What is the evidence behind the things we are forced to wear in the OR? Do they help? Are they voodoo?
On this episode, Karl takes us through the evidence behind the different pieces of OR attire. Some things seem to work… some things do nothing… some things might actually be harmful. 🤨
Overview of adoption of OR attire through history, by examining historical photographs.
Adams, L., Aschenbrenner, C., Houle, T., Roy, R. (2016). Uncovering the History of Operating Room Attire through Photographs. Anesthesiology 124(1), 19-24. https://dx.doi.org/10.1097/aln.0000000000000932
Case report of surgeon performing appendectomy on himself.
Rogozov, V., Bermel, N. (2009). Auto-appendectomy in the Antarctic: case report BMJ 339(dec15 1), b4965-b4965. https://dx.doi.org/10.1136/bmj.b4965
An experimental study of how clothing effects the dispersal of staph.
Hill, J., Howell, A., Blowers, R. (1974). EFFECT OF CLOTHING ON DISPERSAL OF STAPHYLOCOCCUS AUREUS BY MALES AND FEMALES The Lancet 304(7889), 1131-1133. https://dx.doi.org/10.1016/s0140-6736(74)90885-x
First experimental study on surgical draping.
Beck, W., Collette, T. (1952). False faith in the surgeon’s gown and surgical drape The American Journal of Surgery 83(2), 125-126. https://dx.doi.org/10.1016/0002-9610(52)90196-7
RCT including cloth vs. paper drapes for CABGs.
Bellchambers, J., Harris, J., Cullinan, P., Gaya, H., Pepper, J. (1999). A prospective study of wound infection in coronary artery surgery European Journal of Cardio-Thoracic Surgery 15(1), 45-50. https://dx.doi.org/10.1016/s1010-7940(98)00255-3
Cochrane review on using plastic adhesive drapes.
Webster, J., Alghamdi, A. (2015). Use of plastic adhesive drapes during surgery for preventing surgical site infection Cochrane Database of Systematic Reviews 4(4), CD006353. https://dx.doi.org/10.1002/14651858.cd006353.pub4
Disposable gowns have less infectious risk than multi-use gowns.
Moylan, J., Kennedy, B. (1980). The importance of gown and drape barriers in the prevention of wound infection. Surgery, gynecology & obstetrics 151(4), 465-70. https://www.ncbi.nlm.nih.gov/pubmed/7414454
Large study of the effect of using jackets on surgical site infections (spoiler: none).
Stapleton, E., Frane, N., Lentz, J., Armellino, D., Kohn, N., Linton, R., Bitterman, A. (2019). Association of Disposable Perioperative Jackets With Surgical Site Infections in a Large Multicenter Health Care Organization JAMA Surgery 155(1), 15-20. https://dx.doi.org/10.1001/jamasurg.2019.4085
Association of mouth flora with surgical site infections
HAMILTON, A. (1905). DISSEMINATION OF STREPTOCOCCI THROUGH INVISIBLE SPUTUM.IN RELATION TO SCARLET FEVER AND SEPSIS. JAMA: The Journal of the American Medical Association XLIV(14), 1108. https://dx.doi.org/10.1001/jama.1905.92500410032001g
First study testing the association of using masks and surgical site infections.
Orr, N. (1981). Is a mask necessary in the operating theatre? 63(6), 390-2.
Study of 41 patients testing the association of masks with surgical site infections.
Chamberlain, G., Houang, E. (1984). Trial of the use of masks in the gynaecological operating theatre. Annals of the Royal College of Surgeons of England 66(6), 432-3. https://www.ncbi.nlm.nih.gov/pubmed/6391343
Larger study (>3000 patients) testing efficacy of masks. No difference in infections.
Tunevall, T. (1991). Postoperative wound infections and surgical face masks: A controlled study World Journal of Surgery 15(3), 383-387. https://dx.doi.org/10.1007/bf01658736
Full RCT of using masks by non-scrubbed staff. No difference in infections.
Webster, J., Croger, S., Lister, C., Doidge, M., Terry, M., Jones, I. (2010). Use of face masks by non-scrubbed operating room staff: a randomized controlled trial ANZ Journal of Surgery 80(3), 169-173. https://dx.doi.org/10.1111/j.1445-2197.2009.05200.x
Case reports of possible association of infections with hair.
Dineen, P., Drusin, L. (1973). EPIDEMICS OF POSTOPERATIVE WOUND INFECTIONS ASSOCIATED WITH HAIR CARRIERS The Lancet 302(7839), 1157-1159. https://dx.doi.org/10.1016/s0140-6736(73)92933-4
Retrospective study of infectious rates in neurosurgical procedures after implementing bouffant policy.
Shallwani, H., Shakir, H., Aldridge, A., Donovan, M., Levy, E., Gibbons, K. (2017). Mandatory Change From Surgical Skull Caps to Bouffant Caps Among Operating Room Personnel Does Not Reduce Surgical Site Infections in Class I Surgical Cases: A Single-Center Experience With More Than 15 000 Patients Neurosurgery 82(4), 548-554. https://dx.doi.org/10.1093/neuros/nyx211
Experimental comparison of disposable bouffants, skullcaps and cloth caps.
Markel, T., Gormley, T., Greeley, D., Ostojic, J., Wise, A., Rajala, J., Bharadwaj, R., Wagner, J. (2017). Hats Off: A Study of Different Operating Room Headgear Assessed by Environmental Quality Indicators Journal of the American College of Surgeons 225(5), 573-581. https://dx.doi.org/10.1016/j.jamcollsurg.2017.08.014
Experimental study comparing types of beard covers.
Parry, J., Karau, M., Aho, J., Taunton, M., Patel, R. (2016). To Beard or Not to Beard? Bacterial Shedding Among Surgeons. Orthopedics 39(2), e290-4. https://dx.doi.org/10.3928/01477447-20160301-01