Tuesday, May 31, 2016

Does wearing jackets over scrub suits prevent infections?

I always enjoy papers that reinforce my biases. Here’s one called “The Impact of Perioperative Warm-up Jackets on Surgical Site Infection: Cost without Benefit?”

If you’re a regular reader of my blog, you undoubtedly know the answer. Wearing jackets over scrub suits doesn’t prevent infections and adds costs.

Investigators from the University of Minnesota looked at infection rates one year before the institution of a mandatory warm-up jacket over scrub suit policy and one year after.

The rate of surgical site infection for the 13,302 cases done in the year before jackets had to be worn was 2.42% compared to 2.67% for the 12,998 cases done during the year after. The difference was not statistically significant with a p value of 0.1998.

The cost of laundering the jackets was about $1000 per month and does not include their purchase and the time wasted by the staff in complying with the policy.

The warm-up jacket policy was mandated after a Centers for Medicaid and Medicare Services review of the hospital and was based on a recommendation by the Association of Perioperative Registered Nurses (AORN).

Research on this topic is sparse. In the mid-1980s, a group published remarkably similar papers in two nursing journals stating that colony counts from the shoulders of subjects wearing scrub suits were lower when cover gowns were used. The abstracts [available here and here] do not contain any data or statistics for comparison.

Another study from 2003 found no significant differences in colony counts of personnel whether they were wearing cover garments or not. However, only 75 subjects were involved.

The AORN has apparently seen the light because as of November 2014, its policy now reads as follows:

The collective evidence does not support wearing cover apparel to protect scrub attire from contamination, and there is evidence that lab coats worn as cover apparel can be contaminated with large numbers of pathogenic microorganisms.

Here’s the real question. Is there any relationship to bacterial colony counts on clothing and surgical site infection?


artiger said...

During the mandatory warm-up jacket period, if someone omitted their jacket, did that constitute a medical error.

Forgive the sarcasm, I'm just trying to see humor in hopelessness. I have a question though...were the warm-up jackets worn outside the hospital at any time?

George Gasman said...

Thanks for the link. As someone who sits at the head of the table, frequently under some awful, just AWFUL-COLD ventilation ducts, I wear a "warm-up" jacket - have for years.

But, I wear it because it (get this!) warms me up, not because of some not-even-half-baked pseudoscience.

But, the basic question, how does it affect the patient, is unanswered.


Skeptical Scalpel said...

Artiger, undoubtedly not wearing a jacket was a medical error. Any complication that a patient suffered was a direct result of staff not wearing a jacket [just kidding]. The paper didn't go into detail about what activities the jacket wearers engaged in.

George, I understand that anesthesiologists' metabolic rates can go quite low during a long case. :-) I don't know if the presence or absence of a jacket makes any difference in patient outcomes. For SSIs, it looks like it doesn't matter.

I've got a post about white coats coming out tomorrow on Physician's Weekly. Look for it by mid-morning at http://www.physiciansweekly.com/

Oldfoolrn said...

I used to work with an old school thoracic surgeon that always wore his expensive suit jacket over his scrubs while rounding. A very cool, unique style and the pockets of his suit jacket contained everything he needed to perform his favorite procedure; pleural taps. My favorite part of the procedure was when he ceremoniously produced a band aid from his vest pocket and carefully applied it. We did not have warm up jackets back in the day but anyone that felt cold could slap on cloth gown.

Anonymous said...

"I always enjoy papers that reinforce my biases." ROFL LOL.

So an article on Physicians' Weekly? I think you have found your second job. :)

Skeptical Scalpel said...

Old Fool, I knew a surgeon who wore a suit jacket over scrubs too. To be honest, it looked dorky.

Anon, I've been writing for Physician's Weekly for 5 years. It's no so new.

artiger said...

Well, now that we have some evidence to exonerate white lab coats, can someone do a similar study to clear up the bouffant vs surgical cap controversy noted below?

Anonymous said...

I to had a mentor with the burning passion to look like a dork outside the confines of the theater. He insisted on wearing this nonsensical single breasted tweed-like jacket. It had pockets to hold his nonsensicals including my most hated of instruments the dreaded Zippo lighter. As a head and neck surgeon he would use the lighter to heat up his mouth/throat mirror to all but glowing red to "prevent it from fogging up" as he described. I asked him on numerous occasions why not simply use fog-off or for that matter hand soap or even an alcohol wipe but he insisted that not only was his way better it was more "sanitary" since the flame sterilized the mirror. I don't get why we seem to look for reasons to make more trouble. Surely there is no logical reason why a warm up or for that matter any cover-up is going to prevent disease and if the whole goal is to prevent creepy cruddies from getting on our clothes from outside the OR spaces then the one way is to prevent OR clothes from leaving the OR area but if they do that I know of about 200 surgeons who will retire. We need to look carefully at how REASONABLE it is to eliminate nosocomial infections from the craziest of places when in reality the hospitals themselves are the cesspits of bacterial growth thru pure definition (hello they have sick patients in them). Before we discuss dressing differently lets look at the 100K other areas of improper hygiene in the confines of the facility. How many times do we really wash our hands before each and ever room visit or iPad interaction or laptop contact or even for that matter door knob?
Dr Dave

Skeptical Scalpel said...

Artiger, I thought I cleared up the cap controversy last month http://skepticalscalpel.blogspot.com/2016/04/its-time-to-discuss-surgeon-headgear.html

Doctor, I agree with you. Let's focus on the real issues and forget about OR cover-ups and caps.

artiger said...

Scalpel, yes, you cleared it up, but apparently some states aren't able to view your blog.

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