What’s important to know when

Barrier to liquid penetration: This type of barrier is designed to protect the surgical team from liquids used in irrigation as well as from patient blood and other bodily fluids. As skin is not always an intact barrier (cuts, abrasions, rash, eczema, etc.), contaminated fluids that penetrate through a gown ("strike through") can put the wearer at risk. The patient is also at increased risk of infection when any fluid penetrates the gown as bacteria from the wearer may "wick through" the fabric utilizing the fluid as a mode of transport. After reaching the outer surface of the gown, these bacteria may enter the surgical wound, planting "seeds" for a surgical site infection.

Liquid barrier protection evaluations consist of several components. Performance levels are determined using different 1) test fluids 2) levels of exerted pressure and areas of the gown to be tested.

Barrier to penetration by bacteria laden aerosol or dry particles containing spores: Movement and pressure against the operating room table can create a "bellows effect" forcing air through the gown. As skin cells and bacteria are shed continually, air forced through the gown from the wearer’s side may transport microorganisms through the fabric, into the surgical field. Test performance also demonstrates the ability of the gown to protect the wearer during aerosol generating procedures such as those that occur during the use of power drills and saws, or during aggressive irrigation of infected or contaminated wounds. Testing utilizes either a very small droplet mist containing microorganisms, or a very dry aerosol of talcum powder mixed with bacterial spores. The contaminated air is "pulled" through the fabric using a vacuum source. These tests, though very important, are not required for gowns and must be requested of the manufacturer.

Abrasion resistance: When the arm of the surgeon rubs against the drapes or the waist rubs up and down against the table, the resulting abrasion can adversely affect the fabric’s fluid resistance performance and weaken the material’s tear resistance. Abrasion also produces lint. If lint is deposited in the open wound, or onto instruments that later enter the wound, there are a number of potential associated post-surgical complications that can occur (described below). Abrasion testing should be performed on gowns under both wet and dry conditions to mimic use. Depending upon manufacturing methods, delamination of some materials may occur when the gown is wet.

Strength: Gowns must be strong enough to withstand the stresses encountered during use under both wet and dry conditions. Strength assessments can apply to the gown’s ability to resist rupture, tearing and puncture.

Lint and particulate generation: Fabrics vary significantly in the amount of lint they produce. If lint or other particulates generated from the gown contaminate the surgical wound, they may carry microorganisms with them - either from the surgical team or picked up anywhere in the operating room (OR). They may also lower the threshold for infection by interfering with the patient’s immune response and can cause granulomas and adhesions via a foreign body response or a delayed hypersensitivity reaction to chemicals on the fibers. Any fabric that contains cellulose is especially reactive.

Flammability: There are many potential ignition sources in the OR including surgical lasers, endoscopic fiberoptics, electrosurgical units (ESU) and high speed drills or saws (heat of friction). These together with a fuel source in an oxygen rich environment can cause devastating fires. Fabrics should resist ignition. Proof of passing 16 CFR 1610, should be part of the required specifications. Gowns should not ignite when touched by an ignition source such as an ESU. Note, however, that if flammable materials placed on ignition resistant materials catch fire, even the ignition resistant fabric beneath may burn.

Electrostatic properties: Some fabrics can elicit sparks which can be an ignition source for a fire. Although the United States has discontinued the use of flammable anesthetics in an effort to reduce this risk, the use of oxygen-rich ventilation and of alcohol containing surgical hand scrubs and patient skin prep products has increased OR fire risk. It is important that fabrics dissipate electrostatic energy rather than build a charge that can be released as an ignition spark.

Comfort: It is impossible to fully concentrate on any surgical procedure if the protective apparel feels confining, is annoyingly stiff or causes discomfort. Testing on drapeability (suppleness) and air permeability (breathability) is important especially when developing a gown, as it provides good quantitative data - but opinions from wearers are more important in the pre-purchasing assessment.

Reusable Gowns: If considering purchasing reusable gowns, make certain the reusable gown still performs according to specifications after washing AND in-use wear conditions for the number of cycles expected.

CONFIRM that the data evaluated, the gowns ordered, and the gowns received are identical. Too many data/gown identity disconnects and product substitutions have occurred to just assume the "gown must be the same because it looks the same." Confirm in the contract that the performance levels previously shown will not be changed.