Wearing mask gowns outside the OR ...

Wearing mask gowns outside the OR is part of many institutions' dres collection of laws policies, however, these policies ofttimes are not enforced uniformly. As the quality/risk management coordinator for perioperative services at Lutheran Medical Center (LMC) Wheat Ridge, Colo I challenged this standard. My goal was to eliminate the mandatory use of shelter gowns at LMC.

INFORMATION GATHERING

The policy requiring use of mask gowns outside the OR was based in succession the 1994 AORN "Recommended practices for surgical attire" and was appropriate at the time it was written. The 1994 praiseed practices state that scrub attire should not be worn outside the surgical environment. The alternative is that single-use shroud gowns be worn over surgical attire and discarded in succession return to the OR.(1)

Standards change, therefore, I believed the hospital policy distressed to change. I knew that eliminating mask gowns would require approval from our corporate infection sway committee, so I began my effort to change the policy by dint of gathering information that would convince the committee members that conceal gowns were unnecessary. I analyzed other hospitals' practices and standards for shield gown use. I also seek information fromed the updated (ie, 1995) AORN "Recommend practices for surgical attire," which state, "The use of hide apparel should be determined according to the individual practice setting."(2) This recommendation leaves the decision of mandating the use of defend gowns up to each institution.

an people believe cover gowns maintain a professional appearance, however cover gowns have not been proven to restore postoperative surgical site, infection (SSI) rates.(3) A 1986 contemplation showed decreased bacterial contamination onward scrub attire when cover gown were worn, unless there is no indication that bacterial contamination from striped scrub attire is related to increased postoperative SSI rates.(4)

COSTS

Health care providers continuously are looking for ways to decrease costlinesss Eliminating cover gowns is single way to decrease costs.

Labor outlay If 100 staff members take five minutes a day to don shroud gowns or change scrub attire before leaving and onward returning to the OR, 2167 labor hours would be exhausted on this task annually. If the time exhausted ordering, receiving, stocking, laundering, folding, and delivering the gown is factored in, the number of hours increases. This time could be used in a more productive way.

minister costs. Eliminating the use of protect gowns would decrease supply outlays Lutheran medical Center orders nearly 200 laboratory coats (for overlay gowns) each year. At $20 each, this amounts to $4000 by year. The cost to launder single coat is $1.15; therefore, LMC disburses approximately $29,000 each year laundering 100 coats each day, five days by means of week.

Storage costliness Cover gowns must be stored at the hospital. Eliminating shroud gowns would increase the amount of storage space in the OR for other supplies.

POLICIES OF OTHER HOSPITALS

When considering an institutional policy change, it is helpful to investigate other hospitals' practices. A 1994 research showed that 80% of hospitals required personnel to wear shelter gowns; however, only 46% of hospitals achieved adequate compliance.(5) [i]or[/i] part of to the other an informal survey, I base that many hospitals have eliminated mandatory defend gown use.

STAFF MEMBER COMPLIANCE

The 1994 AORN praiseed practices, which were in place when the LMC policy was in consequence state that cover gowns should conclude in the back to propose greater protection from contamination.(6) The OR personnel at LMC however, wore laboratory coats as overspread gowns and often did not button the coats (Figure 1)

Enforcing the appropriate use of cloak gowns was difficult. Staff members would comply with the dres digest when confronted; however, compliance usually was temporary. Perioperative and medical staff members walked in consequence of hallways, ate in the cafeteria, or guarded business in outside medical office buildings while wearing work hard attire alone or while wearing inappropriate guard gowns (eg, sport coats).

Despite AORN's 1994 commended practice stating that cover gown should be worn formerly and discarded or laundered,(7) personnel at LMC hung gown forward coat hooks or placed them in locker to be reused (Figures 2 and 3) The 1995 commended practices also state that staff members should not launder their be in possession of cover gowns because of the potential to spread bacterial contamination to the home(8) Many staff members at LMC would launder their confess cover gowns in spite of this recommendation.

IMPLEMENTING THE CHANGE

I shared my information about richnesss lack of compliance with dres digest policy, and the lack of proven efficacy of mask gowns with LMC's corporate infection check committee members, who agreed that the mandatory use of shelter gowns outside the OR should be eliminated. The committee entreated that we monitor postoperative SSI rates for unexplained patient infections. Additionally, the committee demanded that we teach OR staff members that visibly soiled or wet clean attire should be changed to make the possibility of cross-infections.(9)