Monday, March 7, 2016

Perineal Fallout - A Scourge in the Operating Room

After making a brief mention of countermeasures to prevent perineal fallout in my last post, I received a couple of questions via email. I decided the best way to answer them would be to interview an expert, Alice, an operating room  nurse from the greatest generation here to enlighten us aging baby boomers and whippersnapperrns as well.  Alice hates foolishness, so if you don't want to be permanently stuck in the cysto room hanging endless bottles of irrigant, pay close attention.

Alice, (background)  wearing perineal fallout detecting headgear
on duty in the  never ending war against infection inducing perineums.

Alice, "What exactly is perineal fallout?"
If you recall from your most basic anatomy class, the skin is composed of layers. The outer layer is continually being sloughed off into the atmosphere forming a potentially infectious fog that spreads like radiation. It is especially prevelant where skin rubs together in areas like hairy masculine thighs or other skin folds.  

Is perineal fallout a gender issue restricted to men?
No of course not. In my Operating Rooms, women wear scrub skirts as orderd in the Bible. Just read Deuteronomy 22:5. Women wear undergarments under their skirts that trap and contain perineal fallout so it's not a big issue.. Who knows what those hairy surgeons have under those baggy scrub pants, but I suspect there are huge colonies of microorganisms just itching to be set free and cause a very nasty infection.

What can be done to prevent dreaded perineal fallout?
Like everything else in nursing, an ounce of prevention is worth a pound of cure. Men should always have perineal fallout contained by ankle constrictions. I'm from the old school and back in my day we had scrub pants with elastic ankles. This worked like a charm. The best substitute for elastic cuffs, that I've come up with is rubber bands so the next time you unwrap your copy of The Chicago Tribune, be sure to save the rubber band and bring it to work. Waste not - Want not.

Years ago we had other measures to combat those pesky crotch bacteria. One of my all time surgical heroes, Joseph Lister, sprayed carbolic acid  all around the room during surgery. I don't want any complaints about that caustic fog of carbolic acid burning your eyes or constricting your airway, it's one of the sacrifices we make for our patient in the never ending battle against perineal fallout.
A wardrobe failure of catastrophic proportion resulting in spontaneous
release of perineal fallout. This is the operating room equivalent of the Chernobyl
disaster. Fallout all over the place. Even the "Alice approved" rubber banded ankle
trick is useless as a containment measure. Maybe Lister's carbolic spray needs resurrected.

Alice was a true crusader in the battle against perineal fallout. Sometimes nurses that came before me harbored customs and beliefs that were not rooted in science. The way I viewed the perineal fallout issue was that any escaping microorganisms would wind up on the floor which was by it's nature is contaminated. So what is the big deal?

 It did not really pay to argue with people like Alice. Empirical beliefs that stood the test of time were usually very fixed. I don't know if modern nurses have encountered this issue, but perineal fallout made for much argument and discussion back in the day. About the only people Alice could cajole into her rubber banding were hapless first year residents. Too much arguing with attending surgeons was hazardous to continued employment.

Alice would really have fun with OR staff and nurses in general now that everyone wears scrub pants which were her true nemesis if found sans her ever present rubber bands.


  1. I graduated from nursing school in 2012, however the instructor who lead us through our surgical clinical was an old timer who seemed to be held in great esteem by the surgeons (maybe they were faking it I don't know) and the OR staff.
    I do remember her reminding me and the other male students in our group to
    tuck our scrub tops into the waste bands of our pants. There was some mention of
    skin cells and detritus possibly escaping into the atmosphere. I don't recall if the
    women had a similar instruction. Nor do I recall lf there was any discussion about
    possible perineal fallout, but it doesn't seem outside the realm of possibility. Some of our instructors harbored ideas about sanitation that seemed to be relics of a bye gone era. A pillow case was never to be seen with the open end facing an open doorway--a pathway for
    bacteria and toxic vapors. This seemed ironic considering the slip shod housekeeping practices that prevailed in the hospital. I always wondered what bugs colonized the curtains that hung between the patients beds. I never recalled seeing them changed. Your blog is wonderful and I look forward to each new post
    Thank you.

  2. I wonder what sort of non sterile substances were lingering in the folds of the sisters coif in the image you chose.

  3. My old school (old school doubled to you youngsters) operating room supervisor, Alice, had a thing about men having their scrub shirts tucked tightly into scrub pants too. Her rationale for this was that an untucked scrub shirt could inadvertently come into contact with a sterile field. I always thought this was kind of sexist as the scrub nurses wore loose fitting scrub dresses which to me seemed more likely than scrub suits to contaminate. Women were never permitted to wear scrub suits. I guess it had to do with that Deuteronomy 22 verse 5 thing. One time, we ran out of large scrub suits and my hero Dr. Slambow, showed up in one of our pink scrub dresses to do an emergent case. His motto was "Whatever it takes." Not a sole said anything to him about his unique attire, but there was certainly much tongue wagging.

    I had that picture of the circulating nurse with the dramatic headgear for some time and was just looking for an excuse to post it.

    Thanks so much for indulging in my ancient foolishness!


    1. I surely do remember the elastic ankle scrub pants. I thought it was a very practical way to manage perineal fallout. What would Alice make of thong-wearing nurses attired in a scrub dresses I wonder? This thread brought back faint memories about this subject when I started nursing school in 1971. I loved the "Flying Nun" nurses cap in the photo! And thinking back about caps, we used to hold serious beliefs about different caps and their school"s reputation. At the time the little upside down ruffled med cup of Henry Ford was the most prestigious in our area (MI). My cap was sort of generic signifying nothing special except to me of course.

  4. There was a fascinating article in this months Smithsonian about "zoot suits" which were popular in the beginning of the 20th century. The elastic cuffed ankles on the "zoot" pants grabbed my attention and reminded me of old time scrub suits. Zoot suits did not have elastic ankles for perineal fallout prevention; they were designed for dancing, but I thought the similarity was amusing.

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