Various guidelines have been proposed regarding which portions of a surgical gown may be considered sterile. Unfortunately,
the validity of these recommendations has not been definitively established. We therefore evaluated gown sterility after major
spinal surgery to assess the legitimacy of these guidelines. We used sterile culture swabs to obtain samples of gown fronts
at 6-inch increments and at the elbow creases of 50 gowns at the end of 29 spinal operations. Another 50 gowns were swabbed
immediately after they were applied to serve as negative controls. Bacterial growth was assessed using semiquantitative plating
techniques on a nonselective, broad-spectrum media. Contamination was observed at all locations of the gown with rates ranging
from 6% to 48%. Compared with the negative controls, the contamination rates were greater at levels 24 inches or less and
48 inches or more relative to the ground and at the elbow creases. The section between the chest and operative field had the
lowest contamination rates. Based on these results, we consider the region between the chest and operative field to be the
most sterile and any contact with the gown outside this area, including the elbow creases, should be avoided to reduce the
risk of infection.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest,
patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations
were conducted in conformity with ethical principles of research.