Change without Progress

Dr. Nathan Belkin

Clearwater, FL

To the Editor:

As I read Associate Editor Susan English`s article “Cost, Comfort and Contamination Control Drive Cleanroom Garment Trends” ( Sept. 1996, p. 39), I could not help but marvel at the progress that has been made since I first became involved in that segment of the apparel (uniform) market more than 35 years ago.

Back in those days, the cleanroom industry maintained that its level of environmental cleanliness was one that should be found in every hospital operating room. Comparing that level of contamination to that found on a typical industrial loading dock, it was argued that reductions in airborne particles would contribute to a reduction in the rates of post-operative wound infections. So it was that the concept of greenhouse designs and the use of laminar-flow air circulatory systems were considered. Although the system(s) was never officially supported or adopted by any professional clinical group, its use stirred up a heated controversy which actually proved to generate some advancements in surgical techniques during that period. In the interim, a number of surgical societies responded to those advocating the application of the cleanroom technology on the basis of their discipline in terms of aseptic practices.

Adoption of aseptic practices such as surgical scrubs, gloves, masks, and gowns is an acknowledgment of the role and importance of contamination. Not to be overlooked is the regimen and discipline of all the personnel engaged in the performance of various functions in the overall methodology. However, the fact of the matter is that there is virtually no agreement about the importance of airborne contamination and its role in the infection of surgical wounds. Nevertheless, in recognition of the potential problem, the surgical community has, over the years, examined and evaluated various methods of coping with the viable airborne vectors. At the moment, it is maintained that although conventional air flow systems may effect considerably fewer room changes of air per hour than laminar air flow, they nonetheless result in the same infection rate as that experienced with laminar air flow systems.

Although there have been improvements made in the types of materials used in surgical apparel items, Ms. English`s treatise clearly indicates that they are a far cry from the advancements made in those being used in cleanrooms. As impressive as that may be, it is disconcerting to read about the need to incorporate a microbial agent in a material used in cleanroom garments to stop multiplication of bacteria and control odor because the garments are “usually worn continuously for five days at a time in many fabs!” Can anyone imagine a surgeon wearing the same `sterile` gown during the course of five different procedures let alone for five consecutive days?

Where, then, is the parallel between an industry`s cleanroom technology and the environment of the hospital`s operating room? Perhaps the question to ask the cleanroom industry would be whether or not their rejection (infection) rate is better than or at least as good as that of the surgical community. If not, then it might be well for the cleanroom industry to reassess their “aseptic” practices and disciplines and consider changing them or adopting new ones to improve upon their performance record. The solution to their problem(s) is not to be found in the garments themselves.

It has been said that without change there can be no progress. In this instance, it appears that there has been change without progress.