The rise of new pathogens and drug-resistant organisms, combined with an industrywide effort to reduce healthcare-associated infections, is driving hospitals to reevaluate surgical gown protocols to optimize patient and staff safety, as well as cost effectiveness.
"Today, safety is at the heart of quality initiatives aimed to improve the health of the patient, clinician and hospital," said Sandy Albright, BSN, RN, senior clinical consultant for Cardinal Health, during a June 6 webinar hosted by Becker's Hospital Review and sponsored by Dublin, Ohio-based Cardinal Health.
Underestimating the risk of infections can cause serious health and financial consequences, according to Ms. Albright. Pathogens transmitted through blood, fluids and skin cells can lead to dangerous infections such as HIV, hepatitis C and hepatitis B. Surgical site infections are the most common type of healthcare-associated infection, costing as much as $35,000 per incident and $10 billion annually across the healthcare industry, according to a 2009 CDC report.
HAIs are such a costly and lethal issue, the ACA mandates constant improvement and slashes Medicare payments by 1 percent for hospitals that fall into the top 25 percent bracket for infection rates.
Surgical gowns protect patients and clinicians from infectious microorganisms either party may harbor. By implementing safety initiatives surrounding appropriate surgical gown purchasing and use, hospitals can support quality outcomes, enhance patient and staff satisfaction, and protect reimbursements by helping to minimize "never events" — serious, preventable medical errors — and 30-day readmission penalties linked to HAIs.
Choosing the right surgical gown
Selecting the appropriate surgical gown for a procedure is a crucial task for clinicians to prevent the spread of dangerous pathogens and support the hospital's patient safety initiatives.
The Association for the Advancement of Medical Instrumentation — a nearly 7,000-member nonprofit organization that serves as the primary source for medical device standards — established a classification standard to give providers a consistent method to measure surgical gown barrier properties. The Food and Drug Administration subsequently established AAMI's criteria as the gold standard all manufacturers must meet.
"Levels are based on potential exposure to blood, bodily fluids and other potentially infectious materials," she said. "The classification of barrier protection levels range from one to four and are based on the 'hierarchy of risks.'"
The hierarchy ranks medical procedures by exposure risk, accounting for the type and volume of fluid involved in the procedure, and the duration of exposure. When designating a barrier level, AAMI assesses the gown material's resistance to water and blood penetration, among other factors, for four different areas of the gown — the front chest, sleeve seam, sleeve and front belt.
Here are the four barrier levels:
- Level 1 — Offers minimal protection for procedures such as a simple excision biopsy
- Level 2 — Offers low protection for procedures such as tonsillectomies or minimally invasive surgery
- Level 3 — Offers moderate protection for procedures such as mastectomies or arthroscopic orthopedic surgery
- Level 4 — Offers high protection for procedures where a surgeon's hands and arms are in a patient's body cavity such as open heart procedures or Cesarean sections
Clinicians can ensure the gowns they use align with these levels of protection by looking for an AAMI level on the gown's label, according to Ms. Albright.
While information on the gown's label can be helpful, clinicians should make the ultimate decision about which barrier level to wear based on their knowledge of the procedure and past experience.
To guide this decision, Ms. Albright said clinicians should consider the following three questions:
- How much fluid do you expect to be present during the procedure?
- How long will this procedure last?
- What is my role in the procedure?
Ms. Albright highlighted the importance of clinicians using their own judgment to select the proper surgical gown by sharing an anecdote of her clinical experience in the perioperative setting.
"I worked with a general surgeon whose laparoscopic cholecystectomies often turned into long, fluid-intense open cholecystectomies," she said. "Ordinarily, I would choose a level 3 barrier for this type of procedure — but for this surgeon, I knew to wear a level 4 barrier based on my past experience scrubbing in with him."
Streamlining gown purchasing
Clinicians and materials management staff should work together to improve gown purchasing, ensuring there is always adequate supply of the right gown for the right procedure, according to Ms. Albright.
When purchasing surgical gowns, materials management staff must assess the risk of surgical site infections — and consider clinicians' personal preferences and comfort — while discouraging overuse of the protective equipment to rein in inventory costs.
Materials management can also use the AAMI standards to determine the product mix needed at each facility and streamline product or vendor selection to maximize safety and cost effectiveness, according to Ms. Albright. Once they weigh these factors, they'll be able to make more informed decisions about which AAMI level to stock at each facility.
To view a recording of the webinar, click here.
To download a PDF of the presentation slides, click here.
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