Surgical Attire in the Operating Room, an AORN Guideline

The AORN guideline for surgical attire in the operating room provides evidence-based advice to perioperative team members for wearing proper clothing (e.g., long sleeves, cover apparel, head coverings, shoes). It also covers recommendations for lowering the patient’s risk for surgical site infections by reducing microorganisms that can be shed from perioperative personnel, including: laundering scrub apparel; cleaning identification badges, stethoscopes, and personal items such as backpacks, briefcases, cell phones, and electronic tablets; and determining attire for visitors to the perioperative area.

Here are some of the issues addressed in the surgical attire guidelines from AORN:

When should surgical attire be cleaned?

Surgical attire and personal clothing that has been penetrated by blood, body fluids, or other potentially infectious materials must be removed immediately or as soon as possible. 1.5

Changing contaminated, soiled, or wet attire may reduce the potential for contamination and protect personnel from exposure to potentially pathogenic microorganisms.

Attire contaminated with visible blood or body fluids must remain at the health care facility for laundering.

Contaminated attire must be bagged or containerized at the location where it was used and not be rinsed or sorted.

How should you cover your head in the OR?

Cover the scalp and hair when entering the semi-restricted and restricted areas.

Cover a beard when entering the restricted areas and while preparing and packaging items in the clean assembly section of the sterile processing area. Beards of various lengths can harbor microorganisms, including drug-resistant bacterial species, which are shed into the environment at high rates. 5.2

Surgical headwear, such as magnifying loupes and headlights, can affect the type of head cover selected because these devices are often removed and maneuvered during wearing of surgical head covers, making an effective fit and comfort a priority. Correct-sized head covers can also contribute to hair containment and prevention of shedding. 5.3

What kind of shoes should you wear in the OR?

Wear protective footwear that meets your health care organization’s safety requirements.

The Occupational Safety and Health Administration (OSHA) regulations for foot protection require the use of protective footwear that meets ASTM F2414 standards in areas where there is a danger of foot injuries from falling or rolling objects or objects piercing the sole. 6.2

Fluid-resistant shoe covers or boots must be worn in instances when gross contamination can reasonably be anticipated. 6.3

Shoe covers worn as PPE must be removed immediately after use. After removal, discard the shoe covers and perform hand hygiene. 6.4

Should you clean your cell phone before entering the OR?

Cell phones, tablets, and other personal handheld devices can be highly contaminated with microorganisms, some potentially pathogenic. Researchers recommend regular cleaning of these devices and implementing hand hygiene before and after use. Reducing the numbers of microorganisms present on the devices may protect patients from the risk of HAIs resulting from the transfer of microorganisms from the devices or hands of health care workers to patients. 8.4

Surgical Attire Guideline References

• Guideline for sterile technique. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2024:959–996. [IVA]
• West GF, Resendiz M, Lustik MB, Nahid MA. Bacterial contamination of military and civilian uniforms in an emergency department. J Emerg Nurs. 2019;45(2):169–177. [IIIB] [PubMed: 30573161]

• Guideline for design and maintenance of the surgical suite. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2024:79–142. [IVA]
• Abu Radwan M, Ahmad M. The microorganisms on nurses’ and health care workers’ uniforms in the intensive care units. Clin Nurs Res. 2019;28(1):94–106. [IIIB] [PubMed: 28627936]