Surgical Attire Research Articles

Enhancing Operating Theatre Conduct through Virtual Reality Simulation

Abstract In hospital operating theatres, inadvertent violations of behavioural rules by novices may increase risk. Virtual reality (VR) can provide a training environment to ease the burden for healthcare professionals. Our work develops and tests a VR training program for correct operating room (OR) etiquette. The VR simulator incorporates realistic 3D models as well as corresponding character and object interactions. The simulator provides a comprehensive interactive educational game covering hand hygiene and disinfection, surgical attire and OR behaviour. 13 clinical trainees and experts assessed acceptance and perceived benefit of the simulator. This evaluation shows promise in supporting clinical staff education. Future developments aim to enhance effectiveness, including the integration of hand tracking and a more detailed selection of interactive tasks.

Guidelines in Practice: Surgical Attire.

Perioperative team members wear surgical attire when working in the OR. Wearing clean surgical attire is important to maintain a high level of cleanliness for patient safety. The recently updated AORN "Guideline for surgical attire" provides perioperative nurses with recommendations for wearing surgical attire in the semirestricted and restricted areas of the perioperative setting. This article discusses recommendations for laundering; head coverings; shoes; and identification badges, access cards, and personal items. It also includes a scenario describing compliance monitoring for an updated policy related to cleaning cell phones and performing hand hygiene after cell phone use. Perioperative nurses should review the guideline in its entirety and apply the recommendations for wearing surgical attire in the perioperative environment.

Guideline Quick View: Surgical Attire.

Guideline Quick View: Surgical Attire.

Nurses' knowledge regarding recommended practices on using surgical attire in operating theatre.

To reduce the risk for surgical site infections, nurses in the operating theatre environment must have knowledge of and adhere to recommended practices regarding the use of surgical attire. To evaluate the effect of an educational intervention on nurses' knowledge related to recommended practices regarding the use of surgical attire in operating theatre. Operating theatres in two public and two private hospitals in the Eastern Cape province, South Africa. An educational pilot study, using a quasi-experimental, two-group pre- and post-test design, was conducted. A convenience sample of n = 85 nurses was purposively allocated to a control group and an intervention group. An existing educational intervention consisting of an interactive training session, brochures based on the Association of periOperative Registered Nurses' (AORN) guidelines and a summary of these guidelines was implemented for the intervention group, while the control group received only the summary of the guidelines. Data were collected through self-administered pre- and post-test questionnaires from March 2019 to August 2019. The overall knowledge score for nurses in the intervention group post-intervention improved with a large significance (p ≤ 0.000 and Cohen's d = 1.26). The intervention has shown potential to improve the knowledge related to recommended practices of nurses in operating theatres regarding the use of surgical attire. This pilot study encourages the implementation of the intervention on the use of surgical attire but requires further development and a wider implementation to measure its impact, and access to resources, enhancing and sustaining its success.

Guideline for Surgical Attire.

Guideline for Surgical Attire.

Sustainability in the Breast Operating Theatre: Promoting a Multidisciplinary Sustainability strategy across multiple centres

Operating theatres in hospitals are critical areas that generate a significant amount of waste, including single-use items such as disposable hats which has a significant effect on our NHS carbon footprint. The use of appropriate surgical attire, including hats, plays a vital role in maintaining hygiene and promoting a sterile environment within operating theatres. The introduction of the RCS surgical green checklist has highlighted several ways to improve sustainability in a theatre setting.

Airborne bacteria in veterinary surgical theatres in South Africa.

The bioaerosol composition of the theatre environment plays a determining role in the development of surgical site infections (SSIs). It has been demonstrated that the concentration of viable airborne bacteria is influenced by the level of room occupancy, utilisation of surgical attire and importantly, proper ventilation systems, which are often lacking in the average veterinary facility. The aim of this study was to evaluate the airborne bacterial load encountered in non-environmentally controlled small animal veterinary theatres during routine surgical sterilisations, and to correlate these findings with the managerial practices at the facility. Four veterinary facilities with differing throughputs and managerial practices were recruited into the study. Blood agar settle plates, open from first incision to last suture, were used to quantify organisms that could settle in an incision. The 45 plates yielded 487 bacterial isolates (53 species). The Micrococcus (28.8%) and Staphylococcus (16.8%) genera were predominant. Of the isolates 61.8% were classified as human/small animal commensals and 37.2% belonged to species previously implicated in small animal SSIs. Specific trends were additionally evident in the bioaerosol loads. High room occupancy, lack of surgical attire and exposure to the outside environment were associated with higher bacterial counts. Accumulation from consecutive procedures was identified and linked to total occupancy time of the room. Current mitigation measures were not ideal to minimise the SSI risk. Routine, frequent and thorough cleaning in combination with surgical attire utilisation is recommended to reduce the bioburden for patient benefit.

Clinical Issues-August 2022.

Use of sterile vests Key words: sterile technique, surgical attire, gown, contaminated, back. Bare arms for unscrubbed personnel Key words: long sleeves, cover jacket, disposable jacket, patient skin antisepsis, surgical site infection (SSI). Preventing thermal injury from electrosurgical devices Key words: electrosurgical unit (ESU), monopolar electrosurgical device, electrode, alternate site thermal injury, burn. Preoperative site marking for minimally invasive procedures Key words: surgical site, wrong-site surgery, alternative site marking, point of access, preprocedure verification.

Surgical Helmets Used During Total Joint Arthroplasty Harbor Common Pathogens: A Cautionary Note

BackgroundThe use of personal-protection surgical helmet/hood systems is now a part of the standard surgical attire during arthroplasty in North America. There are no protocols for the disinfection of these helmets. MethodsThis is a prospective, single-center, observational study. Helmets worn by 44 members of the surgical team and foreheads of 44 corresponding surgical personnel were swabbed at three distinct time points. In addition, 16 helmets were treated with hypochlorite spray to determine if pathogens could be eliminated. Swabs obtained were processed for culture and next-generation sequencing (NGS). ResultsOf the 132 helmet samples, 97 (73%) yielded bacteria on culture and 94 (71%) had evidence of bacterial–deoxyribonucleic acid (DNA) on NGS. Of the swabs sent for bacterial identification at the three time points, at least one from each helmet was positive for a pathogen(s). Of the 132 forehead samples, 124 (93%) yielded bacteria on culture and 103 (78%) had evidence of bacterial-DNA on NGS. The most commonly identified organism from helmets was Cutibacterium acnes (86/132) on NGS and Staphylococcus epidermidis (47/132) on culture. The most commonly identified organism from the foreheads of surgical personnel was Cutibacterium acnes (100/132) on NGS and Staphylococcus epidermidis (70/132) on culture. Sanitization of helmets was totally effective; no swabs taken the following morning for culture and NGS identified any bacteria. ConclusionThis study demonstrates that surgical helmets worn during orthopedic procedures are contaminated with common pathogens that can potentially cause surgical site infections. The findings of this study should at the minimum compel us to develop protocols for the disinfection of these helmets.

Children's and parents' perceptions concerning surgical attire: a systematic review.

ABSTRACTObjective: To review the literature about children’s and parent’s perceptions on surgical attire.Data source: A systematic search was conducted in the databases EMBASE, Latin American and Caribbean Health Sciences (LILACS), PubMed, PsycINFO, Scopus and Web of Science. Grey literature was searched on Google Scholar, Open Grey and ProQuest Dissertations, and Theses Database.Data synthesis: A total of 2,567 papers were identified. After a two-phase selection, 15 studies were included in narrative synthesis. Children favored wearing white coats in five of the nine included studies (55.5% [95%CI 48.3-62.7]; p=1.00). With respect to parents’ preferences, results of vote counting showed that in 11 of 15 included studies, they favored physicians wearing white coats (73.3% [95%CI 67.9-78.6]; p=0.11).Conclusions: Children and parents have preferred physicians to wear a white coat with a very low certainty of evidence.

Clinical Issues-January 2022.

Cleaning the central core floor Key words: semirestricted area, cleaning practices, vacuum, flooring, mopping. Wearing a cooling vest under a sterile gown Key words: thermal comfort, thermal stress, cooling vest, scrubbed personnel, surgical attire. Fluorescence-guided surgery Key words: fluorescence-guided surgery (FGS), fluorescent agent, fluorophore, imaging, indocyanine green (ICG). Containment of used suture needles Key words: sharps injury, sharps containment device, suture packet, suture needle, needle return.

Postoperative Infection Rates After Total Ankle Arthroplasty: A Comparison With and Without the Use of a Surgical Helmet System

Following total joint arthroplasty, surgical site infections (SSI) and periprosthetic joint infections (PJI) are associated with increased patient morbidity and healthcare utilization. Current positive-pressure surgical sterile helmet system (SHS) were developed as a feasible, useful version of the body exhaust system.The use of SHS has not yet been proven to decrease infection rates in the orthopedic literature. The primary purpose of this study is to compare the infection rates between patients who underwent total ankle arthroplasty (TAA) with a surgical team wearing SHS versus without SHS.A retrospective chart review in patients undergoing primary TAA with the surgeon wearing SHS (Group 1) or standard surgical attire (Group 2) was conducted. The primary outcome was postoperative SSI and PJI. The rate of wound complications, revision rates, and associated procedures were also analyzed. We identified 109 patients in Group 1 and 151 patients in Group 2. The rate of SSI was 12.8% in Group 1 and 14.6% in Group 2 (p=.411). The rate of PJI was 0.92% in Group 1 and 2.6% in Group 2 (p=.411). There was no difference in revision rates between the two groups. This study suggests that SHS does not appear to protect against postoperative SSI or PJI after TAA. Conversely, we did not find a higher infection rate compared to standard surgical attire despite recent in-vitro studies suggesting SHS as a source of wound contamination. The utility of SHS does not appear to influence the prevalence of postoperative SSI or PJI.

Iatrogenic Contamination With a Surgical Helmet System in Orthopedic Surgery.

Surgical helmet systems (SHSs) have been used to decrease iatrogenic contamination to prevent periprosthetic joint infections. However, the use of SHSs has been controversial. Therefore, the purpose of this study was to investigate iatrogenic contamination of traditional surgical attire (TSA), SHSs, and SHSs with delayed ventilation (SHS-DV) (helmet fan not turned on until surgeon gowned and gloved). A total of 180 orthopedic surgical procedures were prospectively enrolled and randomized into one of three cohorts. The TSA cohort included any orthopedic procedures, while the SHS and SHS-DV cohorts included arthroplasty procedures. Cultures were obtained from bilateral forearms, axillae, the sternum, and face shields for SHS groups. There were 60 surgeries in each group. The rate of positive cultures was calculated for each cohort and stratified by location and type of microorganism. The positive culture rates were 15% in the TSA, 25% in the SHS, 18% in the SHS-DV cohorts. The positive swab culture rates were 6% in the TSA, 7% in the SHS, and 4% in the SHS-DV cohorts. The positive culture rate was highest from the forearms in the TSA cohort (10%), the face shield in the SHS cohort (20%), and the chest in the SHS-DV cohort (7%). Coagulase-negative Staphylococcus was the most common bacteria cultured. The overall bacterial contamination rates were similar between the TSA and the SHS cohorts, with a lower rate in the SHS-DV cohort. Waiting to initiate airflow in SHSs and treating the shields as contaminated may reduce iatrogenic contamination. [Orthopedics. 2021;44(6):e753-e756.].

Clinical Issues-July 2021.

Debris in sterilized instrument sets Key words: organic debris, inorganic debris, instrument sets, sterile processing, sterilizing agent. Preventing debris in sterilized instrument sets Key words: debris, instrument sets, sterile processing equipment, instructions for use (IFU), quality assurance. Bone cement precautions during pregnancy Key words: bone cement, exposure, methyl methacrylate (MMA), pregnant. Using a bed sheet or blanket for positioning Key words: patient positioning devices, improvised positioning device, pressure distribution, skin shear, pressure injury. Laundering of cloth head coverings Key words: laundering, head covering, reusable cloth hat, surgical attire, disposable bouffant.

Surgical Scrubbing and Attire in the Operating Room and ICU: A Multicultural Guide

In response to the challenges faced as diverse students when first encountering the intricacies of scrubbing into the operating room (OR), we have prepared a rudimentary surgical skills guide to supplement the knowledge of students and educators alike. In keeping with the need to adapt standard protocols to accommodate religious and cultural practices, this guide focuses on hijab, natural hair, dastar, protective styles, and beard protocol in the OR. It addresses some of the personal protective equipment needs of Muslims, Orthodox Jews, Sikhs, and groups maintaining beards as a part of cultural or religious practices. We intend this guide to serve as a foundation on which the medical field can update its educational practices in line with the increased diversity of the medical professions, while also continuing to ensure the safety of OR and ICU patients. This guide also highlights COVID-19-specific changes in personal protective equipment and seeks to open up a conversation about the necessity of currently held surgical practices.

Problems and impact of use of private owned theatre wears as seen by theatre users

Background: The surgical theatre wear or attire include but are not limited to surgical caps, surgical scrubs, theatre aprons, and theatre foot wears. The basic principles in the care and maintenance of theatre wears are aimed at ensuring safety and infection prevention and control. Aim was to explore the problems associated with private owned theatre wears (scrubs, boots and aprons); and examined the impact of semi-closed mode of procurement and maintenance of theatre wears on theatre users in the tertiary healthcare setting.Methods: A cross-sectional descriptive study was done among theatre users in a tertiary healthcare center using self-administered semi-structured questionnaires. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 20.0.Results: One hundred and twenty-nine (60.6%) respondents affirmed that the mode of care of theatre scrub was not standard. 133 (62.4%) of the respondents asserted that there were problems associated with the semi-close mode of care. Nearly half (42.3%) of the respondents stressed that bad smell and contamination were their worries, and most respondents call for a change in the model of procurement and care of theatre wears.Conclusions: There were problems associated with the semi-closed system as revealed in this study, which bothers on safety of the theatre staff. Most respondents were negatively impacted, rated the current practice below standard, and call for a change in policy.

Engaging Perioperative Learners Using Online game-based Education.

Nurse educators may experience challenges (eg, distracted learners, inability to provide immediate feedback) when teaching in a classroom setting. Further, the perioperative workforce is multigenerational-younger staff members may have started using technology on a daily basis at a young age, so they may become distracted during traditional lectures and not retain important information. Online game-based learning (GBL) platforms are one technological solution that perioperative educators can use to maintain student engagement and foster learning. Educators at an academic medical center used an online GBL platform to develop presentations on instrument sterilization and surgical attire with sterile technique. At the conclusion of the sessions, the participants submitted surveys evaluating the teaching method. The survey results showed that the respondents found the GBL program to be a fun and positive interactive learning experience. Nurse educators should consider using this type of technology to improve participation and knowledge retention when developing educational programs.

A Grounded Theory of Intraoperative Team Members’ Decision Making Regarding Surgical Attire Guideline Adherence

Surgical attire guidelines (SAGs) assist perioperative nurses with minimizing the risk of patients developing surgical site infections. However, some intraoperative team members fail to fully adhere to SAGs, which may put patients at risk. Because there is a lack of published literature on the reasons for intraoperative team members' SAG nonadherence, I undertook a grounded theory study to explore the decision making of intraoperative team members related to the AORN SAG. The resulting model identifies the factors that affect decision making regarding SAG adherence, including personal identity needs, adherence anchoring activities, SAG awareness, direction from authority figures and organizations, guideline evidence strength, and resource availability. After weighing the influence of each factor, team members decide to what extent they will adhere to the SAG. The theory also provides guidance for enhancing adherence decisions.

Chlorhexidine Gluconate Application as A Strategy to Reduce Cardiac Implantable Electronic Device Surgical Site Infection

Background: The electrophysiology laboratory within the cardiac procedures unit (CPU) at Michigan Medicine specializes in implanting, exchanging, and extracting cardiac implantable electronic devices (CIED). During routine surveillance of surgical site infections (SSI), an increase in CIED infections (specifically endocarditis) was noted starting in 2016. The predominant organisms involved with infection were skin organisms such as Staphylococcus aureus and coagulase-negative Staphylococcus. Methods: Cases of SSI following CIED implantation were identified using positive microbiology results collected within 90 days of a procedure. Cases were classified using the NHSN SSI definitions. Upon identifying an increase in infections, a work group of key stakeholders was formed to determine root causes. Factors discussed included standardized surgical skin preparation techniques, patient education regarding bathing before and after procedures, types of surgical drapes in use, traffic in and out of procedure rooms during cases, environmental cleanliness of the procedure area, and adherence to the institutional surgical attire policy. In addition to the workgroup, several cases were observed by the IP team. Results: The investigation revealed several areas for improvement. As a first step, a practice of using 2% chlorhexidine gluconate (CHG)–impregnated bathing clothes on patients prior to surgery was implemented for the chest, neck, axilla, and arm. No other changes were implemented during this time period. In the year following implementation, there were zero cases of endocarditis and only 2 superficial SSIs (Figs. 1 and 2). Conclusions: Employing application of CHG to reduce the microbial burden on the skin significantly aided in preventing infections related to CIEDs.Funding: NoneDisclosures: None

Clinical Issues-July 2020.

Ensuring patient safety under time pressure Key words: on-time starts, turnover time, briefing, team communication, delays. Holes in the outer layer of sterilization wraps Key words: package integrity, defects, sterilization wrap, contaminated item, sterile field. Changing surgical attire after smoking outside Key words: surgical attire, cigarette smoke, tobacco smoke, third-hand smoke, wound healing. Methemoglobinemia after local anesthesia Key words: methemoglobinemia, methemoglobin (MetHb), lidocaine-prilocaine, methylene blue, cyanosis.