Lint in the Operating Room

Contamination of exposed tissues with lint during surgical procedures introduces the potential for a variety of post-surgical complications to occur. Adoption of preventive linting measures such as use of low-linting surgical apparel and accessories combined with modified operating room practices may reduce tissue contamination by lint and its associated complications. Such strategies are likely to be engaged by making healthcare workers aware of linting sources and tissue invasion mechanisms, and alternatives to those sources in an effort to significantly decrease the threat of linting in the operating room.

Authors Mark Lavigne and Kevin Friedman of Halyard Health, formerly Kimberly-Clark Health Care, answer questions about this very topic.

 

1. What is the origin of lint in the operating room, and how can lint introduce post-surgical complications?

Lint is composed of ultra-fine fibers that can separate from the surface of fabrics such as surgical gowns, drapes, and sterilization wraps. Unbound lint or lint bound by nosocomial pathogens may become dispersed into the operating room environment, and settle in surgical wounds or on medical instruments.1 Lint carried on air currents throughout the operating room can bind to guidewires, pacemaker leads, and catheters through static cling. Pathologies associated with lint depend on lint size, composition, and fiber quantity, as well as the tissues into which it is deposited.

 

2. What are some of the most common complications associated with lint contamination of tissues?

In addition to increasing the potential for surgical site infections, some of the most common complications associated with lint contamination of tissues include blood clots, adhesions, granulomas, amplified inflammation, and delayed wound healing.

Each of these problems is associated with increased physiological effort to remove or contain lint fibers. Thus, lint can be indirectly responsible for tissue damage by chronically activating bodily defense processes such as inflammation and/or thrombosis. Furthermore, lint may contain toxic glues, adhesives, and/or fire-resistant agents that may leach into tissues, and thereby exacerbate the potentially damaging physiological defense mechanisms initiated by lint itself.

 

3. What surgical apparel fabrics are prone to lint generation?

Lint can be generated from both natural and synthetic sources, and in either case, lint fibers do not dissolve. Cellulose-based cotton or wood pulp surgical apparel products can each produce excessive lint compared to similar products made from polypropylene.2,3

 

4. What surgical apparel fabrics are considered low-linting?

Polypropylene is a relatively low-linting surgical apparel material compared to cellulose-based cotton or wood pulp fabrics.2,3 Polypropylene gowns and drapes elicited 17 times less lint into the environment compared to these surgical apparel composed of cellulose.2 Surgical gowns and scrubs constructed of 100% polypropylene released significantly less lint into the operating room than such products made from wood pulp polyester, both adjacent to and four meters removed from the surgical field.3 Twenty-four cases of foreign body reactions secondary to cellulose fiber deposition in tissues following various surgeries collectively required an additional 400 days of hospitalization.4

SEE ALSO: Earn CE: Robotic Surgery

The authors of this report proposed the possibility of alternative use of polypropylene surgical gowns and drapes as a mitigation strategy for this problem. Thus, polypropylene surgical wear and accessories may be preferable for facilitating surgery compared to cellulose-based cotton or wood pulp products to minimize lint burden in the operating room, and to reduce post-surgical complications.

 

5. What strategies can healthcare professionals exercise to reduce lint contamination of tissues?

Efforts to reduce lint contamination of tissues can be implemented at both organizational and individual healthcare worker levels. Organizational elements include the development and execution of policies and procedures to prevent lint contamination. For example, healthcare facilities may replace gowns and drapes composed of cellulose with those made from polypropylene.2-4 Additionally, through training sessions, healthcare staff can become aware that lint can be derived from various surgical resources, and that lint may induce complications in patients.

Armed with this knowledge, healthcare workers may become motivated to regularly perform learned methods for reducing tissue contamination by lint. Use of relatively low-linting surgical apparel combined with preventive linting healthcare worker practices may minimize the possibility that patient complications can originate due to tissue intrusion by lint.

 

References

1. AORN. Recommended practices for selection and use of surgical gowns and drapes. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc. 2012:119-123.

2. Verkkala K, Eklund A, Ojaj„rvi J, Tiittanen L, Hoborn J, M„kel„ P. The conventionally ventilated operating theatre and air contamination control during cardiac surgery–bacteriological and particulate matter control garment options for low level contamination. Eur J Cardiothorac Surg. 1998;14(2):206-210.

3. Edmiston CE Jr, Sinski S, Seabrook GR, Simons D, Goheen MP. Airborne particulates in the OR environment. AORN J. 1999;69(6):1169-1183.

4. Janoff K, Wayne R, Huntwork B, Kelley H, Alberty R. Foreign body reactions secondary to cellulose lint fibers. Am J Surg. 1984;147(5):598-600.

 

Kevin Friedman is the medical director and Mark C. Lavigne is senior clinical scientist, both at Halyard Health, Alpharetta, Ga.

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