Examination of Surgical Helmet and Surgical Hood Application Methods in Reducing Contamination in Arthroplasty Surgery

Abstract

Background: Contamination of the surgeon during gowning is a possible risk factor for prosthetic joint infection in arthroplasty surgery. Surgical helmets are a common form of personal protective equipment used during this type of surgery. Increasingly, there is a focus on the methods of application of the surgical hood and gown while wearing these helmets. Methods: Ultraviolet fluorescent powder was used to represent air-borne contaminant and applied through the airflow inlet of the surgical helmet. Seven methods of helmet and surgical gown application methods were examined. A ultraviolet torch was used to determine the level of contamination across 11 body regions. A single body region with less than 10 particles was classified as minor contamination, and over 10 particles as major contamination. Results: Early activation of the surgical helmet resulted in significant level of contamination across the majority of body regions. Major contamination also affected the scrub nurse when applying the surgical hood to the surgeon's helmet. Late activation of helmet system resulted in only minor level of contamination to the surgeon's shoulders and forearms. Adhesive wrist wraps over the inner gloves did not decrease contamination when added to late activation of the helmet. Conclusion: It is our recommendation that the surgical hood should be applied by an unsterile theater assistant and that the surgical helmet system should be activated after the surgeon has applied inner gloves to minimize the level of contamination to the surgeon's gown.

The Relationship between Bacterial Load and Initial Run Time of a Surgical Helmet

“…Kang et al used ultraviolet light and fluorescent powder to assess airborne contamination. 11 They found that early fan activation resulted in contamination of the body and also the scrub nurse. They recommended activation of the helmet after the surgeon was gowned and the gloves were applied.…”

“…Two studies assessed timing of surgical helmet fan activation and concluded that early activation prior to gown dressing increased contamination rates of both the surgeon and scrub nurse. 11 , 12 …”

“…Two studies assessed timing of surgical helmet fan activation and concluded that early activation prior to gown dressing increased contamination rates of both the surgeon and scrub nurse. 11,12 Given the previous research, we conducted a prospective microbiological study examining potential contamination. The primary aim of this study was to determine the possibility of surgical field contamination due to the outflow of the surgical helmet systems and preexisting dust on the helmet.…”