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Sterile Regions of an Operating Gown during a Lower Limb Joint Replacement Surgery

Mohammad Reza Abbasian MD, Seyyed Mohammad Qoreishy MD*, Ali Akbar Esmailiejah MD

Shahid Beheshti University of Medical Sciences, Tehran, Iran
* Corresponding Author

Introduction: Surgical intervention is associated with an inherent risk of postoperative wound infection. Contamination of the operative field is a major concern to all orthopaedic surgeons. However, this concern is much bigger for arthroplasty surgeon. The aim of this study was to determine the boundaries of the most sterile part of the surgical gowns used during arthroplasty procedures at the beginning and the end of the index procedures.

Materials and methods: We took cultures from 32 sterile disposable surgical gowns (sterilized by ethylene oxide) from a series of 8 surgical cases performed by one surgeon. These swabs were streaked on one quadrant of a 5% sheep blood agar plate, which is a standard, nonselective media that is known to support the growth of numerous bacterial strains, including Gram-negative and Gram-positive species (eg, Staphylococci and Streptococci).

Results: Bacterial growth was observed most frequently in the areas above the chest (27%–44%) and below the operating room table (17%–23%). In contrast, the portion of the gown between the chest and the operating room table had the lowest contamination rates (6%–9%). Likewise, 23% of swabs acquired from the elbow creases and 24% and 36% of the swabs taken from 5 and 10 cm above the elbow crease, respectively, were contaminated after surgery.

Conclusion: Based on our data, we regard the front of the gown between the operative table and the chest to be the area of greatest sterility and we strongly advise scrubbed personnel to avoid contacting the surgical field with their elbow creases to minimize the risk of infection.

Keywords: Operating Gown, Sterile Site, Joint Replacement, Bacterial Infection