OR barrier materials--necessity or extravagance?

Abstract

The issue at hand, therefore, is not one of reusable versus disposable, but rather the cost-effectiveness and expense associated with use of barrier versus nonbarrier materials. As mandated by the Occupational Safety and Health Administration, the need and function of the surgeons' gown barrier is a given. Initially the gown was used to protect the patient from members of the surgical team; its role now is to protect the surgical team members from the patient and the hazards associated with exposure to bloodborne pathogens. As for barrier drapes (i.e., patient, Mayo stand, back table covers), considering the influence of today's antibiotics and the advent of minimally invasive surgical techniques on the incidence of postoperative infection, just how necessary are they? Initially the use of barrier drapes was viewed as a reasonable practice. The problem, however, with any reasonable type of practice of this nature is identifying the kind and quality of supporting evidence and testing the practice itself. If there is no evidence for or against a practice; its advocates make up the process as they go along. In the case of barrier drapes, there were individuals who assumed that there were studies that conclusively demonstrated their need, even though they never sought confirmation to that effect. In the process, whether the drapes were cost-effective escaped criticism, and their use survived over the years because of the "that's the way we've always done it" syndrome. In a comprehensive examination of draping practices written 60 years ago, a physician discusses the myriad sources of contamination that could contribute to postoperative infection. He concluded that "to minimize the chances of contamination, all of these sources must be separately and individually studied." In terms of the influence of barrier surgical drapes, there remains a need for unbiased, statistically valid, conclusive research. Until such data become available, their use cannot be indisputably defended.