In this study, we found that combined tying tends to loosen more than separate tying after upper extremities exercise. But, for wearing comfort during the actual performance of the surgeries, the combined tying method was significantly better than the separate tying method. The wearing comfort results were compatible with the observed reality, in that, some medical staff in our institute changed the separated ties into combined ties to improve wearing comfort in their daily practice.
When the surgical gown is worn, it may slip down if it is not securely wrapped around the body. The medical staff will feel discomfort when it is halfway slipping down. The rear neck tie(s) of the reusable surgical gown are meant to secure the gown to appropriately fit the surgeon. But if the tie(s) are not secured, they could loosen over time, especially as the body motions of the staff wearing the gown increase. Also, the slippery material of the surgical gown would more likely lead to ties loosening due to the gown’s tendency to slip down on the staff’s body.
With the reusable surgical gown with 2 rear neck ties, there is a possible reason for wearing discomfort when the 2 sets of tie belts are tightened under different degrees of tightness in order to pull the gown closer. From the outside, it looks as though the staff’s back side is well-covered with the surgical gown. But actually, the upper part of the gown was secured and supported by only one set of rear neck ties which is the tighter one. The other set of ties does not contribute to securing and supporting the gown. Discomfort may result from the uneven tightening of the tie belts on the rear of the neck. In addition, the tie may loosen over time, so that the tightness of the tie belts differs more obviously, thereby causing more discomfort (Fig. 1g).
However, the combined ties distribute the pulling strength equally onto each tie belt, and the staff wearing the gown might feel better than when each tie belt has a different pulling strength. In our after-exercise test, the combined ties showed a higher likelihood of loosening, but wearing comfort was still better than that with separate ties. This may also be because the pulling strength was equally distributed on each rear neck tie belt as they loosened over time. Also, body movement during surgery is not as extreme as during our testing exercises, so the tendency to loosen during surgery would be minimized.
Loosening tended to be more significant after exercise while wearing an x-ray protective apron underneath. But for the discomfort evaluation, there was no significant difference after surgery for staff wearing an x-ray protective apron. The main reason for this is that the greater discomfort is related to the wearing of a heavy apron, which tends to minimize the discomfort from the surgical gown.
Another advantage to the combined ties is that they could facilitate wearing and taking off the gowns. The ease in the wearing procedures would be more specific to the newly trained circulating nurse. In other words, when they are handling the 2 neck ties one by one, if the tying is not smooth, he or she will be embarrassed or even afraid of not doing well. So, tying the 2 neck ties together would be a help. Shortening the time of body contact and increasing the ease of performance would allow the newly trained circulating nurse to feel more comfortable and build up confidence.
For reusable surgical gowns that have 2 rear neck ties with a tendency of loosening and allowing the gowns to slip down, we suggest fastening the 2 sets of rear neck ties together as one combined set of ties to mimic gowns with only one set of rear neck tie belts. With this, tying could be performed easier and faster, and wearing comfort could be improved for medical staffs.