Evaluation of the protective value of hospital gowns against blood strike-through and methicillin-resistant Staphylococcus aureus penetration.

BACKGROUND: Hospital gowns protect patients and health care workers from exposure to blood and other infectious materials. Previous studies have shown that certain gowns do allow blood strike-through. Because of worldwide increases in the incidence of Staphylococcus aureus infections, especially with methicillin-resistant strains, there is now increased concern regarding bacterial transmission through gowns. METHODS: This study evaluated six gown types used in hospitals (one disposable cover or isolation gown, three disposable operating room gowns, and new and washed reusable operating room gowns). Gowns were evaluated for dry spore and S. aureus filtration efficiencies and were subjected to 20 time-pressure combinations with methicillin-resistant S. aureus-spiked blood (10(4)/ml) to evaluate blood strike-through and passage of methicillin-resistant S. aureus. RESULTS: Blood strike-through was lowest with disposable operating room gowns 1 and 2 (polypropylene). Disposable operating room gown 3 (polyester-wood pulp) showed the greatest strike-through and overall passage of methicillin-resistant S. aureus. Operating room gowns 1 and 2 showed minimal bacterial passage, whereas the disposable cover (polypropylene) only allowed passage at pressures greater than 1 psi. Bacterial filtration efficiency testing showed operating room gowns 1 and 2 to be the most protective; operating room gown 3 and both reusable (cotton) gowns were the least protective. Dry spore passage was greatest for reusable gowns. CONCLUSION: Different hospital gowns offer varying degrees of protection against fluid strike-through or bacterial passage. Gowns therefore should be chosen according to the task performed and conditions encountered.

Determination of surgeon-generated gown pressures during various surgical procedures in the operating room.

BACKGROUND: Patients' blood or other potentially infectious body fluids frequently pass through surgeons' gowns in the operating room. These fluids are absorbed by the scrub suit and can directly contaminate the surgeons' skin. Protective barriers remain an important method of exposure control for many blood-borne pathogens. The efficacy of surgical gowns in preventing this passage or strikethrough has therefore become the focus of much attention. Limited data are available concerning the magnitude and duration of pressure against surgeons' gowns. METHODS: A 32-sensor mat placed in the abdominal area was used to obtain pressure data for 15 surgeons of both sexes performing 20 procedures. RESULTS: The percentage of time any pressure was detected varied from 0% during knee reconstruction to 97.4% for excision of a stomach mass. In 16 procedures, more than 87.8% of pressure contacts were 2 N/cm2 (2.9 psi or less); in addition, more than 80% of the contacts were 15 seconds or less during 13 of the procedures. No correlation was found between the amount of pressure and sex of the surgeon, surgical service, or length of the procedure. CONCLUSIONS: Because pressure is related to the type of procedure, gowns should be chosen to afford protection against fluid strikethrough for the pressures and blood loss anticipated.

Preventive antibiotic usage in traumatic thoracic injuries requiring closed tube thoracostomy.

OBJECTIVE: To evaluate the safety and effectiveness of antibiotics in reducing the infectious complications following closed tube thoracostomy for isolated chest trauma. DESIGN: Double-blind, randomized clinical trial. SETTING: Medical school affiliated large urban teaching hospital and trauma center. PATIENTS: One hundred nineteen of 159 patients over 18 years old presenting to the emergency department requiring closed tube thoracostomy for isolated chest injuries (113 penetrating, 6 blunt). INTERVENTION: Patients received either placebo or 1 g cefonicid daily intravenously started at chest tube insertion and stopped within 24 h of removal. MEASUREMENTS AND RESULTS: The development of wound infections, pneumonia (CDC criteria), or empyema; the incidence of adverse events; length of hospitalization. One nonspecific infection was seen in the cefonicid group (1.6 percent) and six respiratory tract infections (10.7 percent) in the placebo group (three empyema, one empyema with pneumonia, two pneumonia) (p = 0.0505; p = 0.0094 [excluding nonspecific infection]). No significant differences with antibiotic use were seen in the duration of chest tube use (p = 0.766), peak WBC counts (p = 0.108), lower peak temperatures (p = 0.063), or length of hospitalization (p = 0.165). Patients who developed infectious complications averaged approximately 8 days longer hospitalization than those without (p < 0.0001). CONCLUSION: This study showed that patients receiving antibiotics had a significantly reduced rate of infection than did patients administered placebo. No significant adverse events were seen in either group.

Variability of laboratory coat resistance to blood strikethrough.

Protection from contamination by potentially infectious fluids is an increasingly important aspect of hospital safety programs. Technical personnel in clinical laboratories may handle numerous samples of human blood and other fluids daily, and to protect themselves against exposure to bloodborne pathogens they routinely wear laboratory coats. We studied the effectiveness of six disposable (polypropylene; either spun-bond or spun-bond/melt-blown/spun-bond construction) and four reusable (polyester-cotton) laboratory coats in preventing blood passage. Fabrics (1018 samples) were tested at six time durations (1 s-5 min) and five pressures [1.7-13.8 kPa (0.25-2.0 psi)]. A standard spray test used to evaluate resistance to wetting showed that reusable coats were less repellent than disposables (P < 0.05). Pressure testing showed that reusable and spun-bond coats allowed greater blood passage than the spun-bond/melt-blown/spun-bond. Laboratory coats should be chosen that have sufficient resistance to blood or other body fluid passage for the task performed and for the period of time used.

Prospective alterations in therapy for penetrating abdominal trauma.

In a double-blind, randomized study, 170 patients with traumatic perforation of the gastrointestinal tract were administered an advanced-generation cephalosporin. Patients were divided into infection risk groups (< or = 40%, low; 40% to 70%, mid; and > 70%, high) at surgical closure using a logistic regression formula based on four proved risk factors--age, blood replacement, ostomy, and the number of organs injured. Patients in the low group received 2 days of antibiotic therapy; those in the mid to high group received 5 days of antibiotic therapy. Those patients in the low to mid group had primary wound closure; those in the high group had their wounds packed open and closed later. Most of the patients (144 [85%]) were in the low group. Their major and minor infection rates (10% and 12%, respectively) were not significantly different from 145 historic control subjects receiving 5 days of antibiotic therapy (9% major; 14% minor). Patients in the mid to high group showed a greater incidence of major infections (46%) but a similar incidence of minor infections (12%). The results indicate that risk factors can be used to identify low-risk patients who require only short-term antibiotic therapy and primary wound closure. The remaining patients are at greater risk for infection despite prolonged antibiotic therapy and delayed wound closure.

Isolation gowns: a false sense of security?

BACKGROUND: Isolation gowns have traditionally been used in health care situations to protect against microbial contamination. There is now concern over protection of the health care worker from contamination by patients' blood and body fluids. We quantitatively determined the effectiveness of commercially available isolation gowns against human blood leakage or strike through. METHODS: More than 1200 samples of 11 types of disposable gown and one type of reusable gown (new and washed 40 and 80 times) were tested at five different pressures (0.25 to 2 psi) and six durations (1 second to 2 minutes) by means of an apparatus designed to simulate pressures generated during gown usage. RESULTS: In all studied conditions, testing showed significant differences (p less than 0.0001) in the amount of strike through allowed by the gowns and demonstrated important differences in the gowns' protective capabilities. CONCLUSION: Although traditional thought assumes that isolation gowns protect the wearer from contamination, our data show this belief may provide a false sense of security.

Enterococcal infections in surgical patients: the mystery continues.

The frequency of isolation of enterococci from surgical patients has increased significantly during the past decade, although the role of these organisms as pathogens in mixed infections remains a mystery. Bacteremia and other infections in which enterococci are the only pathogens frequently result in high morbidity and mortality among patients unless specific antimicrobial therapy is initiated promptly. Debate continues concerning the necessity for treatment with such agents when this organism is isolated as a component of a polymicrobial infecting flora. Our recent data indicate that enterococci are rarely isolated in postoperative infections after penetrating abdominal trauma if no gastrointestinal perforation has occurred. However, they were found in 56% of postoperative infections of patients with gastrointestinal perforation. In contrast, enterococci were isolated in only 9% of cultures of specimens from patients with secondary suppurative peritonitis. The occurrence of superinfection after therapy with a cephalosporin appears to be an important factor in this finding. Future studies are necessary to evaluate the efficacy of antibiotic treatment of enterococcal infections and to assess the need for prophylaxis against enterococci.