3 Tough Attire Challenges Solved
By: Aorn Staff
Published: 10/22/2019
Publish Date: May 22, 2019
AORN has updated the guideline on surgical attire following the release of several new published studies regarding attire that were significant enough to consider practice changes, according to Lisa Spruce, DNP, RN, CNS-CP, CNOR, ACNS, ACNP, FAAN, AORN director of evidence-based practice and lead author of the update.
While the updated guideline is slated for publication July 1, public comment has already garnered many questions about implementing the guideline changes.
As with any change in OR practice, use the evidence to drive adherence and understanding, Spruce advises.
“The evidence should be used to provide a rationale for practice change and to guide perioperative team members on making policy decisions,” she says, suggesting that “providing the evidence will give team members the ‘why’ to understand the importance of following the recommendations.”
Spruce shares three of the most common questions on the surgical attire guideline updates and the evidence cited in the update that nurses can use to help their team members adapt to new practices.
Question #1: Can we allow cloth caps?
Answer: It’s a facility decision.
Based on input from four recent studies that evaluated different OR headgear assessed by environmental quality indicators, AORN encourages the formation of an interdisciplinary team, including members of the surgical team and infection preventionists, to determine the type of head covers that will be worn at the healthcare organization.
Evidence to Review: A study by Markel et al 2017 studied the effectiveness of operating room headgear in preventing airborne contamination by testing disposable bouffant and skull cap hats and newly laundered cloth skull caps in a mock surgical procedure. The researchers found no significant differences in particle or actively sampled microbial contamination between disposable bouffant and disposable skull caps. They did find that disposable bouffant hats had significantly higher microbial shed at the sterile field.
Question #2: Do we have to cover our arms in the restricted and semi-restricted areas?
Answer: No, but arms may be covered during performance of preoperative patient skin antisepsis.
Based on one new study that suggested a healthcare provider wear long sleeves when prepping a patient to reduce airborne contaminants, facilities can choose to have perioperative team members cover their arms during performance of patient skin antisepsis.
Evidence to Review: A study by Market et al 2018 conducted a mock patient skin prep with the provider conducting the skin prep wearing long-sleeved gown and gloves, or bare arms to perform the procedure. Particle counters were used to assess airborne particulate contamination. When the provider wore long sleeves and gloves while applying the skin preparation solution, particulate and microbial shedding decreased.
Question #3: When do beards need to be covered?
Answer: Cover beards when entering the restricted areas and while preparing and packaging items in the clean assembly section of the sterile processing area.
Evidence to Review: A study by Wakeam et al 2014 compared bacterial shedding among bearded and clean-shaven men, as well as women. They found significantly more bacterial shedding by bearded men than by clean-shaven men or by women, even when a mask was worn.
Following the latest evidence is crucial to providing the most effective, high-quality patient care to improve patient outcomes, Spruce stresses. “Healthcare is constantly changing, and new research is being published on a daily basis—being aware of these changes is important to provide the best care to patients and it increases team member knowledge about practice.”
Additional Resources
Markel TA, Gormley T, Greeley D, Ostojic J, Wise A, Rajala J, Bharadwaj R, Wagner J. Hats Off: A Study of Different Operating Room Headgear Assessed by Environmental Quality Indicators. J Am Coll Surg. 2017 Nov;225(5):573–581.
Markel TA, Gormley T, Greely D, Ostojic J, Wagner J. Wearing long sleeves while prepping a patient in the operating room decreases airborne contaminants. Am J Infect Control. 2018 Apr;46(4):369–374.
Wakeam E, Hernandez RA, Rivera Morales D, Finlayson SRG, Klompas M, Zinner MJ. Bacterial ecology of hospital workers' facial hair: A cross-sectional study. J Hosp Infect. 2014;87(1):63-67.
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