What’s New in the Patient Safety World

September 2016

American College of Surgeons Statement on Operating Room Attire



Tired of seeing your surgeons and OR personnel traipsing through your hospital cafeteria dressed in their scrubs (with all the contaminants you don’t want to even think about)? Well, get them all to comply with the new recommendations in a statement from the American College of Surgeons (ACS) on operating room attire (ACS 2016). And, while you are at it, make sure everyone in your cath labs or GI labs or other procedure areas also comply with the new recommendations.


The ACS bases its guidelines for appropriate attire on “professionalism, common sense, decorum, and the available evidence”. They are as follows:


The ACS strongly suggests that scrubs should not be worn outside the perimeter of the hospital by any health care provider. To facilitate enforcement of this guideline for OR personnel, the ACS suggests the adoption of distinctive, colored scrub suits for the operating room personnel.


But not everyone is on board with the ACS statement. In particular, AORN (Association of periOperative Registered Nurses) has issued its own statement (AORN 2016) noting that several of the ACS recommendations are not evidence-based. The AORN statement comments on the ACS recommendations item-by-item but especially differs on several points. Whereas the ACS statement recommends that “Scrubs and hats worn during dirty or contaminated cases should be changed prior to subsequent cases even if not visibly soiled.” AORN notes that OSHA requires "attire that has been penetrated by blood, body fluids, or other infectious materials be removed immediately or as soon as possible and be replaced with clean attire." AORN also questions the recommendation about wearing a lab coat over scrubs, noting evidence that lab coats are often contaminated by large numbers of pathogenic organisms. AORN also discusses issues regarding head coverings and how difficult it would be for facilities to enforce vague terminology like “modest sideburn” or “limited amount of hair”. Read the AORN statement in full for other details. AORN also has its own guidelines on surgical attire.


The ACS plans to publish its statement in the October 2016 issue of Bulletin of the American College of Surgeons. One would hope that ACS and AORN would get together with the ASA (American Society of Anesthesiologists) and organizations representing all other OR healthcare workers to agree on standards that apply to all.






ACS (American College of Surgeons). Statement on Operating Room Attire. Online August 4, 2016




AORN (Association of periOperative Registered Nurses). AORN Responds to ACS Statement on Surgical Attire. Periop Insider Newsletter 2016; August 16, 2016




AORN (Association of periOperative Registered Nurses). Clinical FAQ’s. Surgical Attire.






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