Effects Of Laundering On The Barrier Properties Of Reusable Surgical Gown Fabrics

AORN Journal, June, 1999 by Maryanne K. Coughlin

EFFECTS OF LAUNDERING ON THE BARRIER PROPERTIES OF REUSABLE SURGICAL GOWN FABRICS K K Leonas American Journal of Infection Control Vol 26 (Oct 1998) 495-501

Surgical apparel worn during surgical procedures must protect against exposure to pathogens through body fluids. Perioperative nurses often have little information about what pathogens a surgical patient's body fluids may harbor; therefore, perioperative nurses must have a high level of assurance that the apparel worn during a surgical procedure will protect scrub personnel from exposure.

There also is concern that the patient is adequately protected from organisms that may penetrate in reverse through a wet surgical gown from the skin of scrub personnel to the surgical field. The US Occupational Safety and Health Administration, the Centers for Disease Control and Prevention, and AORN have published guidelines and recommendations to reduce the risk of occupational exposure. The surgical gown is one of the key items used in surgery that can prevent exposure of health care workers and protect patients.

There are two types of surgical gowns on the market today--disposable and reusable. Disposable gowns are designed for single use and are made of a nonwoven fabric. Reusable gowns are made of woven fabrics and require laundering and sterilization between uses. Approximately 20% of the gowns used today are reusable. The ability of reusable gowns to prevent transfer of pathogens through body fluids is determined by fabric characteristics, the bacteria, and characteristics of the bacteria-containing fluid.

Bacteria and other pathogens are transported from one location to another by carriers (eg, dust, liquid). Blood, perspiration, and alcohol are considered carriers in the OR. The fabric used in surgical gowns must prevent the transmission of carriers to be effective in protecting scrub personnel and patients from exposure to pathogens in the surgical environment. Adding a layer of impermeable film to the fabric base will prevent the transmission of carriers; however, the comfort characteristics of the gown may be reduced, particularly during long surgical procedures. Many studies have been conducted to evaluate the effectiveness of various surgical gowns as barriers to microbial transfer. Fabric construction and repellency have been identified as critical characteristics. Few studies have been conducted to evaluate the effect of laundering on the barrier efficacy of surgical gowns.

Purpose. The purpose of this research project was to examine the relationships between selected fabric characteristics and barrier effectiveness of surgical gown fabric to bacterial transmission and to determine whether laundering had an effect on these characteristics.

Methods. In this study, researchers evaluated five commercially available surgical gowns after zero launderings, 25 launderings, and 50 launderings. Gowns were designated A (ie, 99% polyester, 1% carbon; plain construction, woven), B (ie, 100% polyester, plain construction), C (50% cotton, 50% polyester; plain construction), D (ie, 100% polyester face, composite construction; water-repellent fabric, plain construction; 100% polyester back, membrane jersey, knit), and E (ie, 100% polyester, plain construction). Researchers took fabric samples for testing from the front panels of the gowns and from areas similar to the front panel. Researchers prepared samples in accordance with the recommended test methods used.

Laundering procedures. The gowns were laundered at a laundry service facility. Researchers decided to follow the laundry service's protocol for laundering because it simulated the same laundering conditions of gowns during their normal life. The gowns in the study were segregated from soiled gowns to prevent transference of contaminants. Gowns were not sterilized between laundering; however, the gowns were sterilized before being exposed to bacteria-containing fluid.

Testing. Researchers evaluated fabric characteristics at zero, 25, and 50 launderings. Researchers evaluated thickness, weight, pore size, oil and water repellency, and yarn count (ie, number of yarns per inch in the warp [lengthwise] and filling [crosswise] directions). Staphylococcus aureus was the microorganism used in the study.

Fabric penetration. The ability of the fabrics to prevent bacterial penetration was measured in accordance with the Association of the Nonwovens Industry Standard Test 80.7a-82 Resistance to Penetration of Bacteria in Saline Solution, which measures the resistance of nonwoven fabrics to the penetration of microorganism under a hydrostatic pressure.

Results and discussion. Four of the five gown fabrics (ie, A, B, C, E) showed a reduced repellency rating after 25 launderings. The largest reduction was exhibited by B and C, with a loss of 26% and 24%, respectively. Gown E showed a 10% loss, and gown A had a 14% loss. Three of the gown fabrics (ie, B, C, E) received a zero rating (ie, scale of zero to 100, with 100 representing the highest repellency and zero the lowest) after 50 launderings. Gown A's fabric maintained a mean repellency of 62 after 50 launderings. Gown D's fabric had the lowest repellency initially, but increased to 50 after laundering.