Home E-Weekly May 16, 2017

Thinking About Banning Skullcaps? Read This First

Published: May 15, 2017

TAKE COVER Banning skullcaps in favor of bouffant-style caps did not have a statistically significant effect on SSI rates.

All this uproar over banning skullcaps from the OR in favor of bouffant-style caps because of infection risk, and now comes research that suggests a surgeon's choice of headwear might not impact SSIs.

The Association of periOperative Registered Nurses opts for hoods or bouffant-style coverings over skullcaps, because the skullcap may not effectively contain the hair and minimize microbial dispersal. But using bouffant caps in the OR in place of other types of head covers does not appear to offer any additional protection against surgical site infections, say the researchers from the University at Buffalo (N.Y.) who authored a new study in Neurosurgery.

The authors reviewed monthly infection-control summary reports from a single, 25-OR site that mandated the use of bouffant caps in February 2015. The data, pulled from January 2014 to March 2016, was categorized into 2 groups: a non-bouffant group, which included the period before February 2015, when OR personnel could use headwear of their choice; and a bouffant group, which included the post-implementation period, when all OR personnel were required to wear a bouffant cap. In both groups, personnel with beards were required to use a hood-style hat to cover the hair on the face and scalp.

"Our results comparing the use of bouffant caps with other choices of headwear indicate that for class I OR cases, the use of bouffant caps instead of other types of head covers does not influence the rate of SSI," the authors write. "In fact, for all class I OR cases and for all spinal procedures, the rate of SSI had a non-statistically significant increase after the use of bouffant caps in the OR became mandatory in accordance with hospital policy."

The mean monthly rate of SSI in all Class I OR cases was 0.79 ± 0.44% before the implementation of the bouffant-only policy; this increased to 0.85 ± 0.42% in the year following the mandate.

The authors say bouffant caps are often donned improperly, meaning the hair could fall from the cap when a surgical headlight or neurosurgery loupe is applied, removed and otherwise maneuvered around the surgeon's headwear. In addition, some surgeons who wear bouffant caps complain of experiencing hearing difficulties and discomfort. For others, the skullcap is simply a style preference, even something of a status symbol.

Bill Donahue

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