Tonsillectomy is a common procedure performed nationally. The personal protective equipment and surgical gowning practices used during this procedure vary widely. We compiled a survey of ENT specialists to gain a national opinion about gowning in tonsillectomy with the aim of determining whether we could make it more environmentally friendly whilst maintaining the highest safety standards.

We developed a nine-question survey that was piloted prior to final implementation. The questionnaire was sent to senior registrars and consultant otolaryngologists in the UK.

The survey was completed by a total of 63 ENT specialists. It was found that 82.54 per cent of clinicians would consider wearing a reusable gown that would be sterilised between each procedure.

Our survey suggests most ENT clinicians would consider using a more environmentally friendly surgical gown and some may even consider wearing no gown at all, although many are understandably concerned about the transmission of infection or blood splatter.

In September 2007, the Department of Health published Uniforms and Workwear: an Evidence Base for Guiding Local Policy. Following this, most National Health Service trusts imposed a ‘bare below the elbow’ dress code policy, with clinical staff asked to remove ties, wristwatches and hand jewellery and to wear short-sleeved tops. There is currently no evidence linking dress code to the transmission of hospital-acquired infection. We designed the current survey to assess patients' perceptions of doctors' appearance, with specific reference to the ‘bare below the elbow’ policy.

A questionnaire showing photographs of a doctor in three different types of attire (‘scrubs’, formal attire and ‘bare below the elbow’) were used to gather responses from 80 in-patients and 80 out-patients in the ENT department. Patients were asked which outfit they felt was the most hygienic, the most professional and the easiest identification of the person as a doctor. They were also asked to indicate their overall preference.

Formal attire was considered most professional and the easiest identification that the person was a doctor. Scrubs were considered most hygienic. Respondents' overall preference was divided between scrubs and formal clothes. ‘Bare below the elbow’ attire received the lowest votes in all categories.

This finding raises significant questions about the Department of Health policy in question. The authors suggest that an alternative policy should be considered, with scrubs worn for in-patient situations and formal attire during out-patient encounters.

The objective of this study was to assess the effect of 20 minutes of heavy treadmill exertion in military-style, Level-C chemical and biological personal protective equipment (PPE), including a filtering face piece respirator, on physiological variables including venous pH, venous PCO2, SpO2 and tympanic temperature.

Baseline physiological variables were measured in 19 healthy subjects who undertook heavy physical exertion on a treadmill at a constant room temperature of 20°C: (1) once while wearing a short-sleeved t-shirt, shorts, and running shoes; and (2) once while wearing chemical and biological PPE. Repeat measurements of physiological variables were made after 10 and 20 minutes of exertion in both groups.

Twenty minutes of physical exertion was undertaken by healthy subjects wearing chemical and biological PPE resulted in moderate hypoxemia, significantly decreased pH (p = 0.003), elevated PCO2 (p = 0.018) and elevated tympanic membrane temperature (p < 0.001), compared to baseline values. Despite these significant differences, none of the mean venous blood gas values deviated from the normal range during physical exertion.

The degree and duration of physical exertion undertaken in chemical and biological PPE induced some significant changes in physiological variables compared to control but, with the exception of SpO2, did not result in changes considered to represent abnormal physiology. However, it is likely that core body temperature was underestimated by tympanic measurement. Blood gas data indicating that CO2 was retained during exertion in this type of PPE were unanticipated and require further investigation.

To determine core temperature (Tc) elevations in hazardous materials (HazMat) technicians wearing level-A fully encapsulated, chemically resistive suits (FECRSs) during training scenarios.

Cross-sectional, observational feasibility study with Institutional Review Board approval.

HazMat training scenarios held during the summer of 1994. Weather conditions included both rainy and sunny days, with a mean ambient temperature of 75.8°F(24.3°C) (range 69–83° F [20.6–28.3°C).

Nine male firefighters participating in training scenarios in the Midwestern United States.

Each volunteer swallowed a capsule containing a Tc sensor developed by the National Aeronautics and Space Administration. The capsule continuously monitored Tc and stored data in an ambulatory recorder worn under the level-A FECRS during training.

Mean age of the volunteers was 34 years, mean weight was 92.6 kg, and average baseline Tc was 36.7°C (97.1°F) (range 35.3–38.2°C [95.5–100°F]). Time in the FECRS averaged 25.4 minutes (range 14–35 minutes). All subjects demonstrated increased Tc while in the suit; the mean Tc increase was 0.8°C (1.4°F) (range 0.2–1.3°C [0.4–2.3°F]). The Tc continued to increase during wet decontamination procedures and after suit removal. Mean heat storage values (ΔTcx LBMx 3.47 kJ) were calculated, and found to be moderately elevated to 3.6 kJ/kg (range 2.1–4.6 kJ/kg).

These observations support the validity and significance of implementing prophylactic measures for firefighters using protective clothing. Simple protective measures include enforced time limitations, hydration, and efforts to minimize heat buildup by avoiding both direct sunlight and unnecessary time encapsulated in the suit.