Validity of a disposable catheter to drain urine overnight in neurogenic bladder.

BACKGROUND: Overnight catheter drainage (OCD) is introduced to avoid overdistention of the bladder at night-time when clean intermittent catheterization proves ineffective for daytime management of neurogenic bladder. We adopted OCD using disposable silicone no-balloon (DSnB) catheters, with the distal end outside the body opening into diapers. OCD using DSnB catheter, however, had risks of retrograde bacterial contamination. Therefore, in this study, the validity of equipping DSnB catheters with check valves to prevent retrograde bacterial contamination was examined. METHODS: For the in vitro study, excised saline-filled swine bladders were drained using DSnB catheters with or without check valves, and the time required for intravesical pressure to reach 5 cmH2 O was measured. For the in vivo study, in cross-over experiments comparing DSnB catheters with and without check valves, OCD using DSnB catheters for 10 h was performed in rabbits under analgesia. Bacterial growth from urine samples before and after OCD and residual urine volume were examined. RESULTS: For the in vitro experiment, the median drainage time was 368.2 s (range, 88-1,085 s) and 344.7 s (range, 28-840 s) with and without check valves, respectively (n = 6), which was not significantly different. For the in vivo experiment, in cross-over experiments (n = 8) new bacterial growth rates after OCD did not differ, and median residual urine volume was 17.1 mL (range, 0-75 mL) and 1.2 mL (range, 0-5 mL) with and without check valves, respectively (P = 0.055). CONCLUSIONS: Installing a check valve in the DSnB catheter did not decrease new bacterial growth, while tending to increase residual urine volume. DSnB catheters without check valves appear to be better for continuous drainage of urine from bladder.

Reprocessing of single-use endoscopic variceal band ligation devices: a pilot study.

Background and study aims The preferred management of bleeding esophageal varices includes endoscopic band ligation. Endoscopic ligation devices (ELDs) are expensive and designed for single use, limiting their uptake in developing countries. We aimed to assess the efficacy of reprocessing ELDs using terminal microbial cultures and adenosine triphosphate (ATP) testing. Materials and methods ELDs were recovered after clinical use and their components (cap, handle, and cord) were subjected to reprocessing. This included manual cleaning, automated high-level disinfection (HLD), and drying with forced air. Using sterile technique, ELD components were sampled for ATP at three stages: before manual cleaning, after manual cleaning, and after HLD. Components were sent to an external laboratory for culturing. Cultures were interpreted as positive upon identification of Gram-negative bacilli. Results A total of 14 clinically used ELDs were studied, and 189 ATP tests and 41 cultures were evaluated. Overall, 95 % (39/41) of components and 86 % (12/14) of ELDs were culture-negative or did not yield Gram-negative bacilli. Two components (5 %; one handle and one cord) harbored Gram-negative bacilli in quantities of 1 CFU per component. There was no apparent correlation between ATP at any juncture of reprocessing and terminal cultures. Conclusions Reprocessing of ELDs is effective, resulting in infrequent and minimal microbial contamination. Microbial culturing can be used to ensure adequacy of ELD reprocessing if pursued. Until reusable ELDs are commercially available, continued efforts to better define the adequacy and long-term effects of reprocessing ELDs are needed.

Contamination of single-use bronchoscopes in critically ill patients.

Disposable bronchoscopes such as the Ambu aScopeTM 3 are marketed as 'single use' The risks of contamination from prolonged device storage before possible re-use are unknown. Following clinical bronchoscopy in patients whose lungs were mechanically ventilated, 20 aScopeTM 3's bronchoscopes received a standard 'social clean' and were then stored. Subsequent paired saline flush and swab samples were taken at time zero, and at 24 h and 48 h. Positive microbiological cultures were obtained from at least one time point from 16 of the 20 bronchoscopes. Pathogens considered at high risk of causing pneumonia were isolated from seven bronchoscopes, with significant quantities from six of them. Our study demonstrates that aScopeTM 3's should not be re-used on the same patient, as clinically significant growth of micro-organisms occurs frequently, despite adequate social cleaning. Culture of bronchoscopes themselves may be a potentially useful diagnostic tool in the context of pulmonary infection. Our data make it clear that these devices are single use and not single patient use.

Post-photorefractive keratectomy contact lens microbiological findings of individuals who work in a hospital environment.

OBJECTIVE: To describe the microbiological findings from bandage contact lenses in patients who work in a hospital environment submitted to photorefractive keratectomy (PRK). METHODS: This prospective comparative case series enrolled 43 eyes of 22 volunteers (28.05 ± 3.50 years). Fourteen individuals (n = 27) were health care professionals who work in health care facilities or community physician's offices. Eight individuals (n = 16) were patients who do not work in hospital environment. Photorefractive keratectomy was performed using standard technique, and a silicone hydrogel bandage contact lens was placed on the cornea and evaluated for adequate fit. Seven days after surgery, the bandage lenses were removed and imprinted in the following culture media: blood agar, chocolate agar, anaerobic-selective agar, and Sabouraud agar. When microbial growth was detected, the microorganism was identified, colony-forming units were quantified, and morphology and Gram-staining properties were analyzed. All isolates were tested for susceptibility to various antibiotics. Significance was assessed by Fisher exact test. RESULTS: Microbial growth was detected in 16.27% of all contact lenses samples. No fungi or anaerobes were found. Microbial growth was only observed in bandage lenses removed from patients who work in hospital environments. Most microorganisms found were sensitive to all antibiotics tested. CONCLUSION: These results suggest that working in hospital environments increase contamination of the contact lenses after PRK.

Cleanliness of disposable vs nondisposable electrocardiography lead wires in children.

BACKGROUND: Mediastinitis costs hospitals thousands of dollars a year and increases the incidence of patient morbidity and mortality. No studies have been done to evaluate adenosine triphosphate (ATP) counts on disposable and nondisposable electrocardiography (ECG) lead wires in pediatric patients. OBJECTIVE: To compare the cleanliness of disposable and nondisposable ECG lead wires in postoperative pediatric cardiac surgery patients by measuring the quantity of ATP (in relative luminescence units [RLUs]). ATP levels correlate with microbial cell counts and are used by institutions to assess hospital equipment and cleanliness. METHODS: A prospective, randomized trial was initiated with approval from the institutional review board. Verbal consent was obtained from the parents/guardians for each patient. Trained nurses performed ATP swabs on the right and left upper ECG cables on postoperative days 1, 2, and 3. RESULTS: This study enrolled 51 patients. The disposable ECG lead wire ATP count on postoperative day 1 (median, 157 RLUs) was significantly lower (P < .001) than the count for nondisposable ATP lead wires (median, 610 RLUs). On postoperative day 2, the ATP count for the disposable ECG lead wires (median, 200 RLUs) was also lower (P = .06) than the count for the nondisposable ECG lead wires (median, 453 RLUs). CONCLUSION: Results of this study support the use of disposable ECG lead wires in postoperative pediatric cardiac surgery patients for at least the first 48 hours as a direct strategy to reduce the ATP counts on ECG lead wires.

A microbiological evaluation of level of disinfection for flexible cystoscopes protected by disposable endosheaths.

BACKGROUND: Flexible cystoscopy is used in urological outpatient departments for diagnostic cystoscopy of bladder cancer and requires a high-level disinfection between each patient. The purpose of this study was to make a microbiological post disinfection efficacy assessment of flexible cystoscopes (FC) using disposable sterile endosheaths. METHODS: One hundred endosheaths underwent a leak-test for barrier integrity after cystoscopy. Microbiological samples from these cystoscopies were obtained; after removal of the endosheath, and after cleaning the scope with a detergent cloth, rinsing with tap water followed by 70% ethanol disinfection and subsequent drying. The number of colony forming units (cfu) from the samples was counted after 72 hours and then divided in three categories, Clean FC (<5 cfu/sample), Critical FC (5-50 cfu/sample) and High-risk FC (>50 cfu/sample). The result was compared with data of 10 years continuous control sampling recorded in the Copenhagen Clean-Endoscope Quality Control Database (CCQCD) and analyzed with a Chi-square test for homogeneity. RESULTS: All 100 endosheaths passed the leak-test. All samples showed a Clean FC and low means of cfu. A query to the CCQCD, showed that 99.8% (1264/1267) of all FC with a built-in work-channel reprocessed in a WD were clean before use. CONCLUSION: The reprocessing of FC using endosheaths, as preformed in this study, provides a patient-ready procedure. The results display a reprocessing procedure with low risk of pathogen transmission, high patient safety and a valid alternative to the recommended high-level disinfection procedure of FC. However, the general impression was that sheaths slightly reduced vision and resulted in some patient discomfort.

Single-use surgical clothing system for reduction of airborne bacteria in the operating room.

It is desirable to maintain a low bacterial count in the operating room air to prevent surgical site infection. This can be achieved by ventilation or by all staff in the operating room wearing clothes made from low-permeable material (i.e. clean air suits). We investigated whether there was a difference in protective efficacy between a single-use clothing system made of polypropylene and a reusable clothing system made of a mixed material (cotton/polyester) by testing both in a dispersal chamber and during surgical procedures. Counts of colony-forming units (cfu)/m(3) air were significantly lower when using the single-use clothing system in both settings.

Efficacy of decontamination and sterilization of a single-use single-incision laparoscopic surgery port.

OBJECTIVE: To determine the efficacy of decontamination and sterilization of a disposable port intended for use during single-incision laparoscopy. SAMPLE: 5 material samples obtained from each of 3 laparoscopic surgery ports. PROCEDURES: Ports were assigned to undergo decontamination and ethylene oxide sterilization without bacterial inoculation (negative control port), with bacterial inoculation (Staphylococcus aureus, Escherichia coli, and Mycobacterium fortuitum) and without decontamination and sterilization (positive control port), or with bacterial inoculation followed by decontamination and ethylene oxide sterilization (treated port). Each port underwent testing 5 times; during each time, a sample of the foam portion of each port was obtained and bacteriologic culture testing was performed. Bacteriologic culture scores were determined for each port sample. RESULTS: None of the treated port samples had positive bacteriologic culture results. All 5 positive control port samples had positive bacteriologic culture results. One negative control port sample had positive bacteriologic culture results; a spore-forming Bacillus sp organism was cultured from that port sample, which was thought to be an environmental contaminant. Bacteriologic culture scores for the treated port samples were significantly lower than those for the positive control port samples. Bacteriologic culture scores for the treated port samples were not significantly different from those for negative control port samples. CONCLUSIONS AND CLINICAL RELEVANCE: Results of this study indicated standard procedures for decontamination and sterilization of a single-use port intended for use during singleincision laparoscopic surgery were effective for elimination of inoculated bacteria. Reuse of this port may be safe for laparoscopic surgery of animals.

The impact of cellular debris on Pseudomonas aeruginosa adherence to silicone hydrogel contact lenses and contact lens storage cases.

OBJECTIVES: To evaluate neutrophil-enhanced Pseudomonas aeruginosa (PA) biofilm formation on silicone hydrogel contact lenses and to determine the effect of epithelial biodebris on PA adherence in contact lens storage cases. METHODS: A fully invasive PA corneal isolate stably conjugated to green fluorescent protein was used. Unworn lotrafilcon A contact lenses were incubated at various ratios of PA to polymorphonuclear neutrophil (PMN) for 24 hours at 37°C. Lens-associated PA was evaluated using laser scanning confocal microscopy and nonviable PA were visualized using propidium iodide. Viable bacteria were enumerated by colony-forming unit (CFU) analysis. For acute epithelial cell studies, PA viability was determined after coincubation with freeze-thaw epithelial cell lysates in 96-well polystyrene plates. Levels of residual cellular debris and bacterial viability were further assessed in used contact lens storage cases. RESULTS: Laser scanning confocal microscopy demonstrated that cotreatment with PMA-stimulated neutrophils increased PA adherence over 24 hours to lens surfaces with a striking alteration of PA architecture. Propidium iodide staining showed that the adherent bacteria consisted of a mixture of viable and nonviable PA; a PMN-associated increase in viable PA was confirmed by CFU (PA:PMN 0.1:1, P = 0.025; PA:PMN 1:1, P = 0.005). Acute epithelial cell debris studies revealed a significant increase in viable PA in 96-well plates in the presence of epithelial freeze-thaw lysates (PA:debris 1:1, P = 0.002; PA:debris 100:1, P = 0.002). Crystal violet staining of used lens storage cases revealed residual cellular debris at all time points, which was independent of microbial contamination; all lens cases used for periods of 9 months or more were uniformly associated with high levels of viable microorganisms. CONCLUSION: These results demonstrate that prolonged corneal inflammation with the presence of PMNs when confronted with simultaneous PA challenge in extended contact lens wear has the potential to stimulate biofilm formation on silicone hydrogel contact lenses. These findings further suggest that a persistent buildup of extracellular debris in lens storage cases may contribute to the heavy biofilms reported on these surfaces.

Assessment of sterility in fluid bags maintained for chronic use.

Fluid therapy is an integral component of standard supportive care in veterinary medicine and is often given subcutaneously for ease of administration. Multiple animals may be treated by using the same bag. These bags often are used repeatedly until they are empty or until a time specified by an IACUC or similar advisory group. This practice introduces the risk of contamination. Here we assessed the sterility of multiple-use fluid bags in the laboratory setting for a maximum of 60 d. Bags were manipulated to mimic infrequent and frequent use. Bacterial cultures of fluid and bag wall and assays for endotoxin and ATP activity were negative at all time points through 30 d. Two fluid samples yielded bacterial growth at 60 d, although all other tests were negative. These results suggest that fluid bags used chronically can be maintained in a sterile condition for a maximum of 30 d.

Prospective randomized single-blinded in vitro and ex vivo evaluation of new and reprocessed laparoscopic trocars.

BACKGROUND: Reprocessing of single-use medical instruments has been proposed as a mechanism for managing the rising costs of health care. We compared the performance of new and reprocessed laparoscopic trocars. STUDY DESIGN: New and reprocessed laparoscopic trocars were evaluated. Testing consisted of visual and microscopic inspection, force of trocar insertion and removal through a porcine abdominal wall, trocar seal leak rate determination, and testing of blade shield speed. RESULTS: Three hundred twenty-eight reprocessed trocars and 199 new trocars were evaluated. Trocars undergoing force testing were inspected for imperfections. In this group, 28.2% of reprocessed and 3.79% of new trocars manifested some gross or microscopic imperfections (p = 0.063). D12LT trocars (Ethicon) required more force with insertion with reprocessed compared with new trocars (0.021). D5LT (Ethicon) new trocars required more force to remove than reprocessed trocars (p = 0.004). Both the shield cover time and the shield response time were found to be faster in the reprocessed (p = 0.0001) compared with the new trocars. Leak testing performed with probes (4.7 mm and 12.9 mm) in place demonstrated a significantly greater amount of leakage for the reprocessed trocars compared with the new trocars, both before and after insertion of the right-angled instrument (p = 0.0001). CONCLUSIONS: When comparing new and reprocessed trocars, there are significant differences in visual trocar defects, insertion and extraction forces, shield response times, and trocar leak rates for some of the device comparisons. The clinical significance of these changes should be weighed against cost savings and environmental impact. Additional testing is necessary for a better understanding of the impact of trocar reprocessing.

Coagulase-negative staphylococci isolated from ocular wound infections after laser refractive surgery: attachment to and accumulation on soft contact lenses.

OBJECTIVES: Disposable soft contact lenses that are commonly used after laser refractive surgery are known to be colonized by bacteria and play a key role in Bacterial Keraitis (BK) pathogenesis. Coagulase-negative staphylococci (CoNS) have been found to be the most common pathogen involved in this postoperative infection. In this study a rapid and a simple assay was developed for studying attachment and accumulation of CoNS on soft contact lenses in vitro using [3H] thymidine. METHODS: Thirty-five isolates of CoNS were obtained from 27 laser refractive surgery patients. Twenty-five of these thirty-five CoNS were isolated in multiple cultures. Ten CoNS were isolated in cultures from patients who underwent reoperation. The assay was optimized using a biofilm-producing strain, S. epidermidis RP62A, which was subcultured overnight at 37 degrees C on blood agar medium. Quantitative determination of biofilm production was tested. Presence of the genes icaADB and icaD was determined in all isolates. All isolates were biochemically analyzed using the Phene Plate (PhP) system modified for typing of CoNS. The CoNS isolates were further characterized to species level using ID32Staph.Mann-Whitney rank sum test and chi-square test were used to identify statistical differences in adherence, index, antibiotic susceptibility patterns, and biofilm production or presence of the ica operon between clinically significant isolates and non-postoperative BK isolates. RESULTS: No differences in attachment and accumulation were found between isolates causing BK after laser refractive surgery and contaminant isolates. In addition, there were no differences in the distribution of the ica operon between the two groups, as determined by polymerase chain reaction. Nevertheless, the ability to produce biofilm was found to be present significantly more frequently among BK isolates than among non-postoperative BK isolates. CONCLUSIONS: This study shows that the method using radioactive thymidine to analyze adherence of CoNS to soft contact lenses enables detection of differences in the adherence patterns of individual isolates.

Which regions of the operating gown should be considered most sterile?

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.

Microbiologic study of soft contact lenses after laser subepithelial keratectomy for myopia.

PURPOSE: To evaluate the extent and agents of bacterial contamination of bandage disposable soft contact lenses after laser subepithelial keratectomy (LASEK) and to correlate the findings with clinical data. METHODS: Disposable soft contact lenses were collected from 52 eyes of 26 consecutive patients treated with LASEK for myopia. The patients were treated with a fixed combination of tobramycin and diclofenac until epithelial closure. The lenses were removed on the fourth or fifth postoperative day with sterile forceps and immediately placed in sterile tubes containing culture media brain-heart infusion broth. The lenses were evaluated for microbial colonization. RESULTS: Of the 52 contact lenses analyzed, six (11.5%) had positive cultures. However, no clinical finding of infection was noted. Isolated microorganisms were coagulase-negative staphylococci (two lenses), Stenotrophomonas maltophilia (two lenses), Acinetobacter species (one lens), and Aeromonas hydrophila (one lens). Except for one case, the microorganisms were sensitive to the administered antibiotic. CONCLUSIONS: The risk of infectious keratitis after LASEK seems to be low. Except for staphylococci, the isolated microorganisms have not been previously reported to colonize the ocular surface or cause keratitis after refractive surgery. These findings may suggest a changing trend of potentially infectious agents after surface ablation.

Reutilización de catéteres de angiografía en una Unidad de Hemodinamia de un hospital del sector público-Chile / Angiographic catheter reuse at the Hemodynamic Department of a public hospital in Chile

Se presentan los resultados de un estudio realizado en 421 pacientes que se sometieron a procedimientos invasores utilizando catéteres con fines diagnósticos y terapéuticos en la Unidad de Hemodinamia de un hospital público en el período julio-diciembre del año 2003. El objetivo de la investigación fue conocer si existen riesgos en la re-utilización de catéteres de angiografía empleados en dicha unidad y que son catalogados como de uso único. Para este fin se seleccionó como metodología de investigación la de estudio epidemiológico de tipo analítico observacional de cohortes prospectivas. De la población estudiada, 63,4 por ciento correspondió a población masculina con edad promedio de 64 años. Del total de los pacientes 27 por ciento presentaban diabetes mellitus y 24 por ciento obesidad. El 82 por ciento de los procedimientos tenía fines diagnósticos y 74 por ciento fueron realizados con catéteres reutilizados. Se encontró 4,3 por ciento de complicaciones infecciosas locales o reacciones a pirógenos; sin embargo, no se encontró diferencia significativa entre el grupo que fue intervenido con catéteres de primer uso respecto a los que utilizaron catéteres antes usados (p < 0,05) en ninguna de las variables estudiadas.

Contamination of disposable tonometer prisms during tonometry.

AIM: Due to the theoretical possibility of prion transmission in applanation tonometry, many ophthalmological units in the United Kingdom now use disposable tonometer prisms. We have investigated the potential for bacterial and viral transmission from the health practitioner to the patient via disposable prisms. METHODS: All staff who perform applanation tonometry at the Sussex Eye Hospital (SEH) received a questionnaire to evaluate if the applanating face of the prism is touched during tonometry and the ease of use of the disposable prism compared to the reusable prisms that were previously used. We then cultured prisms handled by a random sample of staff members for common bacteria. Finally, we constructed a model to investigate the possibility of interpatient adenoviral transmission via disposable tonometer prisms. RESULTS: The questionnaire revealed that almost 50% of the staff admit to touching the applanating face of the tonometer prism prior to applanation. Cultures of the prisms grew a range of bacteria including Staphylococcus epidermidis, Staphylococcus aureus, and Bacillus species. The viral model suggested that adenovirus could be transmitted by applanation tonometry. CONCLUSION: The use of disposable prisms for applanation tonometry may reduce the risk of prion transmission but is not bacteriologically or virologically aseptic. This is a potential infection risk to patients.

Prions and disposable surgical instruments.

Single-use surgical instruments have been used in the UK's ENT departments. This is in response to guidelines issued by the Department of Health and the British Association of Otolaryngologists and Head and Neck Surgeons, in order to prevent the spread of new variant Creutzfeldt-Jakob disease (vCJD) in a young population of patients undergoing routine adenotonsillectomy. In one institution we found that the new single-use instruments were inferior to previous standard kits and that postoperative haemorrhage rates had increased following children's tonsillectomy from 1.7% to 7.8% (p<0.01). Because of the increased reporting of complications following the use of single-use surgical instruments for adenotonsillectomies, ENT departments in the UK are no longer obliged to use these disposable instruments. This is due to the theoretical risk of prion infection being outweighed by the actual risk to the patient from increased postoperative haemorrhage.

Contamination of single-use biopsy forceps: a prospective in vitro analysis.

BACKGROUND: It has been suggested that single-use biopsy forceps prevent interpatient transmission of infection during endoscopy. Passage of sterile forceps through the accessory channel of the endoscope may lead to contamination, however, if the endoscope has been inadequately processed. The potential for contamination of single-use biopsy forceps at various stages of endoscope reprocessing was prospectively evaluated. METHODS: A total of 50 disposable biopsy forceps were passed through the accessory channels of 10 colonoscopes at the following stages of reprocessing: (1) before use in patients to establish a baseline of high-level disinfection, (2) directly after colonoscopy to confirm contamination with use, (3) after manual cleaning and flushing of the accessory channel to support the claim that manual cleaning significantly decreases bioburden, (4) after manual cleaning and a 2-minute soak in 2% glutaraldehyde to assess for contamination after an inadequate cleaning time, and (5) after manual cleaning and a 20-minute soak in 2% glutaraldehyde. The forceps were then sealed in sterile plastic bags after adding 20 mL of thioglycollate broth medium. The suspension was passed through a 0.2-micron vacuum filter and the filters were cultured. All cultures were incubated more than 48 hours. RESULTS: Biopsy forceps underwent a total of 50 aerobic and 50 anaerobic cultures. Colony-forming units too numerous to count of GI flora, including Escherichia coli, Klebsiella, Pseudomonas, and Clostridium species, grew on 19 of 20 culture plates from biopsy forceps passed through colonoscopes immediately after use. One plate in this group grew 3 colony-forming units of E coli. Persistence of GI flora was noted on 5 of 20 plates after manual cleaning of the colonoscopes. No GI flora were found on forceps after the colonoscopes after soaking in gluteraldehyde for 2 and 20 minutes. Environmental contaminants including diptheroids, Staphylococcus, and Streptococcus species grew on 16 culture plates. CONCLUSIONS: (1) Single-use biopsy forceps are highly susceptible to contamination during passage through the accessory channels of improperly cleaned endoscopes. (2) Disinfection of the colonoscopes in this study prevented contamination of the forceps at baseline and after reprocessing. (3) Proper endoscope reprocessing may be the most important factor in preventing biopsy forceps-related interpatient infection.

Direct measurement of bacterial penetration through surgical gowns: a new method.

There is a paucity of data on the penetration of bacteria through surgical gowns during operations. A simple new method was developed, using Petri dishes filled with horse blood agar that were attached to the outside of the gown material. This was used to assess bacterial penetration through disposable spun-bonded polyester gowns and re-usable woven polyester gowns during normal use. There was a significant difference between the two gown types when tested in the axilla (P = 0.02), the groin (P = 0.02) and the peri-anal region (P < 0.01), with the disposable gowns performing to a higher standard. Re-usable gowns demonstrated variation in penetrability, and for this reason, may be unsuitable for use in orthopaedic implant surgery.