Infection prevention concerns have led some to question the wearing of cloth caps in the perioperative environment. The Kaiser Permanente healthcare system requires OR staffers to wear only disposable head coverings, says Marshall Woolner, RN.

Others note that in the absence of hard evidence to the contrary — "There is no evidence that infections occur more often with cloth caps than with paper," says an anesthesia provider — reusable cloth caps are acceptable under certain conditions.

Many facilities that let employees wear cloth caps require them to be laundered daily, either on site or through the facility's laundry service. "If you think your cloth hat, not laundered daily, does not harbor organisms, I challenge you to culture it," says Kathleen Kohut, RN, MS, CIC, CNOR, an infection prevention consultant.

Employees at a few facilities say they have to launder their caps themselves at home, a practice that makes the same waves as home-laundering scrubs does: Why should staff bring potentially biohazardous laundry into their homes, especially when domestic appliances can't meet standards for washing it? Accreditors' guidelines require "using an approved laundry for scrubs — and that includes caps!" says Robert Morgan.

More than 1 respondent says cloth caps are OK as long as a disposable covering is worn over it. "For some staff, the cloth cap and bouffant hat together cover hair better than the bouffant cap alone," says a reader.

The primary concern for many readers is that whatever head covering is worn, it carries out its intended purpose. "There is some good evidence that hair can cause SSIs, but we could certainly use more," says Ms. Kohut. "The purpose of a hat is to contain hair, something that a cloth skull cap does not do well."

Adds Jayne Byrd, "We care less about the hats and more about the adequate coverage of head and facial hair." Her facility lets employees wear their own cloth caps, "but if the cap fails to cover all hair, a bouffant cap must be worn in place of or over the cloth cap."