Letter to the Editor

Regarding an April 2000 article

Dear Editor,

Just received my April issue of Infection Control Today and, after scanning the table of contents, turned immediately to the article on page 64, Covergown Policy and Postoperative Infection Rate. Covergown and scrub use has been a hot topic for some time now. The article stated [that] a review of the literature revealed no studies that directly correlated postoperative wound infection with the practice of wearing covergowns over scrubs when leaving the OR. The authors list as the major purpose of their study "to determine the rates of postoperative infection when covergowns are and are not used." In the methodology section, the authors state "for the postoperative infection rate portion of the study, charts from surgical cases were randomly selected...." As an Infection Control Professional (ICP), I would question determination of infection rates based on a sampling (random selection of cases). In infection control practice, denominator data for determining infection rates would include all patients at risk in a given population, i.e., all cardiac surgery cases (surgical site infection) or all ICU patients with central lines (ICU CVC-related bloodstream infections). The article also does not describe definitions used to determine infection or the time frame. By accepted definition, some surgical site infections such as those with implants (sternal wires, joint prostheses, other metal hardware) are considered nosocomial when occurring up to 12 months post-op. The use of accurate denominators may or may not change the outcome of the study. Most ICPs would probably support not using cover gowns because they are seldom worn appropriately, therefore defeating the purpose for wear. I do not believe, however, this decision, based on current studies (or lack of) should be designated as one made because of infection prevention or control reasons. As is stated in the last sentence of the article, the actual basis for decisions not to use covergowns appears to be the significant reduction in operational costs.

Jeanette Daniel, RN, CIC

Infection Control Coordinator

Richmond, VA