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The Hospital Gown

When I first became a cardiac surveillance nurse, I learnt the obvious quickly: hospital gowns are the bane of efficient wound reviews.

Let me begin by saying I am all for #endPJparalyis. But before this terrific campaign started, and anyway for the early post-operative days, I feel for the cardiac patient. I wouldn't want to wear anything other than pyjamas after having just a large meal, so I can imagine wanting to wear the same, if I was still 8 kilos up in fluid weight after cardiac surgery.

So I accept that certainly for the short term, many of our patients cannot yet fit into their regular clothes. What is surpising to me, for all the talk of efficiency and improvement, is that our cardiac care still includes the laborious and traditional 'hospital gown hurdle'.

For instance, at our hospital, cardiac female patients are still provided with a hospital gown, which can be opened up only to just to the under bust line (think granny/empress-style). From that mid chest point- i.e. from under bust to just up to the collar- the hospital gown is stitched closed.

This means to view the wound, one of two things needs to happen: the gown needs to be removed entirely (cue silent prayer that this is done in a sternal protective manner, Houdini style), or the lady has to gather up the front of the gown, and hold it up under her chin. Like an NHS pastel-pink, flowered, cotton beard.

You know how whenever Gram negative bacteria is found in the surgical wound, the surgical team will mutter about how the patient must be scratching themself*? A possible issue might just be that the bacteria were brought up with the hospital gown, from bottom end, up along the length of the chest wound...

Even the back fastening gowns are hard-going for sternotomy wound review. The lungs of a cardiac patient may be still powering-up after surgery, but we might need to squish them just abit again, asking the patient to lean forward so that you can get at the hospital gown ties. If the patient is slim, the back of the gown is double-wrapped and double-tied. If the patient is a very large male, this maybe quicker involving only one tie, but in any event, you still have manoevre in between bed and chair (not always easy). The front of the hospital gown needs to be down to around belly button (again, with a different mix of bugs below), then pulled back up over the surgical wound.

I appreciate that the hospital gown wasn't designed solely with the cardiac surgical patient in mind. It is for all-comers, and all-sizes, for inpatient care. But for our ward based cardiac patients, are hospital gowns fit for purpose? I wish we could increase our stock levels for male pyjamas (some with boxer style longer shorts), across all the sizes. For women, I would hope for a mid-length hospital gown, but with popper-fastens all the way up the length of the front of the gown.

Imagine that - easy access to review cardiac surgical incisions including chest, legs and groin areas. All checked without patient contortion or excessive state of undress. It makes sense from my biased surveillance perspective anyway - particularly if you are paying extra (rather a bit ironically) for a 'visible' style surgical dressing.

Maybe this isn't an issue at your hospital site. But for me, while I am day dreaming about cardiac-surveillance-friendly hospital gowns, I might even add to my mental request warm dressing gowns for patients who need them and/or disposible pants…

*sadly, I have actually seen this- in sort of slow motion/brain scarring stuff for any SSI preventionist, but thankfully, it is a rare occurance