Login Join/Renew

Attire

Get clinical answers to frequently asked questions about Attire. 


Are the AORN recommendations for surgical attire applicable to procedures performed in ambulatory surgery centers, endoscopy centers, and pain management clinics?

The AORN “Guideline for surgical attire” is intended to represent what is believed to be an optimal level of practice. Policies and procedures will reflect variations in practice settings or clinical situations that determine the degree to which the guidelines can be implemented. AORN recognizes the many diverse settings in which perioperative nurses practice, and as such, these guidelines are adaptable to all areas where operative and other invasive procedures may be performed.

Resource

  • Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

Updated November 13, 2014 


Is it okay to wear home laundered cloth caps if they are covered by a disposable cap?

We have surgical team members in our facility that wear reusable cloth caps. The caps are not washed in a health care-accredited laundry. Our director has asked these team members to put a disposable cap over the cloth cap. Is this okay?

Yes. A reusable cloth cap that is contained within a disposable cap may be home laundered, just as other personal clothing (eg, T-shirts) contained within the scrub attire are home laundered.

Resource

  • Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

Updated November 13, 2014 


Should perioperative team members remove surgical head coverings when leaving the perioperative areas?

Personnel wearing scrub attire should not remove the surgical head covering when leaving the perioperative area. The purpose of the head covering is to contain hair and minimize microbial dispersal. When the head covering is removed, hair and microbes may be shed onto the scrub attire.

Head coverings commonly used in the perioperative setting (eg, bouffant caps) are worn for hair and skin containment and are not considered personal protective equipment (PPE). The Occupational Safety and Health Administration (OSHA) requires that PPE not permit blood, body fluids, or other potentially infectious materials to pass through or reach the employee’s clothing, skin, eyes, or other mucous membranes under normal conditions of use.

Resources

  • Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
  • Occupational exposure to bloodborne pathogens. OSHA Final rule. Fed Regist. 1991;56(235):64004-64182.

Updated November 6, 2014 


Should unscrubbed perioperative team members wear long-sleeved jackets when performing preoperative patient skin antisepsis?

Perioperative team members should wear scrub attire that covers the arms while performing preoperative patient skin antisepsis. Wearing long-sleeved attire helps contain skin squames shed from bare arms. Performing the preoperative skin antisepsis without wearing a long-sleeved jacket may allow skin squames from the perioperative team member’s bare arms to drop onto the area that is being prepped and may increase the patient’s risk for an SSI.

Resources

  • Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
  • Guideline for preoperative patient skin antisepsis. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
  • Andersen BM, Solheim N. Occlusive scrub suits in operating theaters during cataract surgery: effect on airborne contamination. Infect Control Hosp Epidemiol. 2002;23(4):218-220.
  • Guideline for sterile technique. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

Updated November 6, 2014 


Should unscrubbed perioperative team members wear long-sleeved jackets when opening sterile supplies?

Perioperative team members should wear scrub attire that covers the arms when opening sterile supplies. Wearing long-sleeved attire helps contain skin squames shed from bare arms. Opening sterile supplies onto the sterile field without wearing a long-sleeved jacket may allow skin squames from the perioperative team member’s bare arms to drop onto the sterile field and may increase the patient’s risk for an SSI.

Resources

  • Andersen BM, Solheim N. Occlusive scrub suits in operating theaters during cataract surgery: effect on airborne contamination. Infect Control Hosp Epidemiol. 2002;23(4):218-220.
  • Guideline for sterile technique. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

Updated November 13, 2014 


Should unscrubbed perioperative team members wear long-sleeved jackets when preparing and packaging items in the clean assembly section of the sterile processing area?

The perioperative or sterile processing team member should wear scrub attire that covers the arms while preparing and packaging items in the clean assembly section of the sterile processing area. Wearing long-sleeved attire helps contain skin squames shed from bare arms. Not wearing a long-sleeved jacket while preparing and packaging items that will be used during operative or other invasive procedures may allow skin squames from the bare arm to drop onto the item that is being prepared or packaged and may increase the patient’s risk for SSI. This organic material may be subsequently transferred to the surgical wound or other areas of the body and may increase the patients risk of SSI or other postoperative complications.

Resources

  • Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
  • Andersen BM, Solheim N. Occlusive scrub suits in operating theaters during cataract surgery: effect on airborne contamination. Infect Control Hosp Epidemiol. 2002;23(4):218-220.
  • Guideline for sterile technique. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

Updated November 6, 2014 


Does AORN recommend wearing scrub dresses?

Scrub dresses may be worn over scrub pants or leggings. The scrub dresses and pants or leggings should be laundered in a health care-accredited laundry facility after each daily use and when contaminated.

Resource

  • Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

Updated November 6, 2014 


What are the AORN recommendations for perioperative team members wearing T-shirts or other personal clothing under scrub attire that are visible at the neck and sleeve?

Personal clothing that cannot be contained within the scrub attire either should not be worn or should be laundered in a health care-accredited laundry facility after each daily use and when contaminated.

Resource

  • Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

Updated November 13, 2014 


Does AORN recommend wearing scrub attire outside of the building?

Health care personnel should change into street clothes whenever they go outside of the building. Surgical attire may become contaminated by contact with the external environment. Changing into clean surgical attire before entering the semi-restricted area(s) decreases the possibility of contamination with microorganisms present in the external environment.

Resource

  • Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

Updated November 6, 2014 


What are the AORN recommendations for wearing cover apparel?

The collective evidence does not support wearing cover apparel to protect scrub attire from contamination, and there is evidence that lab coats worn as cover apparel can be contaminated with large numbers of pathogenic microorganisms. Researchers have found that cover apparel is not always discarded daily after use or laundered on a frequent basis. Cover apparel (eg, lab coats) worn over scrub attire should be clean or single use. Reusable cover apparel should be laundered in a health care-accredited laundry facility after each daily use and when contaminated.

Resources

  • Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
  • Treakle AM, Thom KA, Furuno JP, Strauss SM, Harris AD, Perencevich EN. Bacterial contamination of health care workers’ white coats. Am J Infect Control. 2009;37(2):101-105.
  • Munoz-Price LS, Arheart KL, Lubarsky DA, Birnbach DJ. Differential laundering practices of white coats and scrubs among health care professionals. Am J Infect Control. 2013;41(6):565-567.
  • Munoz-Price LS, Arheart KL, Mills JP, et al. Associations between bacterial contamination of health care workers’ hands and contamination of white coats and scrubs. Am J Infect Control. 2012;40(9):e245-e248.
  • Butler DL, Major Y, Bearman G, Edmond MB. Transmission of nosocomial pathogens by white coats: an in-vitro model. J Hosp Infect. 2010;75(2):137-138.
  • Henderson J. The endangered white coat. Clin Infect Dis. 2010;50(7):1073-1074.

Updated November 6, 2014 


What are the AORN recommendations for shoes worn in the perioperative areas?

Perioperative personnel should wear clean shoes that are dedicated for use within the peri-operative area. Shoes worn within the perioperative environment must have closed toes and backs, low heels, and nonskid soles and must meet Occupational Safety and Health Adminis-tration (OSHA) and the health care organization’s safety requirements. Shoe covers or boots must be worn in instances when gross contamination can reasonably be anticipated (eg, orthopedic surgery).

Resources

  • Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
  • Occupational exposure to bloodborne pathogens. OSHA Final rule. Fed Regist. 1991;56(235):64004-64182.

Updated November 6, 2014 


What are the AORN recommendations for wearing jewelry in the perioperative areas?

Jewelry (eg, earrings, necklaces, bracelets, rings) that cannot be contained or confined within the scrub attire should not be worn in the semi-restricted or restricted areas. Wearing earrings, watches, and rings was found to increase bacterial counts on skin surfaces both when the jewelry is in place and after its removal. The collective evidence supports the removal of rings, the removal or containment of watches, and the complete covering of ear and nose piercings with a surgical mask or head covering in the surgical setting.

Resources

  • Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
  • Saxena S, Singh T, Agarwal H, Mehta G, Dutta R. Bacterial colonization of rings and cell phones carried by health-care providers: are these mobile bacterial zoos in the hospital? Trop Doct. 2011;41(2):116-118.
  • Bartlett GE, Pollard TC, Bowker KE, Bannister GC. Effect of jewelry on surface bacterial counts of operating theatres. J Hosp Infect. 2002;52(1):68-70.
  • Field EA, McGowan P, Pearce PK, Martin MV. Rings and watches: should they be removed prior to operative dental procedures? J Dent. 1996;24(1-2):65-69.
  • Kelsall NKR, Griggs RKL, Bowker KE, Bannister GC. Should finger rings be removed prior to scrubbing for theatre? J Hosp Infect. 2006;62(4):450-452.
  • Jeans AR, Moore J, Nicol C, Bates C, Read RC. Wristwatch use and hospital-acquired infection. J Hosp Infect. 2010;74(1):16-21.
  • Salisbury DM, Hutfilz P, Treen LM, Bollin GE, Gautam S. The effect of rings on microbial load of health care workers’ hands. Am J Infect Control. 1997;25(1):24-27.
  • Khodavaisy S, Nabili M, Davari B, Vahedi M. Evaluation of bacterial and fungal contamination in the health care workers’ hands and rings in the intensive care unit. J Prev Med Hyg. 2011;52(4):215-218.

Updated November 6, 2014 


What are the AORN recommendations for briefcases and personal items taken into the perioperative areas?

Briefcases, backpacks, and other personal items that are taken into the semi-restricted or restricted areas should be cleaned with a low-level disinfectant and should not be placed on the floor. Items brought into the OR, such as briefcases, backpacks, and other personal items, may be difficult to clean and may harbor pathogens, dust, and bacteria.

Maintaining a clean perioperative environment helps decrease the patient’s risk of SSI. Cleaning these items may help to decrease the transmission of potentially pathogenic microorganisms from external surfaces to perioperative surfaces and from perioperative surfaces to external surfaces. Floors in the OR or procedure room are considered contaminated. Items placed on the floor could become vehicles for transferring microorganisms from the floor to other perioperative or external surfaces.

Resources

  • Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
  • Guideline for environmental cleaning. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

Updated November 6, 2014 


What are the AORN recommendations for briefcases and other personal items made of material that cannot be cleaned with a low-level disinfectant before being brought into the perioperative areas?

If the item is unable to be effectively cleaned, it should be contained within an impervious cover before being brought into the perioperative areas and should remain covered while in the perioperative areas.

Resource

  • Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

Updated November 13, 2014 


What are the AORN recommendations for cell phones and other hand-held electronic equipment taken into the perioperative areas?

Cell phones, tablets, and other personal communication or hand-held electronic equipment should be cleaned with a low-level disinfectant according to the manufacturer’s instructions for use before and after being brought into the perioperative setting. The collective evidence demonstrates that cell phones, tablets, and other personal hand-held devices are highly contaminated with microorganisms, some potentially pathogenic. Reducing the numbers of microorganisms present on the devices may protect patients from the risk of HAIs resulting from the transfer of microorganisms from the devices or hands of health care workers to patients.

Resources

  • Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
  • Saxena S, Singh T, Agarwal H, Mehta G, Dutta R. Bacterial colonization of rings and cell phones carried by health-care providers: are these mobile bacterial zoos in the hospital? Trop Doct. 2011;41(2):116-118.
  • Kilic IH, Ozaslan M, Karagoz ID, Zer Y, Davutoglu V. The microbial colonisation of mobile phone used by healthcare staffs. Pak J Biol Sci. 2009;12(11):882-884.
  • Albrecht UV, von Jan U, Sedlacek L, Groos S, Suerbaum S, Vonberg RP. Standardized, app-based disinfection of iPads in a clinical and nonclinical setting: comparative analysis. J Med Internet Res. 2013;15(8):e176.
  • Al-Abdalall AH. Isolation and identification of microbes associated with mobile phones in Dammam in eastern Saudi Arabia. J Family Community Med. 2010;17(1):11-14.
  • Brady RR, Chitnis S, Stewart RW, Graham C, Yalamarthi S, Morris K. NHS connecting for health: healthcare professionals, mobile technology, and infection control. Telemed J E-Health. 2012;18(4):289-291.
  • Tekerekoglu MS, Duman Y, Serindag A, et al. Do mobile phones of patients, companions and visitors carry multidrug-resistant hospital pathogens? Am J Infect Control. 2011;39(5):379-381.
  • Sadat-Ali M, Al-Omran AK, Azam Q, et al. Bacterial flora on cell phones of health care providers in a teaching institution. Am J Infect Control. 2010;38(5):404-405.
  • Akinyemi KO, Atapu AD, Adetona OO, Coker AO. The potential role of mobile phones in the spread of bacterial infections. J Infect Dev Countries. 2009;3(8):628-632.
  • Basol R, Beckel J, Gilsdorf-Gracie J, et al. You missed a spot! Disinfecting shared mobile phones. Nurs Manage. 2013;44(7):16-18.
  • White S, Topping A, Humphreys P, Rout S, Williamson H. The cross-contamination potential of mobile telephones. J Res Nurs. 2012;17(6):582-595.
  • Ustun C, Cihangiroglu M. Health care workers’ mobile phones: a potential cause of microbial cross-contamination between hospitals and community. J Occup Environ Hyg. 2012;9(9):538-542.
  • Singh A, Purohit B. Mobile phones in hospital settings: a serious threat to infection. Occup Health Saf. 2012;81(3):42-44.

Updated November 6, 2014 


Why does AORN recommend that scrub attire be laundered in a health care accredited-laundry facility?

AORN recommends that scrub attire, cover apparel (eg, lab coats), reusable head coverings, and personal clothing not covered by the scrub attire be laundered in a health care-accredited laundry facility after each daily use and when contaminated.

The benefit of health care-accredited laundering is that it may protect the patient from exposure to pathogens remaining on the attire after home laundering and may prevent transmission of pathogens from the attire worn in the health care facility into the home or community.

Wright and colleagues reported three cases of postoperative Gordonia bronchialis sternal infections after coronary artery bypass grafting surgery. G bronchialis was isolated from the scrub attire, axilla, hands, and purse of a nurse anesthestist, and was implicated as the cause of the SSIs. Cultures taken from her roommate, who was also a nurse, showed the same microorganism. The authors concluded that the home washing machine was the likely bacterial reservoir. This report is the first to demonstrate a causal relationship between home laundering and human disease.

Home laundering is not monitored for quality, consistency or safety. Home laundering may not reliably kill all pathogens and the pathogens may survive in the form of biofilms within the washing machine. Home washing machines may not have the adjustable parameters or controls required to achieve the necessary thermal measures (eg, water temperature); mechanical measures (eg, agitation); or chemical measures (eg, capacity for additives to neutralize the alkalinity of the water, soap, or detergent) to reduce microbial levels in soiled surgical attire. Scrub attire that is home laundered may not be protected from contaminants in the environment during transport to the practice setting.

Resources

  • Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
  • Wright SN, Gerry JS, Busowski MT, et al. Gordonia bronchialis sternal wound infection in 3 patients following open heart surgery: intraoperative transmission from a healthcare worker. Infect Control & Hosp Epidemiol. 2012;33(12): 1238-1241.

Updated November 6, 2014 


What is the AORN recommendation for perioperative team members who may be allergic to the detergent being used by the health care-accredited laundry?

Health care-accredited laundering may reduce the potential for allergies to laundry detergents or other chemical additives because the rinsing process leaves little to no soap residue in the fabric. Perioperative team members with potential allergies to chemical used for laundering scrub attire should work with their facility infection preventionist to determine the source of the specific allergen and eliminate exposure.

Resource

  • Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

Updated November 13, 2014 


I wear eyeglasses during surgery. What are the AORN recommendations for cleaning them?

Reusable eye protection devices worn with surgical masks, such as goggles, or personal glasses supplemented with solid side shields, should be cleaned according to the manufacturer’s instructions for use before and after the health care worker performs or assists with each new procedure. Reducing the number of microorganisms present on eye protection devices and glasses may protect patients from SSIs resulting from the transfer of microorganisms from the devices or hands of health care workers to patients or environmental surfaces.

Resource

  • Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

Updated November 13, 2014 


Are surgical masks required during cystoscopy or myringotomy procedures?

Surgical masks in combination with eye protection devices, such as goggles, glasses with solid side shields, or chin-length face shields, must be worn whenever splashes, spray, spatter, or droplets of blood, body fluids, or other potentially infectious materials may be generated and eye, nose, or mouth contamination can be reasonably anticipated. Wearing surgical masks and face and eye protection is recommended by the Centers for Disease Control and Prevention (CDC) and is a regulatory requirement.

Surgical masks worn in the perioperative setting serve two purposes. First, they help protect the patient and environment from microbial contamination by organisms carried in the provider’s mouth or nose. Second, they provide protection for the wearer from exposure to blood, body fluids, or other potentially infectious materials. The results of an observational, descriptive, nonexperimental study conducted by White et al involving 8,500 surgical procedures showed that 26% of exposures to blood were to the heads and necks of scrubbed personnel, and 17% of blood exposures were to circulating personnel outside the sterile field. For additional information on surgical masks, refer to the AORN Guidelines for Sterile Technique and Prevention of Transmissible Infections in the Perioperative Practice Setting.

Resources

  • Occupational Safety and Health Administration. Toxic and Hazardous Substances: Blood-borne Pathogens, 29 CFR §1910.1030 (2012). Occupational Safety and Health Administration. Accessed November 10, 2014.
  • Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
  • White MC, Lynch P. Blood contact and exposures among operating room personnel: a multicenter study. Am J Infect Control. 1993;21(5):243-248.
  • Guideline for sterile technique. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
  • Guideline for prevention of transmissible infections in the perioperative practice setting. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

Updated November 13, 2014 


Is there a specific length of time after which a surgical mask should be changed?

AORN does not have any recommendations as to the specific length of time a surgical mask should be worn before it is changed. The mask should be replaced and discarded whenever it becomes wet or soiled or has been taken down.

Resources

  • Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

Updated November 6, 2014 


Are masks with ear loops acceptable for use in the perioperative setting?

Masks with ear loops may not have been designed and intended for use as surgical masks and may not provide a secure facial fit that prevents venting at the sides of the mask. The surgical mask should cover the mouth and nose and be secured in a manner that prevents venting at the sides of the mask. A mask that conforms to the perioperative team member’s face decreases the risk of the perioperative team member transmitting nasopharyngeal and respiratory microorganisms to the patient or the sterile field.

Resource

  • Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

Updated November 6, 2014 


Can patients wear their own clothes in the OR?

Necessity for clothing worn into the semirestricted and restricted areas by patients should be determined on an individual basis and be in accordance with the health care organization’s policy. If allowed, considerations should be made for required access during patient care (eg, IV access, electrosurgical unit dispersive electrode), patient injury from attire (eg, restrictive to respiratory or circulatory system, pressure injury, burn injury), soiling of garment, and traffic patterns in the semirestricted and restricted areas (ie, cover patient attire with clean linen).

Resource

  • Burlingame B. Patients wearing personal clothing into the OR. [Clinical Issues]. AORN J. 2012;95(2):288-289.

Updated November 6, 2014 

Guidelines for Perioperative Practice

Education

News & Events

Shop AORN