Miscellaneous
What is the evidence behind the things we are forced to wear in the OR? Do they help? Are they voodoo? On this episode, Karl takes us through the evidence behind the different pieces of OR attire. Some things seem to work... some things do nothing... some things might actually be harmful. ? Literature Referenced: Overview of adoption of OR attire through history, by examining historical photographs. Adams, L., Aschenbrenner, C., Houle, T., Roy, R. (2016). Uncovering the History of Operating Room Attire through Photographs. Anesthesiology 124(1), 19-24. https://dx.doi.org/10.1097/aln.0000000000000932 Case report of surgeon performing appendectomy on himself. Rogozov, V., Bermel, N. (2009). Auto-appendectomy in the Antarctic: case report BMJ 339(dec15 1), b4965-b4965. https://dx.doi.org/10.1136/bmj.b4965 An experimental study of how clothing effects the dispersal of staph. Hill, J., Howell, A., Blowers, R. (1974). EFFECT OF CLOTHING ON DISPERSAL OF STAPHYLOCOCCUS AUREUS BY MALES AND FEMALES The Lancet 304(7889), 1131-1133. https://dx.doi.org/10.1016/s0140-6736(74)90885-x First experimental study on surgical draping. Beck, W., Collette, T. (1952). False faith in the surgeon's gown and surgical drape The American Journal of Surgery 83(2), 125-126. https://dx.doi.org/10.1016/0002-9610(52)90196-7 RCT including cloth vs. paper drapes for CABGs. Bellchambers, J., Harris, J., Cullinan, P., Gaya, H., Pepper, J. (1999). A prospective study of wound infection in coronary artery surgery European Journal of Cardio-Thoracic Surgery 15(1), 45-50. https://dx.doi.org/10.1016/s1010-7940(98)00255-3 Cochrane review on using plastic adhesive drapes. Webster, J., Alghamdi, A. (2015). Use of plastic adhesive drapes during surgery for preventing surgical site infection Cochrane Database of Systematic Reviews 4(4), CD006353. https://dx.doi.org/10.1002/14651858.cd006353.pub4 Disposable gowns have less infectious risk than multi-use gowns. Moylan, J., Kennedy, B. (1980). The importance of gown and drape barriers in the prevention of wound infection. Surgery, gynecology & obstetrics 151(4), 465-70. https://www.ncbi.nlm.nih.gov/pubmed/7414454 Large study of the effect of using jackets on surgical site infections (spoiler: none). Stapleton, E., Frane, N., Lentz, J., Armellino, D., Kohn, N., Linton, R., Bitterman, A. (2019). Association of Disposable Perioperative Jackets With Surgical Site Infections in a Large Multicenter Health Care Organization JAMA Surgery 155(1), 15-20. https://dx.doi.org/10.1001/jamasurg.2019.4085 Association of mouth flora with surgical site infections HAMILTON, A. (1905). DISSEMINATION OF STREPTOCOCCI THROUGH INVISIBLE SPUTUM.IN RELATION TO SCARLET FEVER AND SEPSIS. JAMA: The Journal of the American Medical Association XLIV(14), 1108. https://dx.doi.org/10.1001/jama.1905.92500410032001g First study testing the association of using masks and surgical site infections. Orr, N. (1981). Is a mask necessary in the operating theatre? 63(6), 390-2. Study of 41 patients testing the association of masks with surgical site infections. Chamberlain, G., Houang, E. (1984). Trial of the use of masks in the gynaecological operating theatre. Annals of the Royal College of Surgeons of England 66(6), 432-3. https://www.ncbi.nlm.nih.gov/pubmed/6391343 Larger study (>3000 patients) testing efficacy of masks. No difference in infections. Tunevall, T. (1991). Postoperative wound infections and surgical face masks: A controlled study World Journal of Surgery 15(3), 383-387. https://dx.doi.org/10.1007/bf01658736 Full RCT of using masks by non-scrubbed staff. No difference in infections. Webster, J., Croger, S., Lister, C., Doidge, M., Terry, M., Jones, I. (2010). Use of face masks by non-scrubbed operating room staff: a randomized controlled trial ANZ Journal of Surgery 80(3),