Home E-Weekly October 31, 2017

Study: Skullcaps Prevent Infections Better Than Bouffants

Published: October 30, 2017

BOUFFANT VS. SKULLCAP? Surgeons are being urged to wear the bouffant but many prefer the traditional skullcap.

For years, surgeon and nursing groups have been locked in an intense and public argument over whether the long-beloved surgical skullcap should be abandoned in favor of the bouffant, which nurses argue prevents infection because it covers more hair than a skullcap.

Now, according to a study in the Journal of the American College of Surgeons, researchers claim that bouffant may actually be the riskier piece of headwear.

For the study, which was presented at the American College of Surgeons Clinical Congress earlier this month, researchers tested disposable bouffants, disposable skullcaps and recently washed cloth skullcaps after a mock surgical procedure. They found that bouffants had significantly higher microbial shed at the sterile field than skullcaps — likely because bouffants had larger average and maximum pore sizes compared with cloth skull caps and were significantly more permeable than either disposable or cloth skullcaps.

The findings contradict the argument made by the Association of periOperative Registered Nurses, which has long claimed that the skullcap does not adequately protect patients from infections because it fails to cover both the ears and a surgeon's longer hair. Their argument and the OR guidelines AORN laid out, which dictate that headwear must cover the hair and ears, have led some facilities to ban the skullcap entirely.

The study also follows a similar one completed earlier this month. Surgeons from the Buffalo General Medical Center penned an article in the Bulletin of The American College of Surgeons, arguing that making surgeons switch to the bouffant was unnecessary.

Cases of infection didn't decrease in the 2 years that surgeons at the Buffalo General Medical Center were made to wear the bouffant during their procedures, the article said. In fact, they increased - albeit by a very small amount.

For surgeons at the Buffalo General Medical Center, the core issue is one of comfort but it goes beyond that as well.

They wrote in their article that the growing and heated debate between those who prefer skullcaps and those who deem them unsanitary has had a polarizing effect in the medical community, occasionally even hinting at larger issues of sexism.

"Those divisions and assumptions about gender, surgeon versus nurse, and male versus female should no longer exist in our ORs," the article said.

Anna Merriman

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