Surgical jacket, bouffant use may not prevent surgical site infections
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Use of surgical jackets and bouffants during surgery may be neither beneficial nor cost-effective in preventing surgical site infections, according to published results.
Elie S. Ghanem, MD, Brent A. Ponce, MD, and colleagues compared three periods between January 2017 and October 2018 that corresponded with implementation of surgical jackets and the subsequent mandate of surgical jackets and bouffant head covers. Researchers considered surgical site infections, as defined by the National Healthcare Safety Network, as the primary outcome and wound dehiscence, postoperative sepsis, death and cost of interventions as secondary outcomes.
Of 34,042 inpatient surgical encounters performed at the University of Alabama at Birmingham University Hospital during a 22-month period, results showed no significant difference in the risk of surgical site infection, mortality, postoperative sepsis or wound dehiscence when surgeons used surgical jackets alone, surgical jackets with bouffants or neither. Researchers noted an estimated expenditure of more than $300,000 annually on surgical jackets after review of receipts from the first 6 months of the 2018 to 2019 fiscal year. Researchers also found bouffants were less expensive compared with surgical skull caps.
According Ghanem and Ponce, these results highlight the need to assess administrative decisions with evidence-based medicine and their institutional impact “with continuous feedback to determine the value of recommendations or mandates.”
“Leadership across health systems have good intentions, but we must collect, analyze and interpret data in our decision-making, especially when there is little in the peer-reviewed literature regarding the subject in question,” Ghanem, section chair of arthroplasty in the department of orthopedic surgery at the University of Alabama at Birmingham, told Healio Orthopedics.
Ponce added that orthopedic surgeons need to understand the critical role they play in improving outcomes and reducing costs, as most health care costs are influenced by physicians.
“Shoulder pioneer Dr. Ernest A. Codman initially endorsed the ‘end result idea,’ and orthopedic surgeons should remain champions and leaders in introducing quality improvement measures in health care,” Ponce, senior author and vice chair of clinical affairs at the University of Alabama at Birmingham, told Healio Orthopedics. – by Casey Tingle
Disclosures: Ponce reports he has stock or stock options in Help Lightning; is a paid presenter or speaker and paid consultant for Tornier; and receives IP royalties from Wright Medical Technology Inc. Ghanem reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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John D. Jennings, MD
In their recent publication, Bradley W. Wills, MD, and colleagues found no association between various types of attire worn by OR staff and surgical site infections. This is particularly interesting given our previous efforts at establishing an evidence-based approach to inpatient and outpatient orthopedic surgical attire and its effects on patient perceptions and the patient-physician relationship. Using a large, retrospective cohort of surgical encounters, they have been able to critically examine whether extra cost, effort and even discomfort for some surgeons and OR staff contribute to a meaningful improvement in patient care and outcomes. Both medical personnel and their patients stand to benefit from this study, and ongoing efforts to closely examine the effects of attire on various aspects of patient care.
Reconstructive Orthopedics
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