Recommended practices for use and selection of barrier materials for surgical gowns and drapes

AORN Journal, March, 1996

The following recommended practices were developed by the AORN Recommended Practices Committee and have been approved by the AORN Board of Directors. They were published as proposed recommended practices in the September 1995 AORN Journal for comments by members and others.

These recommended practices are intended as achievable recommendations representing what is believed to be an optimal level of practice. Policies and procedures will reflect variations in practice settings and/or clinical situations that determine the degree to which the recommended practices can be implemented.

AORN recognizes the numerous types of settings in which perioperative nurses practice. These recommended practices are intended as guidelines adaptable to various practice settings. These practice settings include traditional ORs, ambulatory surgery units, physicians' offices, cardiac catheterization laboratories, endoscopy suites, radiology departments, and all other areas where surgery may be performed.

Purpose. These recommended practices provide guidelines for evaluation, selection, and use of barrier materials, including woven fabrics and nonwoven materials, for surgical gowns and drapes. These materials should ensure an effective means of protection to patients and health care personnel during use and should prevent contamination and contact with blood-borne pathogens contained in blood and body fluids.

RECOMMENDED PRACTICE I

Barrier materials for surgical gowns and drapes should be evaluated according to the AORN "Recommended practices for product and medical device evaluation and selection for the perioperative practice setting."

Interpretive statement 1:

Surgical gowns and drapes should

* provide appropriate barriers to microorganisms, particulate matter, and fluids;

* be appropriate to methods of sterilization;

* maintain adequate integrity and durability;

* withstand physical conditions;

* resist tears, punctures, fiber strains, and abrasions;

* be free of toxic ingredients;

* be low linting;

* have positive cost:benefit ratios;

* have an acceptable quality level (ie, freedom from holes/defects); and

* be used and processed according to manufacturers' written instructions.

Rationale:

Barrier materials for gowns and drapes should permit sterilization, assist in maintaining a sterile surgical field, and meet standards and regulations while providing comfort and safety from contamination to patients and health care workers.(1) Surgical gowns and drapes should be made of materials that minimize the passage of microorganisms from nonsterile to sterile areas and prevent the transfer of bloodborne pathogens from surgical patients to health care workers.

Interpretive statement 2:

Materials should be resistant to penetration by blood and other fluids under normal conditions.

Rationale:

Microorganisms are passed from nonsterile to sterile areas by passage of fluids through barrier materials. Two principle causes of this are wicking and pressure.(2)

Interpretive statement 3:

Reusable fabrics (de, woven materials) should maintain a protective barrier through multiple processings (de, laundering, sterilization).

Rationale:

Processing eventually will diminish the protective barrier ability of woven materials.(3) A system should be established to monitor, control, and determine useful life when reprocessing woven materials. This should include, but not be limited to, the number of washing cycles and sterilization processings that can occur before the protective barrier ability of reusable fabrics is compromised.(4)

Discussion:

Tightly woven reusable fabrics will lose their protective barrier ability after repeated processings. Laundering and steam sterilization cause fibers to swell, and drying and ironing cause fibers to shrink. This increases the propensity to loosen the fibers, thereby altering the fabric structure. Manufacturers written instructions for the handling and suggested number of processings should be followed.(5)

Interpretive statement 4:

The amount of surface area covered by heat-sealed patches on woven fabrics should be examined carefully before fabrics are used.

Rationale:

Fabrics should be repaired with heat-sealed patches, which allow for penetration and removal of sterilants while maintaining the integrity of the protective barrier.(6)

Discussion:

Heat-sealed patches never should be stitched to woven barrier materials as a method of repairing holes. Stitching creates permanent holes that reduce the protective barrier's efficacy.(7)

Interpretive statement 5:

Barrier integrity of reusable materials should be determined by visual inspection prior to use.

Rationale:

Visual inspection of barrier materials may determine barrier integrity. User quality standards may address performance criteria that are used to determine barrier effectiveness.(3)

Interpretive statement 6:

Unused single-use surgical gowns and drapes should not be resterilized unless manufacturers provide written instructions for reprocessing.

Rationale:

Surgical gowns and drapes intended for single use may not be resterilized adequately, may be damaged in the sterilization process, or may retain toxic residues.(9) In addition, health care facilities that choose to reprocess single-use items may be considered to have the same responsibilities as manufacturers and thus become subject to US Food and Drug Administration regulations.(10)