Surgical Gowning Technique: Are We Contaminated Before We Cut?

Objectives: To assess possible breaches of sterility during the initial gowning step. Design: Observational study. Twenty-seven gowning events were monitored for contamination during a simulated two-person gowning process in which a surgical technician assists a surgeon in the gowning process at the beginning of a surgical procedure. The lower portion of the technician's gown was coated with resin powder before the gowning process to simulate contamination. Setting: Single-institution Level 1 trauma center. Participants: Three physicians and 3 tenured surgical chnicians. Intervention: Observed contaminated areas represented by ultraviolet resin powder under ultraviolet light on the gown of the surgeon after the two-person gowning step. Main Outcome Measurement: Number and surface area of contamination events. Results: There was a 66.67% rate of contamination of the surgeon's gown sleeves while being gowned by a surgical technician. The overall median contamination for the short surgeon was 1.3 cm(2). For the medium height surgeon, the overall median contamination was 1.4 cm(2). The tall surgeon had an overall median contamination of 2.9 cm(2). Of the short, medium, and tall surgeons, the number of contamination events was 6, 5, and 7, respectively. The study suggested that the surgeon's height was a significant source of variation = 0.046). Conclusion: We present an observational pilot study that suggests that to reduce contamination in the operating room, the two-person method must he highly monitored. This study also proposes that the single-person gowning technique should be used to reduce contamination rate during the gowning process.