The Gown-glove Interface Is a Source of Contamination: A Comparative Study

Area of Science:

• Orthopedic Surgery
• Infection Control
• Biomedical Engineering

Background:

• Historical negative-pressure suits reduced infection in total joint arthroplasty (TJA).
• Modern positive-pressure surgical helmet systems lack proven infection reduction benefits.
• Concerns exist regarding increased wound contamination with current gowning systems, particularly at the gown-glove interface.

Purpose of the Study:

• To compare particle contamination levels at the gown-glove interface across various modern surgical helmet systems and conventional surgical gowns.
• To identify specific gowning systems that may contribute to increased particle shedding during simulated surgical procedures.

Main Methods:

• A fluorescent powder was applied to surgeons' hands and wrists.
• Surgeons performed a 20-minute simulated total joint arthroplasty (TJA) protocol while wearing different gowning systems.
• Gown contamination at the gown-glove interface was quantified under ultraviolet light using a standardized grading scale (0-4).

Main Results:

• All tested gown-glove interfaces exhibited particle contamination.
• Significant differences in contamination levels were observed between gowning systems (p = 0.029).
• The Stryker T5 Zipper Toga system demonstrated substantially higher contamination (median score 4) compared to all other systems, including conventional gowns and other helmet systems.

Conclusions:

• Particle contamination is prevalent at the gown-glove interface in commonly used positive-pressure surgical helmet systems.
• The Stryker T5 Zipper Toga system showed the highest level of particle contamination.
• The gown-glove interface represents a potential source for surgical site infections, necessitating consideration of gowning systems that minimize particle migration.