The Surgical Attire Debate Goes On…

Be it common sense or what we learned in school, it is commonly accepted that surgical attire limits the surgical patient’s exposure to organisms, aiding in the prevention of surgical site infections (SSI). The great debate is not only what should the surgical attire be, but also what rules should be applied for the surgical attire.

In 2015, the Association for Perioperative Registered Nurses (AORN) published their recommendations for OR attire. These recommendations were strict and met with great push-back because many believe there’s no scientific methodology to support the stringent guidelines. Despite the push-back from OR departments, other accrediting bodies have used and enforced these recommendations.

In 2018 a study came out testing if the ears should be covered by bouffant caps instead of the standard skull caps many surgeons prefer. The AORN recommends the bouffant cap, while the American College of Surgeons (ACS) guidelines state that skullcaps are acceptable. It was determined that despite the fact that the ears can be a reservoir for bacteria and pathogens, there were no significant differences in the nine-month study between the two types of caps for the outcome of patients with surgical site infections.

To add to the confusion of caps is the waste of disposable -vs- the inconsistent cleaning methodology of material personal scrub type head caps. While many may prefer their own caps, citing that “It’s good for the environment and I can individualize my look”, studies show that scrubs (and caps) are contaminated throughout the day. Some of these organisms survive home laundry due to the water not being hot enough to kill them, the microfilm in certain materials, and the fact that garments are not laundered on a daily basis. This means not only are we bringing bacteria and bugs back into the OR to our patients which in turn increases SSI, but we are also taking them home to our families!

There are other items discussed in the debate such as shoes and ID badges. Many institutions use the badge for access, but when was the last time any of us cleaned our badge or lanyard?

The AORN and ACS state that any perioperative professional should follow their facility’s guidelines because the foremost concern should be for patient safety and providing the cleanest surgical environment. It makes one realize there is more to preventing surgical infections than just changing out shoe covers between cases and the old adage “we’ve always done it this way”.


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