Surgical operating rooms have long been the site of many commonly accepted rituals that the staff continue to practice long after the reasons for doing them are forgotten. These "sacred cows" are an institution of many facilities' everyday practices, and yet they often provide little or no real benefit to procedure outcomes or patient satisfaction.

Here we'll examine nine practices and present the scientific and anecdotal evidence that seem to suggest that they are, in fact, sacred cows. A few are widely accepted as such, but others are still controversial. We hope that this article will help you decide what is right for your facility.

1. Wearing shoe covers in the OR
Shoe covers used to be worn to guard against contamination from staff members' feet. However, there is little evidence to prove that using shoe covers reduces the risk of infection. In 1999, the Centers for Disease Control released guidelines that recommend abolishing shoe covers, noting that they have never been shown to decrease infection risk or to lower bacterial counts on OR floors. The Occupational Safety and Health Administration and the Association of PeriOperative Registered Nurses suggest shoe covers only when gross contamination can be reasonably anticipated.

Most of the administrators with whom we spoke are heeding the new guidelines. "We have eliminated the mandatory use of shoe covers in the OR. Shoe covers are available to use as necessary," says Dale Bowman, RN, CNOR, manager of Providence Surgery Center in Mission Hills, Calif. Nancy Burden, the Surgical Services Manager at Morton Plant Mease Surgery Center, in Palm Harbor, Fla. agrees, saying, "Shoe covers are not used in our OR unless the case is expected to be messy."

If you are doing procedures where blood and bodily fluids are spilling onto the floor, your staff should take proper precautions and wear moisture