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Which Regions of the Operating Gown Should be Considered Most Sterile?

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Clinical Orthopaedics and Related Research

Abstract

Various guidelines have been proposed regarding which portions of a surgical gown may be considered sterile. Unfortunately, the validity of these recommendations has not been definitively established. We therefore evaluated gown sterility after major spinal surgery to assess the legitimacy of these guidelines. We used sterile culture swabs to obtain samples of gown fronts at 6-inch increments and at the elbow creases of 50 gowns at the end of 29 spinal operations. Another 50 gowns were swabbed immediately after they were applied to serve as negative controls. Bacterial growth was assessed using semiquantitative plating techniques on a nonselective, broad-spectrum media. Contamination was observed at all locations of the gown with rates ranging from 6% to 48%. Compared with the negative controls, the contamination rates were greater at levels 24 inches or less and 48 inches or more relative to the ground and at the elbow creases. The section between the chest and operative field had the lowest contamination rates. Based on these results, we consider the region between the chest and operative field to be the most sterile and any contact with the gown outside this area, including the elbow creases, should be avoided to reduce the risk of infection.

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Acknowledgments

We thank Debbie Callan and Patty Farrel for invaluable assistance with microbiology techniques.

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Authors and Affiliations

  1. Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, PO Box 208071, New Haven, CT, 06520-8071, USA

    Jesse E. Bible BS, Debdut Biswas BA, Peter G. Whang MD, Andrew K. Simpson MD & Jonathan N. Grauer MD

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  1. Jesse E. Bible BS
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  2. Debdut Biswas BA
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  3. Peter G. Whang MD
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  4. Andrew K. Simpson MD
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  5. Jonathan N. Grauer MD
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Corresponding author

Correspondence to Jonathan N. Grauer MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research.

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Bible, J.E., Biswas, D., Whang, P.G. et al. Which Regions of the Operating Gown Should be Considered Most Sterile?. Clin Orthop Relat Res 467, 825–830 (2009). https://doi.org/10.1007/s11999-008-0341-1

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  • DOI: https://doi.org/10.1007/s11999-008-0341-1

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