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:
- Soiled scrubs and/or hats should be changed as soon as feasible and
certainly prior to speaking with family members after a surgical
procedure.
- Scrubs and hats worn during dirty or contaminated cases should be
changed prior to subsequent cases even if not visibly soiled.
- Masks should not be worn dangling at any time.
- Operating room (OR) scrubs should not be worn in the hospital
facility outside of the OR area without a clean lab coat or appropriate
cover up over them.
- OR scrubs should not be worn at any time outside of the hospital
perimeter.
- OR scrubs should be changed at least daily.
- During invasive procedures, the mouth, nose, and hair (skull and
face) should be covered to avoid potential wound contamination. Large
sideburns and ponytails should be covered or contained. There is no
evidence that leaving ears, a limited amount of hair on the nape of the
neck or a modest sideburn uncovered contributes to wound infections.
- Earrings and jewelry worn on the head or neck where they might fall
into or contaminate the sterile field should all be removed or
appropriately covered during procedures
- The ACS encourages clean appropriate professional attire (not
scrubs) to be worn during all patient encounters outside of the OR.
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.
References:
ACS (American College of Surgeons). Statement on Operating Room Attire. Online August 4, 2016
https://www.facs.org/about-acs/statements/87-surgical-attire
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.
https://www.aorn.org/guidelines/clinical-resources/clinical-faqs/attire
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