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Original Investigation
October 23, 2019

Association of Disposable Perioperative Jackets With Surgical Site Infections in a Large Multicenter Health Care Organization

Author Affiliations
  • 1Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Plainview Hospital, Plainview, New York
  • 2Department of Infection Prevention, Northwell Health, Lake Success, New York
  • 3Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
  • 4Krasnoff Quality Management Institute, New Hyde Park, New York
  • 5Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
JAMA Surg. 2020;155(1):15-20. doi:10.1001/jamasurg.2019.4085
Key Points

Question  Is use of perioperative disposable jackets associated with the incidence of surgical site infections?

Findings  In this cohort study of 60 009 patients, implementation of a mandated policy for use of disposable perioperative jackets was not associated with significant reductions in the surgical site infection incidence in clean procedures in a large multicenter health care organization.

Meaning  Disposable perioperative jackets are not associated with surgical site infections in clean operative procedures.


Importance  To help prevent surgical site infections (SSIs), recommendations by a national organization led to implementation of a mandatory operating room policy in a large multicenter health care organization of required use of disposable perioperative jackets.

Objective  To assess whether the use of perioperative disposable jackets is associated with the incidence of SSIs.

Design, Setting, and Participants  Surgical site infection data for patients undergoing clean surgical procedures were retrospectively reviewed from 12 hospitals in a large multicenter health care organization during a 55-month period from January 1, 2014, to July 31, 2018. The incidence of SSI was analyzed for all National Healthcare Safety Network monitored and reported procedures. The patient population was split into 2 groups; the preintervention group consisted of 29 098 patients within the 26 months before the policy starting March 1, 2016, and the postintervention group consisted of 30 911 patients within 26 months after the policy.

Main Outcome and Measures  Comparison of the incidence of SSIs before and after intervention periods underwent statistical analysis. The total number of disposable jackets purchased and total expenditures were also calculated.

Exposures  Implementation of the mandated perioperative attire policy.

Results  A total of 60 009 patients (mean [SD] age, 62.8 [13.9] years; 32 139 [53.6%] male) were included in the study. The overall SSI incidence for clean wounds was 0.87% before policy implementation and 0.83% after policy implementation, which was not found to be significant (odds ratio [OR], 0.96; 95% CI, 0.80-1.14; P = .61). After accounting for possible confounding variables, a multivariable analysis demonstrated no significant reduction in SSIs (OR, 0.85; 95% CI, 0.71-1.01; P = .07). During the postintervention study period (26 months), a total of 2 010 040 jackets were purchased, which amounted to a cost of $1 709 898.46.

Conclusions and Relevance  The results of this study suggest that the use of perioperative disposable jackets is not associated with reductions in SSI for clean wounds in a large multicenter health care organization and presents a fiscal burden.

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