The effect of surgical gowns made with barrier cloth on bacterial dispersal

A dispersal chamber (body box) technique has been used to compare bacterial dispersal from the skin of subjects carrying out a stepping test under controlled conditions while wearing four differing garment systems namely: basic underwear, cotton 'blues' (standard pyjama style jacket and trousers for men or dress for women), ankle socks, boots for men and shoes for women, mask and theatre hat; the basic set covered with a cotton gown; the basic set covered by a gown with a front made from GORE-TEX fabric in which an expanded polytetrafluoroethylene membrane is sandwiched between layers of woven or knitted polyester; the basic set covered with a fully enclosed suit of the same fabric. A slit sampler was used to measure the number of bacteria liberated in a downward current of air. Six subjects (three female and three male) were studied. Males liberated more bacteria. Covering the 'blues' with a cotton gown increased the bacterial count; a gown of the new material reduced the increase by 50%, and the suit cut the dispersal to virtually zero. Preliminary work suggests that GORE-TEX garments survive laundering better than cotton, and may be cost-effective, but are not yet as comfortable. Research is presently in progress to improve this aspect.     

Attempts to control clothes-borne infection in a burn unit. I. Experimental investigations of some clothes for barrier nursing.

Clothes-borne transmission is an important way of spread of infection from patient to patient which is not interrupted by common cotton gowns. New barrier garments were designed from spun-bonded olefin that, in particle penetration tests, was 100 times better as a filter than cotton cloth. Three designs, a gown, a loose coverall and a close overall, were compared with each other and with conventional cotton gowns in experimental exercise and nursing procedures. Staphylococcus aureus from burned patients were used as markers. The close coverall was 4-7 times better than the loose coverall or gown in preventing the soiling of clothes worn underneath it, but appeared to permit substantially more transfer from garments underneath it to a mock 'patient' and to the air than did the looser garments. A cotton gown reduced the soiling of clothes underneath it by more than 10 times and the contamination of a mock patient by more than 30 times as compared with no barrier garment. The close coverall further diminished the contamination of clothes but not the transfer to the patient. The possible mechanisms for the discrepancy between particle transmission tests annd experimental porcedures are discussed.     

The effect of surgical gowns made with barrier cloth on bacterial dispersal.

A dispersal chamber (body box) technique has been used to compare bacterial dispersal from the skin of subjects carrying out a stepping test under controlled conditions while wearing four differing garment systems namely: basic underwear, cotton ''blues'' (standard pyjama style jacket and trousers for men or dress for women), ankle socks, boots for men and shoes for women, mask and theatre hat; the basic set covered with a cotton gown; the basic set covered by a gown with a front made from GORE-TEX fabric in which an expanded polytetrafluoroethylene membrane is sandwiched between layers of woven or knitted polyester; the basic set covered with a fully enclosed suit of the same fabric. A slit sampler was used to measure the number of bacteria liberated in a downward current of air. Six subjects (three female and three male) were studied. Males liberated more bacteria. Covering the ''blues'' with a cotton gown increased the bacterial count; a gown of the new material reduced the increase by 50%, and the suit cut the dispersal to virtually zero. Preliminary work suggests that GORE-TEX garments survive laundering better than cotton, and may be cost-effective, but are not yet as comfortable. Research is presently in progress to improve this aspect.     

Heat Stress Evaluation of Two-layer Chemical Demilitarization Ensembles with a Full Face Negative Pressure Respirator

The purpose of this study was to examine the heat stress effects of three protective clothing ensembles: (1) protective apron over cloth coveralls including full face negative pressure respirator (APRON); (2) the apron over cloth coveralls with respirator plus protective pants (APRON+PANTS); and (3) protective coveralls over cloth coveralls with respirator (PROTECTIVE COVERALLS). In addition, there was a no-respirator ensemble (PROTECTIVE COVERALLS-noR), and WORK CLOTHES as a reference ensemble. Four acclimatized male participants completed a full set of five trials, and two of the participants repeated the full set. The progressive heat stress protocol was used to find the critical WBGT (WBGT_crit) and apparent total evaporative resistance (R_e,T,a) at the upper limit of thermal equilibrium. The results (WBGT_crit [°C-WBGT] and R_e,T,a [kPa m² W⁻¹]) were WORK CLOTHES (35.5, 0.0115), APRON (31.6, 0.0179), APRON+PANTS (27.7, 0.0244), PROTECTIVE COVERALLS (25.9, 0.0290), and PROTECTIVE COVERALLS-noR (26.2, 0.0296). There were significant differences among the ensembles. Supporting previous studies, there was little evidence to suggest that the respirator contributed to heat stress.     

Effects of Hoods and Flame-Retardant Fabrics on WBGT Clothing Adjustment Factors

Personal protective clothing (PPC) may include hoods and flame-retardant (FR) fabrics that may affect heat transfer and, thus, the critical wet bulb globe temperature (WBGT crit) to maintain thermal equilibrium. The purpose of this study was to compare the differences in WBGT crit for hooded vs. nonhooded versions of particle barrier and vapor barrier coveralls as well as for coveralls made of two flame-retardant fabrics (INDURA cotton and Nomex). Acclimated men (n = 11) and women (n = 4) walked on a treadmill in a climatic chamber at 180 W/m2 wearing four different ensembles: limited-use, particle barrier coveralls with and without a hood (Tyvek 1427), and limited-use vapor barrier coveralls with and without a hood (Tychem QC, polyethylene-coated Tyvek). Twelve of the participants wore one of two flame-retardant coveralls. All participants wore standard cotton clothing. Progressive exposure testing at 50% relative humidity (rh) was designed so that each subject established a physiological steady-state followed by a clear loss of thermal equilibrium. WBGT crit was the WBGT 5 min prior to a loss of thermal equilibrium. Hooded ensembles had a lower WBGT crit than the nonhooded ensembles. The difference suggested a clothing adjustment of 1 degrees C for hoods. There were no significant differences among the FR ensembles and cotton work cloths, and the proposed clothing adjustment for FR coveralls clothing is 0 degrees C.     

Evaluation of various clothing materials for protection and worker acceptability during application of pesticides

Seven different garment materials were examined for resistance to penetration by eight commonly used sprays and one concentrated pesticide formulation. The lightweight materials were four types of spunbonded olefin and a water repellent cellulostic and were compared to heavy cotton drill and rubberized cotton. The latter two materials are used for making coveralls and raingear commonly employed as applicator's protective clothing. Penetration tests were designed to mimic repeated exposure to drifting spray and exposure to concentrated pesticide formulation splashed on a worker during preparation of spray. Lightweight materials were penetrated by more pesticide than would penetrate rubberized rainwear. All of the materials tested would provide significant protection for applicators who chose to wear only short-sleeved shirts and cotton trousers during hot weather rather than endure the discomfort of rubberized cotton garments. Only polyethylene-coated spunbonded olefin and rubberized cotton provided adequate protection against concentrated pesticide formulations. In direct sunlight, the interior surface temperatures of black or dark green, rubberized raingear averaged 70°C (158°F) and reached as high as 83°C (181°F). Under similar conditions the interior surface of white, lightweight jackets averaged 40°C (104°F). Cellulostic material tore too easily for use in orchard spraying. Some garments leaked around the seams, but this may be corrected by use of other seam designs. Spraymen indicated they would wear lightweight garments during hot weather.     

Survey of dermal protection in Washington State collision repair industry

Substantial exposure to isocyanates may occur during spray painting in autobody shops, yet information is lacking on the efficacy of the protective clothing used during spray painting. We investigated the personal and workplace factors associated with painters' dermal protection use during a large-scale exposure assessment study. Survey data indicated that 69% of painters always used gloves, with latex gloves (47%) and nitrile gloves (34%) used most frequently. Among latex glove users, 53% used thin latex (0.05-0.13 mm), 6% used medium latex (0.15-0.20 mm), and 12% used thick latex (> 0.20 mm). Among nitrile glove users, 27% used thin nitrile and 45% used medium nitrile. Sixty-three percent of painters always used coveralls, 44% preferring one particular brand. Although overspray presents an opportunity for dermal exposure to the neck and face, only 19% of painters protected these areas with personal protective equipment. Painters who always used coveralls were more likely to use gloves (odds ratio = 7.9, p = 0.061). Painters who reported ever having smoked cigarettes used gloves (p = 0.05) and coveralls (p = 0.04) more frequently. Painters who sprayed more than 34 clear coat jobs per month used coveralls most frequently (p = 0.038). Exact logistic regressions along with random sample calculations indicated that the survey results were independent of the shops. Because of the small sample size in this study, future research is warranted to corroborate these results. Studying the effectiveness of gloves and coveralls against polyurethane paints and understanding the underlying motivators and preferences for painters and business owners is needed for the development of best practices for the selection and use of dermal protection.     

医护人员预防SARS医院内感染的个人防护措施效果评价

目的 评价医务人员预防SARS医院内感染个人防护措施的效果,验证SARS的传播途径。方法 在广东省10家收治SARS患者的主要医院进行了成组设计的病例对照研究,对象为常规参加SARS诊治工作且直接抢救重患者的医护人员,共257人,其中病例组77例,对照组180人。采用统一调查表了解调查对象接触SARS患者程度、个人防护情况、卫生习惯、预防服药等方面情况。单因素分析采用X2检验、多因素分析利用非条件logistic回归分析。并用趋势X2检验分析个人防护措施的剂量反应关系和联合使用效果。结果 单因素分析结果显示,一直戴12层及以上口罩、穿隔离衣、用鞋套、戴手套、必要时戴眼罩、消毒洗手、漱口液漱口、用滴鼻滴眼液保护鼻眼黏膜、及时洗澡换衣、“不在病区吃饭/饮水/抽烟”、服oseltamivir phosphate等均有保护作用(P<0.05)。非条件logistic多因素回归分析有显著意义的有戴口罩(OR=0.78,95％CI:0.60～0.99)、戴眼罩(OR=0.20,95％CI:0.10～0.41)和穿鞋套(OR=0.58,95％CI:0.39～0.86)。并且趋势分析显示口罩及口罩类型、穿隔离衣、用鞋套、戴手套、必要时戴眼罩、漱口液漱口、用滴鼻滴眼液保护鼻眼黏膜和及时洗澡换衣等措施存在剂量效应关系。无防护参与SARS患者抢救的医护人员的罹患率高达61.5％(16/26),保护率随防     

Composite materials for x-ray protection

We have developed and tested a radiation protection material that provides similar attenuation for diagnostic x-ray spectra to that of conventional Pb apron materials with approximately 30% reduced weight. By combining a number of elements with different K absorption energies, such as Ba, W, and Pb, energy attenuation for given spectra can be optimized with respect to total cross-sectional mass loading. Alternatively, garments with much higher protective factors at equivalent weight to conventional garments could be produced. The reduction in the amount of Pb used also reduces problems associated with the toxicity of the material during manufacture and disposal. Back strain can be reduced for personnel performing special radiological procedures that require wearing protective garments for long periods of time.     

Reducing distress associated with pelvic examinations: a replication.

A previous study of the effect of a new examination gown on patients' experienced discomfort during pelvic examination demonstrated that the gown was effective. This study replicated the previous study with a younger group of subjects. It was hypothesized that the new gown would reduce reported distress. Subjects were 147 patients at a university student health center. Age ranged from 18 to 31. Informed consent was obtained and patients were randomly assigned to either the experimental gown or the standard drape condition. Following examination, subjects completed questionnaires assessing demographic characteristics, state and trait anxiety, desired changes in pelvic examination procedures, and reactions to the examination. The attending nurse recorded blood pressure. Results supported the hypotheses. Experimental subjects rated the gown as more comfortable than control subjects rated the drape. Results indicate that this simple stimulus control intervention reduces one source of distress associated with pelvic examinations.     

Monte Carlo simulation of the dose to nuclear medicine staff wearing protective garments

The literature contains both endorsements of, and advice against, the use of protective apparel in nuclear medicine procedures. The main issues usually centre around: Whether the shielding which can be provided by a protective garment light enough to wear (0 to 0.6 mm lead equivalent at the gamma energies commonly encountered in nuclear medicine) is enough to warrant its use; and (more recently); Whether the dose enhancement behind the protective garment from electron scatter in lead is sufficient to be of concern. In this work, the Monte Carlo code EGSnrc was used to investigate the effectiveness of lead of thicknesses of 0 to 0.6 mm, in shielding staff from photons of energies of 140 and 511 keV. Furthermore, dose escalation behind the lead was investigated. Reasonable dose reductions are obtained at 140 keV with protective garments of 0.5 mm lead equivalence. This perhaps warrants their use, in certain circumstances. At 511 keV, the reduction in dose is less than 10%, and their use is probably not justified (given the weight that has to be carried) from an ALARA point of view. It should be noted here that protective garments designed for X-ray shielding will generally not have the same lead equivalence at the gamma energies used in nuclear medicine. It should also be noted that protective garments which do not contain lead do not always attenuate as much as their stated lead equivalence claims. Dose escalation does occur, but the depth of penetration of the scattered electrons beyond the exit side of the lead shielding is such that it is highly unlikely that a significant dose would be delivered to viable tissue in wearers of protective garments.     

Control of Hand Oedema by use of Lycra Pressure Garments

Lycra pressure garments used in the management of oedema of the hand can be made by occupational therapists using material available in Australia. This is suggested as an alternative to commercially available pressure garments and instructions for the selection, manufacture and application of lycra pressure garments are given. Ninety-five patients using the lycra pressure garments are reviewed to assess the degree of oedema reduction in the hand over a given period. Reduction in oedema was recorded for all patients. The measurements provided serve only as a guideline of results which could be anticipated if a formal comparative study was to be completed.     

Maximum sustainable work rate for five protective clothing ensembles with respect to moisture vapor transmission rate and air permeability

The fabrics associated with protective clothing affect heat stress, which influences productivity and risks of heat-related disorders. This study compared the work limiting effects of five protective coveralls and a semiclothed condition (t-shirt and shorts). Two fabric characteristics determined from bench tests, moisture vapor transmission rate (MVTR), and air permeability were also examined as possible predictors of ensemble performance. A progressive metabolic rate protocol was used where environmentalconditions (T(db) = 32 degrees C; T(pwb) = 26 degrees C) were held constant while treadmill speed was slowly increased. The limiting metabolic rate to just maintain thermal equilibrium was the critical point. At this point, critical speed and critical metabolic rate were noted and total evaporative resistance was calculated for each ensemble. Five acclimatized subjects wore each of the six clothing conditions in a random order. Statistically significant differences were found among the five protective garments and a semiclothed ensemble for critical treadmill speed (S(crit)), critical metabolic rate (M(crit)), and total evaporative resistance (R(e-t)). The semiclothed condition (S(crit) = 1.77 m/sec; M(crit) = 580 W; R(e-t) = 0.0099 kPa m2/W) and ensembles made from spunbonded, melt blown, spunbonded polypropylene (SMS) (1.72 m/sec; 560 W; 0.0135 kPa m2/W) and spunbonded polypropylene (1.67 m/sec; 550 W; 0.0126 kPa m2/W) were able to support higher work rates than fabrics made from Tyvek 1422-A (a nonwoven spunbonded olefin) (1.48 m/sec; 470 W; 0.0183 kPa m2/W) and a microporous film supported by spunbonded polypropylene (1.34 m/sec; 420 W; 0.0231 kPa m2/W). A tightly woven polyester ensemble (1.59 m/sec; 510 W; 0.0130 kPa m2/W) had intermediate values and was not significantly different from either group. Air permeability was a better predictor of fabric work limiting performance than MVTR. An air permeability on the order of 10,000 L/min cm2 bar would have little effect on maximum sustainable work.     

Increased risk of hepatitis E in sewage workers from India

Considering feco-oral transmission of hepatitis E virus (HEV), the risk of the infection was assessed among sewage workers. On the basis of the close contact with sewage, the participants (n = 147) were divided into sewage workers (n = 92) and others (n = 55); none used personal protective equipment (eg, coveralls, boots, gloves) Age-matched individuals from lower socioeconomic status and without any exposure to sewage were used as controls. IgG-anti-HEV positivity in enzyme-linked immunosorbent assay was significantly higher (P < 0.01) among staff members (83/147, 56.5%) than the controls (19%). A significant rise in anti-HEV positivity (P < 0.05) was recorded in sewage workers working for >5 years. Multivariate regression analysis identified contact with sewage as the independent variable associated with anti-HEV positivity. Strict adherence to good working practices must take top priority for protection of these workers from sewage pathogens.     

Reducing distress associated with pelvic examinations: a stimulus control intervention.

The effect of a new pelvic examination gown on patients' experienced discomfort during pelvic examination was tested. It was hypothesized that a better designed gown would reduce reported distress. Subjects were 87 patients at a private gynecology clinic. Age ranged from 17 to 72. Informed consent was obtained and patients were randomly assigned to either the experimental gown or the standard drape condition. Following examination, subjects completed questionnaires assessing demographic characteristics, state and trait anxiety, desired changes in pelvic examination procedures, and reactions to the examination. The attending nurse recorded heart rate and blood pressure. Results supported the hypotheses. Experimental subjects rated the gown as more comfortable than control subjects rated the drape. Experimental subjects desired fewer changes in exam procedures than control subjects, indicating that the gown provided them with an overall more comfortable experience.     

Field evaluation of protective equipment for pesticide operators in a tropical climate

In order to extend the practical advice and information on personal protection when using pesticides in tropical climates, a GIFAP-FAO Working Group carried out a study on protective equipment worn by pesticide workers in hot and humid conditions in Thailand. Items assessed included protective garments worn by workers mixing and loading the organophosphorus insecticide formulation Tamaron and by spraymen applying the diluted formulation for several hours per day to a cotton crop with knapsack sprayers. The mixer-loaders also wore nitrile rubber gloves and a faceshield. The protective garments were made up of two pieces, an upper garment of a double apron design and separate trousers. Garments made up of different materials were assessed for their acceptability to the workers, their comfort and durability and their protectiveness against the insecticide. As a result of the study it is considered that cotton protective garments are appropriate for pesticide workers in these conditions if additional protection is necessary. The nitrile rubber gloves and faceshield were also found to be suitable for mixer-loaders in these circumstances. It is emphasized that the effective use of protective equipment must go hand in hand with safe handling precautions and the adoption of good personal hygiene.     

Direct measurement of bacterial penetration through surgical gowns: a new method

There is a paucity of data on the penetration of bacteria through surgical gowns during operations. A simple new method was developed, using Petri dishes filled with horse blood agar that were attached to the outside of the gown material. This was used to assess bacterial penetration through disposable spun-bonded polyester gowns and re-usable woven polyester gowns during normal use. There was a significant difference between the two gown types when tested in the axilla (P = 0.02), the groin (P = 0.02) and the peri-anal region (P < 0.01), with the disposable gowns performing to a higher standard. Re-usable gowns demonstrated variation in penetrability, and for this reason, may be unsuitable for use in orthopaedic implant surgery.     

空气压力波对肱骨髁上骨折术后肘关节功能恢复的影响

目的探讨肱骨髁上骨折术后空气压力波早期干预与常规康复训练相结合对肘关节功能恢复的治疗效果。方法将80例GartlandⅢ型伸直型肱骨髁上骨折患儿随机分为观察组40例和对照组40例。两组患者均在手术后采用常规康复训练,观察组在常规康复训练的同时早期加用空气压力波治疗。采用Mayo肘关节功能评分比较两组患者术后4、8、12周肘关节功能恢复情况。结果在术后4、8周,观察组综合评分(45.04±2.55和90.04±1.33)高于对照组(40.13±1.23和84.15±1.69),观察组肘关节活动度(92.3±2.4和118.3±3.9)优于对照组(83.8±3.1和106.5±2.8),两组差异有统计学意义(P<0.05)。结论儿童GartlandⅢ型伸直型肱骨髁上骨折术后,早期采用空气压力波结合常规康复训练治疗,可促进肘关节功能的恢复。     

Bacterial strike-through of re-usable surgical drapes: the effect of different wetting agents

Wound contamination and the resultant postoperative infection is a major problem in all forms of surgery. Air contamination, gloves, surgical instruments and drapes have all been investigated as sources of wound contamination. We investigated the effect of different wetting agents on strike-through rate of bacteria through re-usable polyester/cotton surgical drapes using a newly described method. Within 30 min bacterial strike-through of dry surgical drapes occurs. Wetting drapes with blood or normal saline enhances the strike-through rate of bacteria. Wetting drapes with iodine or chlorhexidine diminishes, but does not stop, bacterial strike-through. The use of re-usable polyester/cotton drapes is a potential source of wound contamination especially when wetted with blood or normal saline.     

The influence of personal protection, environmental hygiene and exposure to pesticides on the health of immigrant farm workers in a desert country

Farm workers in developing countries tend not to use protective measures while handling pesticides. This study investigates the use of personal protection equipment and the practice of safety and hygiene procedures in the handling of pesticides in agriculture. Methods: Through a multi-stage sampling technique, one-fifth of the farms in a region were selected and all the farm workers at these farms were included in the study. A comparison population matching in age, socio-economic status and stay in the region was selected. A specifically designed questionnaire was used to collect information on the use of protective measures and the practice of safety and hygiene during work and on the disposal of empty pesticide containers. Blood pressure and erythrocyte acetylcholinesterase (AChE) activity were measured in the exposed and the unexposed populations. Results: Protective equipment was worn by a minority of farm workers – gloves, by 35%; work coveralls, by 36%; a scarf to cover the nose and mouth, by 39%; and shoes at work, by 79%. With regard to personal hygiene measures, 83% of the workers changed clothes after work and the same proportion took a shower after work; 63% and 46% drank and ate while at work respectively; and 11% used articles of domestic use in the preparation of pesticides on the farm. Most of the farm workers (96%) were asked to prepare pesticides for spraying by the foreman and 61% were asked to spray the pesticides on the crops. AChE activity was highly significantly depleted in the exposed population as compared with the unexposed population. Conclusions: AChE depletion was found to be negatively associated with the use of gloves, of work coveralls, and of a scarf to cover the nose and mouth and with the implementation of safety and hygiene procedures on the farm. AChE depletion was positively associated with the frequency of pesticide spraying. Received: 30 January 1998 / Accepted: 19 August 1998