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

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.