Bacterial dispersion in relation to operating room clothing.

The effect of operating clothing on the dispersal of bacterial particles from the wearers was studied in a dispersal chamber. A comparison was made of six gowns as well as four types of trousers. The gowns were of three basic types, namely a conventional cotton type, disposable types made of non-woven fabric and those of the total-body exhaust system (Charnley type). The dispersal chamber could simulate conditions as expected both in down-flow unidirectional ultra-clean systems and in a conventional turbulent plenum-ventilated system. It was found that the disposable gowns would reduce the dispersal rate by about 30% in the simulated conventionally ventilated system and about 65% in the laminar flow system. The total-body exhaust system (Charnley) would reduce the count by 10-fold in the conventional ventilated system and by 66-fold in the laminar-flow system. The poor performance of the gowns in conventionally ventilated systems was caused by the dispersal of bacterial particles from underneath the gown (about 80%). This was not reduced by the disposable gown and only partially by the Charnley type. This small drop would be further decreased in a conventionally ventilated operating-room as only scrubbed staff would wear the gown. In order to overcome this poor performance in conventionally ventilated operating-rooms impervious trousers would be required. Four types were studied and it was demonstrated that those made either from Ventile or non-woven fabric would reduce the bacterial dispersion fourfold. As these tests had been carried out in an artificial environment checks were carried out in the unidirectional-flow operating-room during total-hip arthroplasty. This was done by comparing conventional cotton gowns with non-woven gowns and total-body exhaust gowns. The results showed good correlation between the operating room and the chamber with the non-woven fabric gown but the total-body exhaust system did not perform as well in the operating room (12-fold compared to 66-fold) the difference being possibly due to the contribution from the patient. However, as this comparison was that which would be most open to influence from other variables confidence could be placed on the chamber test results. Values were also obtained for the total number of bacterial particles dispersed by persons during a standard exercise wearing different clothing. This count was dependent on the clothing worn but a median count of between 1000 and 1500 bacterial particles/min. would be expected when conventional clothing was worn, with a range of between 300 and 19,000. This count could be reduced to about 100/min. if a total-body exhaust suit was worn (range 30-400).