Archive April 2017 XVIII, No. 4

Infection Prevention: 3 Surgical Attire Battles Worth Fighting For

Breaks in these safe attire practices could harm patients.

Lisa Spruce, DNP, RN, CNS-CP, CNOR, ACNS, ACNP

When your surgeons and staff don't follow correct attire practices, such as completely covering the hair and not wearing scrubs outside the OR, they're endangering patients by putting them at risk for an infection. Needlessly so.

We may not have all the answers when it comes to keeping our patients safe from infections, but thanks to careful research and high-level evidence collected over many years, there's plenty we do know. And yet, every day, in surgical facilities all over the United States, clinicians who should know better disregard some of the most basic dictates and principles of infection prevention.

What can you do about it? At the very least, you can set a good example by resolving to never let personal preference or convenience override what you know to be right. The choices you make can send a powerful message to your surgeons and staff and help motivate them to make the same choices. Here are 3 areas to focus on right away. I chose these practices because this is where I see consistent breaks in safe-attire practices and also because there's evidence you can share with your practice-breaking colleagues.

1Head coverings
Most surgeons have a strong preference for skullcaps. The skullcap, often personalized with the logos of a favorite sports team or alma mater, is symbolic of the surgical profession. It signifies "surgeon." But these caps sit above the ears, leaving lots of hair uncovered. Regardless of their popularity, we can't rely on skullcaps to contain hair above and in front of the ears or at the nape of the neck. We know for a fact that we shed skin squames and that they can contain potentially pathogenic bacteria. Studies have shown that Staphylococcus aureus and Staphylococcus epidermidis have a tendency to colonize in hair, skin and the nasopharynx (osmag.net/ybbv6t). It's why AORN recommends wearing a bouffant cap — a "clean, low-lint surgical head cover or hood that confines all hair and covers scalp skin [and is] designed to minimize microbial dispersal."

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