Cochrane reviews on double-gloving

What is surgical plume? Surgical plume is the vaporous plume resulting from surgical intervention involving the use of an electrocautery device on tissue, using a heated surgical instrument to stop bleeding or remove a growth. The resulting plume, or surgical smoke, is a noxious and odorous by-product that contains both organic and inorganic matter. Surgical smoke in the operating room can also obscure visibility into the operative site, which could conceivably lead to greater risk to patient safety. Surgical plume can be carcinogenic and can spread infection. To reduce the risk surgical plume poses, hospitals should introduce surgical smoke evacuation guidelines and introduce surgical safety technologies to safeguard the health of their surgical staff. [Video Section] plume   Types of surgical plume The plume falls into two categories, those being chemical and those being bacteriological, of which both have their own health risks. Chemical matter is more likely to be smaller particles, whereas biological matter of larger size particles, however both are potential hazards to health. Surgical plume can contain carbons, hydrocarbons, viral particles, additionally toxic gases, cellular debris, blood borne products, carcinogens and numerous noxious substances like Benzene, Toluene and Formaldehyde. How are healthcare professionals exposed? What is the risk? When thermal energy devices are used, cellular disruption occurs. As a result, this produces a vaporous plume, which rises into the surrounding area and spreads throughout the entire room. The staff are exposed to significant risk levels, which have been likened to cigarette smoking. Some suggest only 1 gram of surgical plume is equivalent in toxicity terms to smoking between 3 to 6 cigarettes1. In the OR, it would be reasonable to suggest that several grams of surgical plume are produced during the average surgical procedure. Based on the assumption during the average working day of 5 operative procedures involving thermal energy, healthcare professionals may be unwittingly exposed to the equivalent of smoking at least 20-30 cigarettes per day. Of course, smoking cigarettes is a lifestyle choice, whereas healthcare professionals would not necessarily choose to be exposed in this manner.  Why has there not been more widespread adoption of surgical plume evacuation devices to date? Possibly, a lack of awareness of the dangers present in surgical plume has led to indifference to the need to remove surgical smoke. Also many of these exposure elements may not present until later in life, perhaps beyond the ability to collate data from individuals. Any suggestions therefore of morbidity or mortality due to surgical plume exposure remain subjective.  In addition, there have been some limitations in the solutions previously offered. Surgeons have complained that solutions have been ‘too noisy’, causing unnecessary distractions or that the ‘hand switch plume pencils are far too bulky and cumbersome’. Finally, a new solution, that addresses these concerns, is in your hands. [Promotional card] plume

What makes up the most efficient OR workflow? The optimal OR setup involves not only processes and steps that OR staff take but also how they select, store and set up surgical instruments in the operating theatre. The interplay between how people work and the tools they work with influences how OR personnel find their most efficient flow and achieve increased output. The bigger goal is maximising value: gaining more capacity from OR resources at lower costs, with less waste and greater handling efficiency. Flexible OR efficiency Customised surgical procedure trays enable surgical teams to select all the components they need for specific interventions, which are then packed in a single package. The result helps achieve the greater goal of  increased safety and efficiency in the operating room, and significant time, money, and waste savings. OR teams that have adopted ProcedurePak customised trays have achieved: Up to 40% reduction in complete preparation time1 Time savings through need for less preparation time, less opening and set-up time, leading to more procedures being carried out – up to a 37% increase in procedures performed1 Reduced packaging leading to less waste2 -- up to 90% less packaging waste2 3, Reduced product spending and logistic costs1,2 – including up to a 54% reduction in invoicing1 Greater accuracy and consistency for every procedure set-up2 The value of end-to-end handling efficiency Savings and efficiency come throughout the handling process – not just inside the OR. From the moment a surgical team configures their procedure-specific tray, through to stocking and handling, to surgery setup, all the way to invoicing and other administrative and procurement activities, every step creates efficiency and savings. These positive outcomes deliver real value you can calculate. For example, you might use your time savings to increase capacity to perform more surgical procedures. Maybe you will use the extra time to run extra OR staff training and education. Potential value-add areas include sustainability (including environmental, social and governance, or ESG), productivity and risk reduction. The value is real – how you claim that value is up to you. OR efficiency value areas: Sustainability Sustainability is a major driver for change in hospitals and in operating rooms, and the ESG agenda is one that organisations aim to derive value from rather than only seeing compliance as a cost. Adding sustainability to operating room efficiency metrics may make up one of the areas of value you can tap into. With customised procedure trays, you can achieve value from both environmental and people considerations. Up to 90% reduction in packaging waste, optimised stock levels and reduced transport are key contributions to environmental improvements. Considering staff needs, getting value from trays and workflows means facilitating improved ways of working, giving OR personnel more time to focus on patients and the things that matter most, and reducing employee stress. ProcedurePak trays simplify OR teams’ work2. OR efficiency value areas: Productivity Every healthcare organisation is under pressure to deliver more with less – safely. Particularly during periods of significant backlogs. How can hospitals reimagine surgical scheduling? Boosting OR capacity and productivity in challenging conditions is a challenge. But up to 70% of OR staff in a UK survey of 500 healthcare professionals4 agreed that customised procedure trays support improvements in operating theatre efficiencies. With ProcedurePak, you can increase the number of procedures you perform by up to 37%1, increasing the capacity of existing OR resources. Procedure-specific trays can also improve cost control per intervention. In more administrative and logistical terms, custom procedure trays can add value by reducing overtime, simplifying invoicing and tracking, and making order and delivery processes smoother and easier. OR efficiency value areas: Risk reduction Healthcare professionals are working under a great deal of pressure, and staff turnover and burnout are significant issues. Working with fewer resources and the requirement to spend substantial time on non-value-adding tasks such as picking and unwrapping individual components and other similar preparatory and clean-up tasks, surgical staff face a number of challenges that can all create risk in the OR. As both surgeons and operating room staff are forced to conduct more procedures with less resources, risk rises. Streamlining the OR workflow with customised surgical procedure trays, though, can contribute to easing staff stress and risk reduction. By requiring fewer packages overall, and saving time and effort in picking, handling, and opening packages, there is less risk of picking errors and less OR foot traffic. These steps lead to increased quality and cost control because the handling and logistics workflow is simplified and more easily managed. Achieving OR efficiency: You’re not alone With Mölnlycke, you’re not alone in starting and accelerating your OR efficiency journey. Taking a consultative approach, Mölnlycke works together with you as a partner to ensure that you achieve the greatest efficiency possible both from adopting ProcedurePak trays and through your OR workflows and practices. Partnership to find your flow and gain greater value How can you reach maximum value and efficiency in your OR? How can you increase output and see time, monetary and environmental impacts? You can influence these factors by finding your flow in the OR. We are here to help. Based on a process designed by the Institute for Workflow Management in Health Care (IWiG) in Germany, we offer a value report based on your specific situation. The report draws on several processes that examine materials management in the OR to help achieve greater time savings and process efficiencies. The value report generated provides an analysis of potential efficiencies and value gains, looking at your current surgical trays and comparing them against ProcedurePak trays customised for specific interventions. With Mölnlycke by your side, you can: Tap into more sustainable processes for both the environment and people/staff, including everything from quantifiably reduced waste and optimised stock levels to reducing staff stress and facilitating more time for focus on patients Protect and increase productivity, increasing the number of possible procedures, improving cost per intervention and simplifying processes Reduce risk, increasing the efficiency of logistics, and cutting down the risk for picking errors, risk due to the handling and opening of more packages and more. With value built in every step of the way, you can increase output with trays – not just in the operating room but throughout the hospital. We can show you how to get there, offering: Partnership in reviewing your current approach, capturing stakeholder insights, defining KPIs, identifying efficiency opportunities, applying expert advice and recommendations and formulating a tailored proposal and implementation plan. Support with evidence-based solutions, regular progress updates and check-ins to ensure opportunities and blockers are identified, full implementation assistance, training and education, and access to the self-serve Mölnlycke Portal. Partnership reviews and performance against KPIs, sharing of best practices, alignment and collaboration with other hospitals.

We are continuously innovating to offer customers the most sustainable solutions, without compromising on the safety and quality of our products. By applying life cycle thinking to existing products, we are proactively steering our product portfolios towards improved sustainability outcomes. Our responsibility stretches to the whole life cycle, from sourcing, transportation, manufacturing, through to customer use and end of life. Here are some examples of initiatives we focus on in our journey towards a sustainable product portfolio.   Sustainability through optimal patient outcomes Mölnlycke’s ‘Sustainable solutions’ are products that offer significant1 sustainability benefits over our standard2 alternatives in the market, while providing the same or better functionality. The sustainability benefits of Mölnlycke’s ‘Sustainable solutions’ can include environmental and resource use considerations as well as social and governance policies. Examples of these sustainable approaches include, for example: Lower GHG emissions and improved energy efficiency More efficient use of natural resources, including the adoption of biobased material Producing lower amounts of waste, recycling measures, and improved waste management Moving toward less packaging Improved inclusivity in the workforce as an engaged, diverse company where all employees can perform at their best and support others Improved health and wellbeing, both for our employees and for society as a whole, in line with UN SDGs, which call for good health and wellbeing. Mölnlycke aims to free patients, caregivers and healthcare systems from the burden of wounds and hospital-acquired infections. We also assess that a given ‘Sustainable solution’ does not have adverse effects on any other criteria2. Sustainable Product Portfolio Assessment Our responsibility includes the entire life cycle, from sourcing, transportation, manufacturing through to customer use and end of life. We assess the sustainability performance of all products and build sustainability thinking into our innovation process through sustainable design insights and eco-design tools..  The assessment work is based on ISO standards 14040/44, the internationally established and recognised frameworks that specify requirements and provide guidelines for Life Cycle Assessment. In 2022 we carried out full Life Cycle Assessments for products including Biogel® surgical natural latex gloves, Biogel PI gloves and Mayo Stand Cover, accounting for 9.5% of the portfolio in terms of net sales. Also in 2022, we piloted a holistic approach, carrying out a full analysis of all sustainability and product safety risks and opportunities for selected product portfolios in our Operating Room Solutions Business Area. Information from the pilot is being used to support product portfolio planning through our marketing and innovation teams. Innovating with renewable raw materials and components In recent years we have introduced product innovations which are focused on ISCC-certified biobased and other renewable materials or components. Examples include Mölnlycke’s range of drapes, ProcedurePak® solutions and natural latex gloves. Thus, we have introduced a number of ISCC (International Sustainability and Carbon Certification) accredited sets of universal drapes that use renewable, bio-based raw materials. One of the three layers that make up the drapes is made of ISCC-certified renewable, biobased raw materials. As a result, an externally reviewed Life Cycle Assessment3 showed these drapes to generate on average 20% less greenhouse gas emissions than traditional products. While ProcedurePak® clearly contributes to reduce the risk of contamination4, with fewer pieces to unpack, it also contributes to improve efficiency in hospitals by reducing the theatre set up time by up to 40%5 and so freeing up staff to support elsewhere. It can also reduce waste, helping hospitals to reach their sustainability targets6 and bring efficiency to purchasing teams, with up to 54% less time spent on invoicing1. We have further improved the sustainability profile of our trays by introducing to the market a series of components, such as a PVC-free diathermia pencil, PVC-free hand activated L hook, and the MIS organiser made of FSC certified virgin pulp as well as a needle counter and tray organiser in biobased materials. Read about our ISCC certified BARRIER® Universal drape Read about our ProcedurePak solutions Read about Mölnlycke Monopolar L-hook electrode Guiding customers to make sustainable decisions To guide customers in their conversion to more sustainable solutions, we have now developed a CO2 calculator digital tool which straightforwardly calculates the environmental benefits of choosing an ISCC drape over our standard product1. The calculator allows the customers to easily view the impact of replacing their existing products with sustainable ISCC-certified drapes, based on their annual consumption of drapes. The result is reported both as a percentage reduction of CO2eq. emissions and as the actual reduction in kg CO2eq. Read more on Mölnlycke Value Calculator Packaging Packaging has an important role to play by extending the lifespan of Mölnlycke’s solutions and protecting them from external factors such as damage during transport and handling, or deterioration caused by contamination. This reduces the need for additional raw materials and resources in products and helps to minimise waste for customers. However, packaging also presents some challenges. It uses valuable resources in manufacturing and generates waste when not recycled – an increasing focus of governments and regulators around the world. As part of our resource efficiency journey, we have set a target that more than 95% of packaging will be recyclable and more than 80% of all packaging made of post-consumer recycled (PCR) and/or renewable material by 2030. These targets are based on total packaging weights and 2022 product scope8. Currently, 91% of the packaging material was recyclable and 72% contained recycled material. The majority of our primary packaging is made of mixed plastic or composite materials. This presents recyclability challenges considering currently available end-of-life infrastructures. We are developing solutions to these issues. In the Antiseptics product assortment, all bottles and ampules are made of 100% recyclable mono-material plastic. We will continue to work with suppliers, recyclers and other partners to increase recyclability for plastic primary packaging in other business areas, as well as optimising their weight and recycled content. Decoupling growth from resource constraints We aim to reduce waste from production and increase efficiency in the use of raw materials. Our ambition to decouple growth from increasing material use goes beyond recycling. It starts with limiting the need to recycle. Therefore, we focus on zero waste, working to the ‘right first time’ principle and repurposing and reclaiming materials. We are on a journey to become a zero-waste company in both material waste and water. This includes ambitious targets of zero waste to landfill and reusing water at the most water intensive sites by 2030, as well as implementing closed water loop systems in all production environments.

The last thing on your surgical team’s mind when hard at work in the OR is probably how much waste your single-use surgical instruments and drapes generate, or how much more efficiency you could gain from customised procedure-specific surgical trays. But as sustainability becomes a watchword for every industry, the single-use nature of antiseptic surgical environments is also coming under scrutiny by regulatory bodies and even by patients. While patient safety leads as the most important consideration, hospitals continue to be beset by resource limitations balanced against new regulations that demand more sustainable and circular operations. Add to this equation the difficult-to-calculate environmental aspects of the operating room: from the CO2 expended in sourcing and producing the materials used in the production of OR goods to calculating the logistics of getting surgical trays and drapes and other surgical equipment into the hospital and properly distributed. But what if you could gain clarity on exactly what impact the CO2 from your surgical business generates? Sustainability roadmap Mölnlycke Health Care launched WeCare, the company’s 2030 sustainability roadmap, in 2021. The roadmap charts the actions the company is taking toward a sustainable future and supports the objectives of the Paris Agreement on climate change and the UN Sustainable Development Goals (SDGs). WeCare builds on three pillars integral to Mölnlycke’s business approach: Green mindset, Responsible relationships and Ethical business. These pillars influence Mölnlycke’s business models, partnerships, resource management and innovation, and state how Mölnlycke strives to create a work environment where everyone can excel. The WeCare program supports the company’s sustainable growth and determination to take a lead in sustainable healthcare and outlines the short and long-term targets that will ensure our progress, tracking it according to Global Reporting Initiative (GRI) standards or internal KPIs. These targets include a number of key measurable outcomes within the three pillars. For the green mindset, for example, we will become a net zero company by 2050, 100% fossil-free electricity use at manufacturing sites by 2024, zero waste to landfill at manufacturing sites by 2030, and more. For responsible relationships, we will provide a healthy, safe workplace for an engaged workforce, including a long-term target of zero injuries, gender oarity at director level and above by 2025, five different nationalities in executive leadership by 2025, and more than 10,000 lives improved with our global CSR program by 2025, among other goals. Finally, for ethical business, we act with integrity to ensure that 100% of employees receive annual training or awareness in the ethics and compliance space by 2023, that 100% of employees feel safe reporting concerns without fear by 2025, and that 100% of active distributors have completed our due diligence process by 2025. Guiding the conversion to sustainability Our own commitments and verifiable results illustrate our credibility in developing and supporting sustainable healthcare solutions and offering support and consultancy to our customers to help achieve sustainability through our partnership. Specific tools and standards can help to ensure that healthcare organisations can also achieve these ambitious targets. Sustainable standards: ISCC-certified solutions Mölnlycke continuously innovates to offer the most sustainable solutions without compromising on the safety and quality of its products. By applying lifecycle thinking to existing products, the company proactively steers its product portfolios towards improved sustainability outcomes. International Sustainability and Carbon Certification (ISCC) sets of universal drapes and a range of surgical gowns offered by Mölnlycke are one example of more sustainable, circular solutions and our commitment to using materials more efficiently. One of the three layers that make up the drapes is made of ISCC-certified renewable, biobased raw materials. As a result, an externally reviewed Life Cycle Assessment 1  showed these drapes to generate on average 20% less greenhouse gas emissions than traditional products. Calculating a more sustainable footprint Creating products that fulfil sustainability goals is one dimension of the issue. Detailing exactly how these products fulfil sustainability targets is another challenge. To help calculate the advantage, Mölnlycke has developed a digital CO2 measurement tool that calculates the environmental benefits of choosing an ISCC-certified drape over a traditional product. Mölnlycke currently offers approximately 20 ISCC-certified drapes, consisting of up to 30% bio-based material. Demand for products using renewable, bio-based raw materials is particularly high in Scandinavia, the UK and Benelux, and is increasing in other markets as well. The calculator’s model includes the product’s entire life cycle, including Scope 1, 2 and 3. We are transparent about our impact on the environment, people and society and want to support our partners to do the same.

Improve efficiency with customised ProcedurePak® trays containing all the single-use equipment you need for hip, knee and shoulder replacement surgeries and other orthopaedic procedures. The more you add to each tray, the more value and efficiency you achieve. Increasing efficiency and turnover time in the operating room are key factors associated with increased productivity, patient safety and quality of care. In orthopaedic procedures, as with all surgical best practices, many factors can contribute to inefficiency and potentially avoidable delays. Identifying issues by looking at operating room best practices can lead to better OR time management and operating room optimization, which underpin critical gains in value. What do we mean by value? Improving operating theatre efficiency goes beyond just the procedure being done in the moment. Thinking more broadly about the operating room environment, applying operating room standards, safe operating procedures, sustainability initiatives in the OR (such as operating room waste management and recycling) and optimising surgical procedure packs for the specific surgery all make a difference in reducing waste, reducing costs, saving time, giving you exactly what you need and not what you don’t, and freeing up OR capacity to safely deliver more procedures in the same amount of time. Being able to customise your surgical tray per procedure also makes a difference to OR efficiency. The more complete a procedure tray is with everything you need, the more efficiencies gained. For example, with a wide selection of orthopaedic components available, such as speciality orthopaedic drapes, pulsed lavage, surgical plume evacuation pencil and more, you have scope to build your procedure-specific tray and gain time savings both in setup and during the procedure and potentially less waste and unused/unnecessary components when the procedure ends. Derive more value and activity by optimising operating room equipment, getting help from automation in operating room inventory management, and continuously improving efficiency management. Find out more about the value you could gain – take a look at our value report. title  body title   

When asked about double gloving as a safety practice, no matter the type of surgery, there are mixed reactions. While all surgeons will exclaim, 'My hands are my everything!', 'My hands are an extension of all my years of training' or 'After my brain, my hands are the most important part of my body. Without my hands, I cannot do anything', the resistance to double gloving still exists among some surgeons, while others refuse to operate without using double gloves. Evidence supporting double gloving Any contact with blood introduces risk in the form of blood borne illnesses, such as hepatitis and HIV, which is why the use of surgical gloves was universally adopted in the first place. But knowing that glove punctures happen frequently (up to 45% in some types of surgery) 1  and can easily go undetected (up to 92% of the time) 2, double gloving has been recommended as an extra layer of protection in all surgical procedures – not only high-risk cases 3. Double gloving is proven to reduce the risk of spreading blood borne illnesses 4, lessening the risk of exposure for both patient and surgeon to dangerous and costly cross-contamination and infection. The Cochrane Review 2014 states that using double gloves reduces the risk of blood contamination by 65% and reduces the risk of an inner-glove perforation by 71%, compared to single gloves 4. Addressing resistance to double gloving Why is this extra layer of safety important, and where does the resistance come from? Apart from the peace of mind and proven protection to staff and patient health that double gloving provides, double gloving is also a protective measure in other ways. For example, for a hospital, double-gloving practice and policy is a form of protecting its investment. First and foremost, a surgeon's hands and training are his/her livelihood, and by extension, the "life blood" of the hospital. The training and work s/he has done at a hospital has a value. The same applies for the entire surgical staff. From a health economics perspective, double gloving protects hospital staff and the hospital by reducing risk. Risks of glove punctures in surgery Healthcare professionals who have sustained a sharps or needlestick injury have explained the anxiety, sleeplessness and worry of waiting for days after exposure to blood to learn their status. They work with their hands and depend on having the most protection they can get. This kind of injury can lead to lost work time, potential emotional trauma for patient and staff and even legal action and financial consequences. Post-exposure testing and preventive treatment can be expensive. According to four US healthcare facilities, the mean cost of managing an exposure to a patient with hepatitis C is USD 650, and exposure to an HIV-infected patient is USD 2,456 5. Costs in Europe are also high; in Spain the costs ranged from EUR 172, if the patient tested negative for hepatitis B and C and HIV, to EUR 1,502 if the patient were positive for hepatitis C and HIV 6. Another concern, of course, is the risk for and treatment of a surgical site infection, which can double the length of a patient’s hospital stay (average of 16.8 additional days) 7 and require an extra week (7.4 days) of antibiotic therapy 6. Essentially this is a 61 percent increase in the overall cost of care 8. Double gloving is a simple and effective way to reduce the cost of Occupational Exposure to percutaneous injuries.   Overcoming concerns about tactile sensitivity The last argument against – and often the last mile to go – in adopting double gloving is usually tactile sensitivity. Compared against the gains in safety, the loss of tactile sensitivity resulting from double gloving is insignificant. Performance is not compromised with double gloving; studies have shown that after an initial period of getting used to double gloving (most surgeons adapt fully within two days 13 ), manual dexterity and tactile sensitivity is not reduced when compared with no gloves or single gloving 12 13. Innovations in creating thinner-than-ever, more responsive surgical gloves are one way to counter arguments against double gloving. The future of surgical safety: double gloving with puncture indication systems The next step in complete protection is adopting a double gloving puncture indication system. Double gloving with a coloured puncture indication system (with a clear, fast and large indicator for early detection and enabling quick action to reduce risk) 14 means even greater safety in the OR and is the best protected a surgeon, staff and patient can be.

How do you maintain patient and staff safety in the OR? In addition to other personal protective equipment (PPE), such as face shields and isolation gowns, surgical gowns protect both the patient and operating room personnel from the transfer of microorganisms, bodily fluids and particulate material. PPE and surgical gowns are regular parts of standard patient and staff safety protocols, but during the COVID-19 pandemic, a greater need suddenly emerged and made the importance of proper protection clearer than ever. Why don a surgical gown Surgical gowning procedures are critical to successful and safe surgical procedures. Applying aseptic technique in donning – or wearing – a surgical gown is central to patient and OR staff safety in surgery. Surgical gowns: Protect staff from transfer of microorganisms, bodily fluids and particulate material Maintain the sterile operating area Help prevent infections of the surgical wound Improving patient and staff safety and outcomes Patient and OR staff safety in the surgical environment depends on many factors, but maintaining an aseptic environment is critical to improving patient and staff safety in the operating room. Patient safety equipment, such as surgical gowns and gloves, make up the tools healthcare professionals use in the operating room to support aseptic practice. Aseptic technique consists of a set of processes and steps that help to minimise the risk of introducing pathogens into a sterile operating room and are part of overall patient safety protocols that surgical teams follow. And even in non-theatre situations, protective equipment can be important for healthcare professionals. When the COVID-19 pandemic suddenly struck, PPE like FFP face masks and face shields became critical. Even though surgical procedures were cancelled in most countries, non-sterile PPE protected wearers from contamination. Minimising risk of surgical site infections (SSIs) Use of personal protective equipment and adhering to aseptic practice is critical to minimising risk of contamination that can lead to complications, such as surgical site infections (SSIs). Surgical gowns are one such form of protection. Patient outcomes are not sufficient, and patients need additional treatment when they contract SSIs. Surgical gowns as OR staff and patient safety equipment Surgical gowns provide protection for both OR staff and patients. Gowns act as a barrier against microbial transmission, and with a physical barrier in place, it is less likely that microorganisms will transfer between patients and staff. Surgical gowns also help minimise the shedding of skin cells and other contaminants, reducing the risk further. Safety first: Being prepared with gowns and appropriate PPE When the COVID-19 pandemic hit, hospitals and healthcare organisations suddenly required an unprecedented amount of protective equipment, such as FFP masks, face shields, and standard surgical gowns as well as isolation gowns. Most hospital facilities faced shortages, prompting many healthcare organisations (and even governments) to include additional PPE supply to be able to meet future health crises safely. Mölnlycke was one of the few suppliers who could support the need for high-quality PPE devices and face masks from the beginning to the end of the pandemic, recognising even before the pandemic that being prepared is one key element of prevention and protection. Making sure you have enough of the right PPE on hand to protect patients and staff is step one to maintaining safety and supporting a culture of safety How to maintain patient safety: Preparing for aseptic gown donning Before putting on a surgical gown, full aseptic preparation process takes place to maintain the sterility of the operating room environment. Surgical gown donning The nine steps of how to put on a surgical gown aseptically [Video Section] donning   [Rich text column section] donning 1-3 [Rich text column section] donning 4-6 [Rich text column section] donning 7-9