Emperor's Clothing for the Contemporary Healthcare Worker

Abstract

In these days when many healthcare personnel have a fear of contracting the acquired immunodeficiency syndrome (AIDS) in the healthcare facility, and powerful organizations, such as the Occupational Safety and Health Administration (OSHA) are making stringent demands for protection of the healthcare worker, the concept of protective attire is becoming trendy. It is now fashionable to get out yesterday's isolation gear (was it really locked away with the fogging machine?) and reinstate this equipment in the name of healthcare protection. Gloves, gowns, protective eye wear, shoe covers, and masks are aspects of isolation that have been around since 1721, when the fear of a plague outbreak was a legitimate concern.1 However, healthcare workers seem to be viewing protective attire with a more critical eye because of the AIDS epidemic. This commentary speaks to the use of gowns as protective attire in the patient care setting; it does not include surgical gowns for the operating room. We know gowns can offer some degree of protection in certain situations, but one issue that needs resolution is how much a gown should be expected to protect. It is amazing to note that professional organizations interested in the protection of the healthcare worker have not developed any guidelines on this issue. The American Association for Medical Instrumentation disbanded its subcommittee on protective gowns due to an inability to agree on criteria. The only comment it had was that reusable cloth with a 140-thread count is readily permeable and is not a satisfactory aseptic barrier.2 The Operating Room Environment Committee of the American College of Surgeons defined barrier materials as impervious to bacteria under usual conditions. It further agreed that ordinary muslin fabric was not a barrier against bacteria.3 The Association of Operating Room Nurses (AORN) in its Standards and Recommended Practices Manual, states that surgical gowns and drapes should be resistant to penetration by blood and other fluids.4 The Emergency Care Research Institute, authors of Healthcare Devices, is not planning to evaluate gowns (Emergency Care Research Institute, personal communication; 1990), as it did surgical drapes.5 If criteria for protective gowns are not defined, each hospital will have to set up its own criteria. It would be ridiculous for the healthcare worker to have to make valuative decisions on the spot. Yet just such a scenario has been repeated throughout the history of healthcare institutions. Since OSHA is the instigator of protective gowns for certain patient care situations, it has attempted to provide some guidelines in this area. These guidelines are not definitive but do give some direction. Currently, OSHA states that gowns, including surgical gowns, "Shall be made of or lined with impervious material and shall protect all areas of exposed skin."6 Its 1989 proposed rule is expected to become law in 1991. These are the standards used by OSHA for current inspections. They state that appropriate protective clothing shall be worn when the employee may be at risk of occupational exposure. The type of attire should be appropriate to the task and degree of exposure anticipated; however, the clothing selected