Scrub Suits Research Articles

Bacterial Contamination in Total Joint Replacement: Should We Change into a New Set of Clean Scrub Suits Whenever Entering the Operating Room?

The aims of this study are as follows: (1) to investigate the level and probability of bacterial contamination on scrub suits over time for medical personnel working inside and/or outside the operating room (OR) area; (2) to discuss the protective role of cover gowns against bacterial contamination; and (3) to consider the necessity of changing into clean suits whenever entering the OR in terms of preventing periprosthetic joint infection (PJI) in total joint replacement (TJR). The bacterial colony count was examined on the chest area of the scrub suits worn during various daily clinical practices. The genus/species of the contaminants were identified by matrix-assisted laser deposition ionization-time of flight mass spectrometry (MALDI-TOF MS). The scrub suits worn outside the OR area showed a greater level of bacterial contamination than those worn inside the OR area, although the colony counts tended to increase over time both in and out of the area. The probability of contamination involving coagulase-negative staphylococci (CNS) (known as the primary cause of PJI) did not increase significantly in the scrubs worn inside the OR area, but did increase significantly after a long-time departure from the OR area. Our results suggest that wearing scrub suits outside and/or the long duration of wearing the same suits can significantly increase the level and probability of any bacterial contamination (including CNS) on scrub suits. We also found that wearing a cover gown over scrub suits outside the OR area may have only a limited protective role against bacterial contamination.

A comparative performance of antibacterial effectiveness of copper and silver coated textiles

During current COVID-19 crises, the antimicrobial textiles primarily those utilized in hospital by doctors and paramedical staff have become increasingly important. Thus, there is an unmet requirement to develop antimicrobial textiles for infection control and hygiene practices. Metallic nanoparticles exhibit great effectiveness towards resistant microbial species making them a potential solution to the increasing antibiotic resistance. Due to this, nanoparticles particularly copper and silver have become most prevalent forms of antibacterial finishing agents for the development of antimicrobial textiles. This review is mainly focused on the significance of copper and silver nanoparticles for the development of antimicrobial textiles. The comparative analysis of the antibacterial effectiveness of copper and silver nanoparticles as well as the possible physical and chemical interactions responsible for their antibacterial action are explained. The negative impact of pathogenic microbes on textiles and possible interactions of antimicrobial agents with microbes have also been highlighted. The significance of nanotechnology for the development of antimicrobial textiles and their applications in medical textiles domain have also been discussed. Various green synthesis and chemical methods used for the synthesis of Ag and Cu nanoparticles and their application on textile substrates to impart antimicrobial functionality have also been discussed. The various qualitative and quantitative standard testing protocols utilised for the antimicrobial characterization of textiles have also discussed in this review. The developed Cu and Ag coated textiles could be effectively applied in the field of hospital textiles for the preparation of antibacterial scrub suits, surgical gowns, panel covers, protective clothing, bedding textiles, coveralls, wound dressings, table covers, curtains, and chair covers etc.

Comparison of number of airborne bacteria in operating rooms with turbulent mixing ventilation and unidirectional airflow when using reusable scrub suits and single-use scrub suits

A low count of airborne bacteria in the operating room is a means to prevent surgical site infection. To investigate levels of airborne bacteria during surgical procedures in two operating rooms with turbulent mixing ventilation (TMV) and unidirectional airflow (UDAF), both with an air supply of 2600L/s, when staff used either reusable scrub suits made from a mixed material (dry penetration ≤300cfu) or single-use scrub suits made from polypropylene (dry penetration ≤100cfu). In the TMV-room cfu/m3 air was measured during eight procedures with staff wearing reusable scrub suits and seven procedures with single-use scrub. In the UDAF-room cfu/m3 air was measured during seven procedures with staff wearing reusable scrub suits. Mean values of cfu/m3 air were 1.3-10.8 in the TMV-room with staff dressed in reusable scrub suits and 0.8-4.0 with staff dressed in single-use scrub suits (P<0.01). Mean values of cfu/m3 air were 0.2-4.5 in the UDAF-room with staff dressed in reusable scrub suits. The difference obtained with reusable scrub suits in the two rooms was significant (P<0.01). The mode of ventilation affects the cfu levels when staff are dressed in less occlusive scrub suits despite a high air supply. It is possible to decrease the cfu levels in a TMV-room by using scrub suits made from a tight material, thus reaching the same levels that are achieved by less protective scrub suits in a UDAF-room.

Association Between Patient Perception of Surgeons and Color of Scrub Attire

This survey study involves asking participants about their opinions on positive and negative character traits of male and female clinicians dressed in 4 different colors of scrub suits.

Comparative life cycle assessment of reusable and disposable scrub suits used in hospital operating rooms

Hospitals are using an important number of textiles for employees, patients and visitors. These textiles are mainly disposable, but reusable options are becoming increasingly interesting. A Life Cycle Assessment (LCA) of reusable scrub suits in France was conducted to assess their potential environmental impacts compared to disposable scrub suits using ten environmental indicators. The functional unit is “to provide an operating room employee with scrub suits daily during 4 years' service”. Primary data were collected from a reusable suit producer, its suppliers and clients. A reusable scrub suit system has a lower environmental impact for the majority of indicators. Reusable’ impact on climate change decreases by 31% compared to disposable scrub suit system. When considering the use of 1.8 disposable scrub suit instead of one per day of work, the impact on climate change of reusable solution is 62% lower compared to disposable scrub suits. However, the impact on water depletion remains much higher for the reusable scrub suit scenario, especially due to the impact of cotton production. Overall, the reusable scrub suit seems an attractive solution for the healthcare sector leading to a reduction of the environmental footprint compared to a standard disposable option.

Application of zinc oxide nano particles using polymeric binders on cotton fabric

Purpose The durability of antimicrobial agents and its effectiveness is the most important factor for consumer usage. One important class of antimicrobial agents are inorganic metals and their metal oxides which can be prepared into nanoparticles and can be imparted to enhance the antimicrobial properties. The purpose of this paper is to investigate the effect of three different polymeric binders during the application of zinc oxide (ZnO) nanoparticles on the antimicrobial and performance properties of the finished fabric. Design/methodology/approach In this study, ZnO nanoparticles were prepared by a wet chemical method. The nano-particles size distributions was determined using Nanoplus Dynamic Light Scattering particle size distribution analyzer and concentration of nano ZnO 0.1% (w/v) was applied with 2% (w/v) polymeric binders, namely, polyvinyl alcohol (PVA), polyurethane (PU) and butyl acrylic (BA) on cotton fabric by pad dry cure method. The treated samples were tested for physical properties such as tearing strength, tensile strength, crease recovery and air permeability and antimicrobial properties using test method American Association of Textile Chemists and Colorists (AATCC) 100. Further, the content of zinc in the treated samples was determined by the atomic absorption method. The treated fabric was analyzed using fourier transform infrared spectroscopy and scanning electron microscopic and also tested for cytotoxicity as per International Organization for Standardization 10993. Findings The results indicated that the type of polymeric binders did not show any influence on the uptake of the zinc content. All treated samples showed positive results &gt;99% with regard to antibacterial property. However, the polymeric treated samples showed a difference in physical properties. The ZnO nano-finish reduced the tensile strength and tearing strength of the fabrics. The difference in crease recovery for samples ZnO/PVA and ZnO/PU was not much except for ZnO/BA where it increased by 38%. The air permeability decreased after application for all treated samples, the lowest among treated samples was in ZnO/PU fabric. Further, ZnO/PVA finished fabric was found to retain antibacterial property up to 50 washes and was effective against MS2 Bacteriophage as a surrogate virus when analyzed as per AATCC 100–2012 test method, and therefore can be potentially used as health-care apparel such as doctors coat and scrub suits. Originality/value The outcome of this research is in its contribution to the field of reusable textiles. It highlights the use of nanotechnology to design and develop cotton fabrics for antimicrobial properties which has the potential of preventing the growth of harmful bacteria. The study brings forth the use of ZnO nanoparticles mixed with PVA binder on 100% cotton fabrics which exhibits antibacterial and antiviral properties with adequate wash durability. Currently, there is a high demand of effective durable textiles with barrier properties and the present study provides a promising solution to provide reusable textiles with a greater level of protection.

Medicolegal Sidebar: A Fast Route To A Criminal Indictment-Violating Fraud and Abuse Laws.

Medicolegal Sidebar: A Fast Route To A Criminal Indictment-Violating Fraud and Abuse Laws.

The effect of the type of protective suit on the thermophysiological comfort of surgeons in an operating room

Surgical gowns and medical clothing have to protect the surgeons from the patient and vice versa. However, all players in the operating room (OR) have to be in a state of thermophysiological comfort. The comfort of the surgeons is of special importance, as they are exposed to stressful situations, which could influence their performance negatively. The study presents an analysis of the thermophysiological comfort of the surgeons in an OR, using protective clothing ensembles with different clothing insulation and protection: a surgical scrub suit (SSS) and a clean air suite (CAS). The analysis is based on the calculation of PMV-PPD indexes, following Fanger’s model. Different combinations of thermal environment parameters and clothing insulation are tested and analysed.

Preparing to Perform Trauma and Orthopaedic Surgery on Patients with COVID-19.

Preparing to Perform Trauma and Orthopaedic Surgery on Patients with COVID-19.

Scrubs contamination, domestic laundry effect and workwear habits of clinical staff at a referral hospital.

To determine contamination rates of scrub suits worn by veterinary surgeons and nurses following a single shift. Cross-sectional preliminary study at a UK small animal referral centre. Sterilised scrub suits were distributed to veterinary surgeons (n=9) and nurses (n=9) at the beginning of their clinical shift and worn for at least 8 hours. They were then analysed for bacterial contamination before and after home laundry at 30°C. A questionnaire was distributed to hospital clinical staff regarding workwear habits. Median bacterial counts were 47 (interquartile range: 14 to 162) and 7 (interquartile range: 0 to 27) colony forming units per cm2 before and after laundering scrub suits. Bacteria identified included Staphylococcus sp., Enterococcus sp., Escherichia coli , Bacillus sp., Pseudomonas aeruginosa , Micrococcus sp., β-haemolytic Streptococci and a Group G Streptococcus. From 101 staff surveyed, 64.0% reported wearing fresh, clean scrub tops and 58.4% fresh, clean trousers each day, while 64.4% left the workplace wearing the same clothing in which they undertook clinical work. Workwear contamination risks spread of pathogens into the community and personnel compliance with workplace guidelines warrants further attention. Home laundry at 30°C significantly decreases, but does not eliminate, the bacterial burden after a single shift.

Operating Theatre Mannerisms &amp; Etiquette: Revisited!

Operating Theatre Mannerisms &amp; Etiquette: Revisited!

Naked Surgeons? The Debate About What to Wear in the Operating Room.

There has been recent controversy regarding recommendations and regulations concerning operating room attire. We performed a nonsystematic literature search regarding operating room attire and surgical site infection (SSI) risk. Much of the literature relies on air sampling and culture of operating room equipment but does not present evidence regarding effect on SSI risk. There is no evidence regarding SSI risk related to operating room attire except for sterile gowns and the use of gloves. Naked surgeons shed fewer bacteria into the operating room environment than ones wearing scrub suits.

The issue of thermal comfort of medical clothing in the operating room

La ropa médica tiene la función principal de protección. Sin embargo, esta función debe estar correlacionada con una buena experiencia de comodidad para el usuario. La comodidad es un tema muy importante, ya que los profesionales están expuestos a situaciones de estrés que pueden influir, negativamente, en su desempeño laboral. Más específico, el confort térmico juega un papel crucial para el mejor rendimiento de la ropa médica usado en la sala de operaciones, que implica la regulación del calor y la transferencia de masa entre un cuerpo vestido y el medio ambiente, una vez que la ropa es la interfaz entre el cuerpo y el medio ambiente. El objetivo de este trabajo fue estudiar el comportamiento de propiedades térmicas de batas quirúrgicos y trajes de aire limpio usados en la sala de operaciones. Se realizó una comparación entre estos dos tipos de prendas con equipos Alambeta, para propiedades térmicas estacionarias y un Maniquí Térmico, para propriedades dinâmicas, como el flujo de calor y el aislamiento térmico. Se encontró que el aislamiento térmico de las prendas es estadísticamente diferente, mostrando que la diferencia entre los trajes puede ser percibida por el usuario.

Comparison of two single-use scrub suits in terms of effect on air-borne bacteria in the operating room

A low level of air-borne bacteria in the operating room air can be achieved if all staff wear clothes made of low-permeability material (i.e. clean air suits). This study investigated if there was a difference in protective efficacy between two single-use scrubs made of polypropylene by testing them during routinely performed orthopaedic surgical procedures. No significant difference in the colony-forming unit count/m3 air was found between the two scrubs, so the choice can be based on which scrub type is more comfortable for staff.

Patients' attitudes towards the participation of medical students in clinical examination and care in Western Saudi Arabia.

Background and Objectives:Patients are essential for the acquisition and development of medical students clinical skills for their tasks. The study aimed to identify factors that influence patients’ attitudes towards the involvement of medical students in clinical examination and care in Western Saudi Arabia.Methods:A cross-sectional study using self-administered questionnaire was conducted among Saudi and non-Saudi patients at two university hospitals in Jeddah, Western Saudi Arabia. Information sought included demographic characteristics (age, gender, educational level, job, income, and marital status); patients’ attitude and comfort level towards different types of students’ involvement; factors influencing patients’ cooperation with medical students (students’ level of training, manner, skills, and attire. All these were assessed on a five-point Likert scale. Data was entered and analyzed using SPSS v 19.Results:Four hundred and seventeen adult patients participated. Fifty-one percent indicated a positive attitude towards involving medical students in clinical examination and care. Female and young patients (<45 years old) were more likely to be negative in their attitude and be less comfortable towards involving medical students in their care. The highest overall mean comfort score was with medical students taking history followed by observations and less invasive examination. Patients’ mean confidence scores regarding students’ attire were the highest for female traditional attire and for scrub suit for males.Conclusion:Of the influential factors that could affect patients’ willingness to cooperate with medical students, clinical skills followed by manner and level of training ranked first. Ensuring that students mastered specific procedures before coming into direct contact with patients using patient simulators, for example, would improve patients’ acceptance of student participation.

Research

The October 2014 Research Roundup360 looks at: unpicking syndesmotic injuries: CT scans evaluated; surgical scrub suits and sterility in theatre; continuous passive motion and knee injuries; whether pain at night is melatonin related;venous thromboembolic disease following spinal surgery; clots in lower limb plasters; immune-competent cells in Achilles tendinopathy; and infection in orthopaedics.

Patients' attitudes toward the attire of male physicians: a single-center study in Saudi Arabia.

BACKGROUND AND OBJECTIVESThe doctor–patient relationship has been influenced by the appearance of physicians, and there is an association between a physician’s physical appearance and the patients’ initial perceptions of physician competence. This study aims to explore patients’ preferences toward the attire of a male physician, and to examine if a physician’s choice of uniform influences the degree of trust, confidence, and follow-up care among respondents.DESIGN AND SETTINGSA cross-sectional survey conducted among patients of the Alwazarat family medicine center in Riyadh, Saudi Arabia.PATIENTS AND METHODSA self-administered questionnaire was completed by 300 patients (50% were male and 83.6% had received a secondary education; the mean age was 33.4 [10.1] years) in the Alwazarat family medicine center in Riyadh. The questionnaire was also customized for the local setting with the inclusion of photos of a male doctor in Saudi Arabian national costume, and 3 other dress styles (Western dress with white coat, scrubs with white coat, and scrubs only).RESULTSOverall, across all questions regarding physician dress style preferences, participants significantly preferred Western dress (39.9%, P<.001), followed by Saudi national dress (26.3%), a scrub suit with a white coat (22.3%), and scrubs only (11.5%). Respondents reported that they were more likely to follow medical advice and would return for follow-up care if a physician wore Western dress. They were significantly more willing to share their social, sexual, and psychological problems with a physician wearing Saudi national dress (P<.001). The importance of a physician’s appearance was ranked significantly higher by older patients (P=.002).CONCLUSIONRespondents were more likely to favor a physician wearing Western attire with a white coat. However, Saudi national dress, followed by Western dress, is the preferred attire when physicians are dealing with social, sexual, and psychological problems.

Bacterial contamination of surgical scrub suits worn outside the operating theatre: a randomised crossover study.

In this study, we aimed to evaluate the bacterial contamination of surgical scrub suits worn outside the operating theatre. We randomised 16 anaesthetists on separate occasions into one of 3 groups: restricted to the operating theatre only; theatre and surgical wards; and theatre and departmental office. For each group, sample fabric pieces attached to the chest, waist and hip areas of each suit were removed at 150 min intervals between 08:30 and 16:00 on the day of study, and sent for microbiological assessment. Mean bacterial counts increased significantly over the course of the working day (p = 0.036), and were lower in the chest compared to the hip (p = 0.007) and waist areas (p = 0.016). The mean (SD) bacterial counts, expressed as colony-forming units per cm(2) at 16:00 on the day of study, were 25.2 (43.5) for those restricted to theatre and 18.5 (25.9) and 17.9 (31.0) for those allowed out to visit the ward and office, respectively (p = 0.370). We conclude that visits to ward and office did not significantly increase bacterial contamination of scrub suits.

The effect of silver impregnation of surgical scrub suits on surface bacterial contamination

Silver-impregnated fabrics are widely used for their antibacterial and antifungal effects, including for clinical clothing such as surgical scrub suits (scrubs). This study investigated whether silver impregnation reduces surface bacterial contamination of surgical scrubs during use in a veterinary hospital. Using agar contact plates, abdominal and lumbar areas of silver-impregnated nylon or polyester/cotton scrubs were sampled for surface bacterial contamination before (0 h) and after 4 and 8 h of use. The number of bacterial colonies on each contact plate was counted after 24 and 48 h incubation at 37 °C. Standard basic descriptive statistics and mixed-effects linear regression were used to investigate the association of possible predictors of the level of bacterial contamination of the scrubs with surface bacterial counts.Silver-impregnated scrubs had significantly lowered bacterial colony counts (BCC) at 0 h compared with polyester/cotton scrubs. However, after 4 and 8 h of wear, silver impregnation had no effect on BCC. Scrub tops with higher BCC at 0 h had significantly higher BCC at 4 and 8 h, suggesting that contamination present at 0 h persisted during wear. Sampling from the lumbar area was associated with lower BCC at all three time points. Other factors (contamination of the scrub top with a medication/drug, restraint of patients, working in the anaesthesia recovery area) also affected BCC at some time points. Silver impregnation appeared to be ineffective in reducing bacterial contamination of scrubs during use in a veterinary hospital.

P17.02 An outbreak Of Staphylococcus aureus after thoracoscopy

s, 7th International Conference of the Hospital Infection Society, 10–13 October 2010, Liverpool, UK / Journal of Hospital Infection 76S1 (2010) S1–S90 S53 flagging system for at risk patients was developed and implemented in October 2005. Education was delivered through formal and informal means. HCWwere targeted at both undergraduate through links with academic bodies and postgraduate level through practice support programs and medical grand rounds etc. Specific clinical units were targeted as part of outbreak management. The audit was repeated in 2008 and 2010 using the same tool. Comparable audit reports were widely disseminated to clinicians and hospital management. Results: Between April 2005 and April 2010 a significant improvement in practice of TBP was observed. Up to 90% of patients colonised/infected with meticillin resistant Staphyloccus aureus (MRSA) were isolated/cohorted in 2010. Conclusions: Sustained education, audit and feedback, supported by protocols and risk management tools have influenced staff knowledge of IPC practices and strategies to control spread of transmissible organisms. Although practice improvement is apparent there remain deficits and challenges in the application of TBP in this hospital. P17.02 An outbreak Of Staphylococcus aureus after thoracoscopy Y. Hendriks, H. Coertjens, M. v. Rijen, J. Kluytmans. Amphia Hospital, Netherlands Background: In a period of 6 weeks there were 4 patients with a Staphylococcus aureus infection after thoracoscopy. Objective: To investigate and control an outbreak of S. aureus after thoracoscopy. Methods: The department of Infection control audited the procedures during thoracoscopy. The healthcare workers (HCW) who were present during the procedures were screened for nasal carriage of S. aureus. All isolates were typed (AFLP). Results: The audit demonstrated that the thoracoscopy took place in a standard hospital room instead of a operation room class II (as recommended by the National guidelines), multiple breaks in infection principles during the procedure e.g. no scrub suits and the lack of knowledge of universal principles of hygiene. AFLP learned that three of the four patients were infected with the same strain. Twelve out of 31 (39%) HCW were nasal carriers of S. aureus. One of the HCW had the same type as the three patients. The following corrective actions were implemented: the HCW with the outbreak strain was treated for carriage and not allowed to work until eradication was achieved, thoracoscopy procedures were performed in the operating theatre, HCW involved in the procedures were trained in the principles of infection control. Follow up during >12 months revealed no infections after thoracoscopy. Of note, the HCW who carried the outbreak strain was recolonised with the same strain 5 months after the eradication treatment. She is allowed to work with this strain under the assumption that the current control measures prevent the spread to patients. No further infections have been found. Conclusions: An outbreak of S. aureus infections after thoracoscopy was traced to a colonised HCW. The suboptimal environmental conditions and breaks in general hygienic measures during the procedures were probably the main cause of the outbreak. The outbreak was terminated by improving the environmental conditions as well as the behavior of the HCW. P17.03 Infection control measures taken during lumbar punctures: a survey of current practice S. Kelly, R. Malhotra. University Hospital Coventry and Warwickshire, United Kingdom; Weston General Hospital, United Kingdom Background: Infective complications of lumbar puncture are not common but are a significant source of morbidity and mortality. It is likely that adhering to infection control measures when carrying out a lumbar puncture will minimize the risk of iatrogenic meningitis. However there is no clear consensus in the literature as to the most appropriate methods to use. Objective: The aim of this survey was to assess what infection control measures doctors currently use when performing lumbar punctures. Methods: We constructed an anonymous, tick-box survey asking about specific infection control measures taken when performing lumbar punctures. This was distributed to doctors in all medical specialties in the West Midlands and Severn Deaneries. Results: The response rate was 63% (119/188 responses) but 12 forms were incomplete and so not included. According to grade, we surveyed 62 (58%) CT1–2 doctors, 27 (25%) ST3–5 doctors and 18 (17%) Senior Registrars. Responders had performed, on average, a total of 16 lumbar punctures (range 3–45). Results show that all doctors use hand-washing, sterile gloves and skin preparation but significant numbers never wore facemasks or caps (Table 1). CT 1–2 doctors were three times more likely than SpRs to perform all of the infection control measures stated (36% vs. 10%, Table 2). Similarly, the number of infection control measures taken by doctors decreased with the number of times the procedure had been performed. Table 1. Infection control measures taken by doctors when performing