US Surgeons Set Guidelines for Proper Attire Both In and Out of OR

The American College of Surgeons (ACS) has issued a statement on proper dress for surgeons, whether in the operating room or interacting with families or the public outside.

ACS Executive Director David B. Hoyt, MD, said the refresher statement is meant to provide evidence-based consensus on appropriate head coverings and when scrubs must be changed.

“Our fellows were concerned they were being told to do things that weren’t necessarily evidence-based,” he told Medscape Medical News. “It just was time for us all to take a step back and say what’s the best evidence, what’s best practice, and let’s all recommit to it.”

The statement was published online August 4 and will appear in the Bulletin of the American College of Surgeons in October.

Guidelines include:

• Change soiled scrubs and/or hats as soon as possible after surgery, and certainly before speaking with family members.
• Change scrubs and hats after contaminated cases, even if clothing is not visibly soiled. Discard paper skull caps at least daily and after every dirty or contaminated case. “Religious beliefs regarding headwear should be respected without compromising patient safety,” the authors explain.
• Do not let masks dangle.
• If wearing scrubs outside the operating room (OR), cover with a clean lab coat.
• Change out of scrubs before leaving the hospital. To enforce this, ACS recommends distinctive, colored scrubs for OR personnel. “I think there’s been a drift of wearing of scrubs into areas where you would not traditionally expect to see them,” Dr Hoyt said. “It does send a message other than that these are things worn for infection control and patient safety.”
• Remove or cover any jewelry on the head or neck that “might fall into or contaminate the sterile field,” before procedures, the authors recommend.
• Cover mouth, nose, and hair during invasive procedures. However, “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,” the guidelines authors write.
• Wear clean, appropriate professional attire (not scrubs) during all patient encounters outside the OR. “Physicians need to be reminded of these things, just like anybody else does,” Dr Hoyt said, although he acknowledged some will see it as one more set of rules to follow.

The authors of the guidelines also suggest clothing changes for all OR personnel, including anesthesiologists, certified nurse anesthetists, laboratory technicians, and aides.

The ACS is not the first organization to issue such guidelines. For instance, the Association of periOperative Registered Nurses updated their surgical attire guidelines in 2014 and included rules governing things such as cleaning protective eyewear, cellphones, and handheld devices and what shoes and shoe coverings are appropriate.

The Association of Surgical Technologists released their hand hygiene, surgical scrub, and surgical attire recommendations in 2008.

The guidelines do not add time to OR practice, and in fact support more flexibility in wearing some apparel, Dr Hoyt explained.

“What it doesn’t support is people getting in their car at night and driving in blood-soiled scrubs,” he said.

Dr Hoyt has disclosed no relevant financial relationships.

“Statement on Operating Room Attire.” ACS. Published online August 4, 2016. Full text