of total joint arthroplasty decades ago. Modern positive pressure surgical helmet systems (SHS) have not shown similar benefit, and several recent studies have shown a trend towards increased wound contamination and infection with SHS use. The gown glove interface may be one source of particle contamination.
Objectives
The purpose of this study was to compare particle contamination at the gown glove interface in several modern SHS vs. a conventional gown.
Methods
A 0.5 micron fluorescent powder was evenly applied to both hands to the level of the wrist flexion crease. After gowning in the normal fashion, the acting surgeon performed a standardized twenty minute simulated total joint replacement. The amount of gown contamination at the gown glove interface was then measured by three observers under ultraviolet light using a standardized grading scale; from 0 (no contamination) to 4 (gross contamination). Using Minitab 15, the Mann-Whitney U test was performed to compare gowns and an ordinal logistic regression analysis was performed to identify variables associated with levels of contamination.
Results
All gown-glove interfaces showed some contamination. There was no difference among any of the gowns except for gown 2, which showed significantly more contamination when compared directly to each of the other four gowns (p<0.001 in each case) (Figure 1). The ordinal logistic regression analysis showed that gown type (p 0.10) was more significantly associated with contamination levels than were the other variables of observer (p 0.70), location of contamination (p 0.56), or trial order (p 0.5).
Conclusions
Particle contamination occurs at the gown glove interface in most commonly used surgical helmet systems and was significantly increased in the gown with stiffer material that may be less apt to make a seal with the glove.
