OR gowns

[DCDAWG]

Why are OR gowns only considered sterile in certain areas? Do they sterilize the whole thing or only those parts of it?

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[smq123]

Why are OR gowns only considered sterile in certain areas? Do they sterilize the whole thing or only those parts of it?

No, while it is still in the package, the whole gown is sterile. Parts of it (specifically the back, and the part below your waist) stop being sterile after you put it on.

 

[rahulb]

the entire thing is sterile but for practical reasons you consider nipple line to waist sterile and should keep your hands within that area. there's no reason to move your hands out of that vicinity anyway.

also don't turn your back towards the patient or table or put your hands under your arms

 

[Substance]

It's kind of a ******ed custom from years past. There's no reason why the front of your gown from nipple to waist is sterile yet one millimetre above or below is not. It's just an arbitrary designation.

That being said, no surgical field is truly sterile. There is crap floating around in the air that you can't prevent. Every breath and word that comes out of people ricochets off the sides of their masks and into the air, along with whatever pathogen decides to hitch a ride.

The only way for a surgical field to be truly sterile would be to put the patient inside a sterile hood, with the surgeons operating through partitions in the glass, not unlike the intro of the Simpsons where Homer is handling the radioactive bars. But that ain't gonna happen.

That being said: do not screw with OR nurses. They are fat dragon ladies with very boring jobs that a high-school student who took a weekend course could do. Even if they yell and bitch, take solace in the fact that they are miserable because they are both ugly and have ugly children, and have/had husbands that cheat on them due to the aforementioned ugliness.

 

[Re3iRtH]

It's kind of a ******ed custom from years past. There's no reason why the front of your gown from nipple to waist is sterile yet one millimetre above or below is not. It's just an arbitrary designation.

That being said, no surgical field is truly sterile. There is crap floating around in the air that you can't prevent. Every breath and word that comes out of people ricochets off the sides of their masks and into the air, along with whatever pathogen decides to hitch a ride.

The only way for a surgical field to be truly sterile would be to put the patient inside a sterile hood, with the surgeons operating through partitions in the glass, not unlike the intro of the Simpsons where Homer is handling the radioactive bars. But that ain't gonna happen.

That being said: do not screw with OR nurses. They are fat dragon ladies with very boring jobs that a high-school student who took a weekend course could do. Even if they yell and bitch, take solace in the fact that they are miserable because they are both ugly and have ugly children, and have/had husbands that cheat on them due to the aforementioned ugliness.

someone bitter? 😎

 

[45408]

Very little is truly sterile. If you watch a lot of attendings, you'll notice they have a much more lax attitude about sterility since a lot of it probably doesn't matter. Some procedures need to be quite sterile (especially if you're placing a foreign object in the pt, like ortho hardware or permanent mesh), but think about it - if you're draining butt pus, does it matter if your knee bumped a non-sterile chair? None of the air is sterile either, and ORs do not have good air circulation the way a real clean room does (like NASA). The water you use to do a full scrub IS NOT STERILE, so you're NOT STERILE. You're just cleaner than you were before.

But like Substance said, don't ever pick this fight with the OR nurse or scrub tech. You won't come out ahead.

No, while it is still in the package, the whole gown is sterile. Parts of it (specifically the back, and the part below your waist) stop being sterile after you put it on.

But this should answer your question.

 

[fergustsi]

the entire thing is sterile but for practical reasons you consider nipple line to waist sterile and should keep your hands within that area. there's no reason to move your hands out of that vicinity anyway.

also don't turn your back towards the patient or table or put your hands under your arms

how come i have seen some attendings do exactly this, in order to "keep sterile" when moving around? the biggest offenders are interventional rads docs, but ive seen others do it too.

 

[45408]

how come i have seen some attendings do exactly this, in order to "keep sterile" when moving around? the biggest offenders are interventional rads docs, but ive seen others do it too.

Everyone does it here - surgeons, fellows, residents, scrub techs. I don't know what the problem is.

 

[smq123]

how come i have seen some attendings do exactly this, in order to "keep sterile" when moving around? the biggest offenders are interventional rads docs, but ive seen others do it too.

When they say "don't put your hands under your arms," I think what they're trying to say is "don't put your hands near your armPITS." That area, because of the sweat, is supposed to be "unsterile." I have seen attendings put their arms under their elbows, which I suppose is "better."

 

[rahulb]

yea sorry i meant armpits. 12+ hours of OR everyday makes me a bit hazy in the evenings.

 

[Winged Scapula]

The REAL reason is to suppress the students and keep them under our thumb without a good reason.

Actually, its the reason smq gives plus its closer to the non-sterile back of the gown. Its a bit ridiculous really.

 

[Law2Doc]

It's kind of a ******ed custom from years past. There's no reason why the front of your gown from nipple to waist is sterile yet one millimetre above or below is not. It's just an arbitrary designation....

Custom yes, ******ed, not really. Yes the lines are arbitrary, but you have to draw lines someplace. Studies suggest that following this sterile OR protocol has resulted in lower infection rates. Could things be redefined by a few inches in any direction? Sure. But is it foolish to pick some protocol and stick with it if the results bear out that it is beneficial? No.

There is plenty of room for improvement, but I suspect the next round of improvement to steile procedures is going to be more confining, not less. The biggest changes are going to be limitations on where people may go in scrubs (ie not leaving the OR area, and especially not leaving the hospital in them). Some places are beginning to implement this. Expect to have to change into fresh scrubs each time you enter the OR suite in the near future.

 

[45408]

Expect to have to change into fresh scrubs each time you enter the OR suite in the near future.

Because of the significant hassle this imposes, unless there's strong data to support this, I doubt this will become a widespread practice.

 

[Law2Doc]

Because of the significant hassle this imposes, unless there's strong data to support this, I doubt this will become a widespread practice.

I don't think you want to put much money on that. There are already quite a few hospitals and administrators moving in this direction, and this is a change that is coming down the pike, albeit slowly, at many of the "centers of excellence" in the field. Extensive community spread of MRSA in some locales is forcing the issue, making hospitals concerned with what is coming to and from the hospital and OR. At one major hospital this past year, the administrative staff periodically stand outside of the building to "catch" people coming and going in scrubs, and make them go change. A number of places implemented the "change for the OR" rule in the past couple of years. Inconvenience is the only real argument against this move, and with the rise of antibiotic resistant bugs, I doubt this argument will be persuasive for too long.

 

[medstud2be]

There is plenty of room for improvement, but I suspect the next round of improvement to steile procedures is going to be more confining, not less. The biggest changes are going to be limitations on where people may go in scrubs (ie not leaving the OR area, and especially not leaving the hospital in them). Some places are beginning to implement this. Expect to have to change into fresh scrubs each time you enter the OR suite in the near future.

Our university hospital system has implemented this exact policy. Several medical students broke this policy, and we almost lost several rotations due to students wearing scrubs outside the OR. Now, we all are threatened with being expelled if we break this policy.

Speaking of nurses, the story is that one of the students was seen by a nurse wearing scrubs outside the hospital. She was indignant at this lack of infection control. She started railing at the student, and the student "was rude and ignored her". Supposedly, she reported it. She and several other nurses made such a stink that it turned into a big deal. Before it was over, it had gone to the Dean and President of the school.

 

[45408]

I don't think you want to put much money on that. There are already quite a few hospitals and administrators moving in this direction, and this is a change that is coming down the pike, albeit slowly, at many of the "centers of excellence" in the field. Extensive community spread of MRSA in some locales is forcing the issue, making hospitals concerned with what is coming to and from the hospital and OR. At one major hospital this past year, the administrative staff periodically stand outside of the building to "catch" people coming and going in scrubs, and make them go change. A number of places implemented the "change for the OR" rule in the past couple of years. Inconvenience is the only real argument against this move, and with the rise of antibiotic resistant bugs, I doubt this argument will be persuasive for too long.

so where's the data? Does it actually make a difference or is it all theoretical?


Neckties are known to be a Petri dishes wrapped around the attending's neck, but not many places have banned those.

 

[FutureInternist]

so where's the data? Does it actually make a difference or is it all theoretical?


Neckties are known to be a Petri dishes wrapped around the attending's neck, but not many places have banned those.

Except UK....We should follow their lead on this for sure...not for cleanliness sake....I just HATE ties.

 

[indo]

That being said: do not screw with OR nurses. They are fat dragon ladies with very boring jobs that a high-school student who took a weekend course could do. Even if they yell and bitch, take solace in the fact that they are miserable because they are both ugly and have ugly children, and have/had husbands that cheat on them due to the aforementioned ugliness.

If you only learn 1 thing on your surgery rotation this should be it.