AORN Guideline for Surgical Attire

Publish Date: May 30, 2017


There is a common belief that AORN has urged the elimination of surgeon’s skull caps and mandated the use of bouffant caps. This misrepresentation continues to be perpetuated in recently published studies, expert opinion pieces, and media reports. Thus, AORN wishes to correct this misinformation. The AORN guideline makes no reference to “skull caps,” and there is no recommendation that bouffant caps should be worn. The AORN guideline simply recommends, “A clean surgical head cover or hood that confines all hair and completely covers the ears, scalp skin, sideburns, and nape of the neck should be worn.” This recommendation is supported by a number of studies showing that hair can be a source of bacterial organisms and potential surgical site infection.

Many organizations are struggling with compliance issues related to perioperative team members who choose to wear head coverings that do not completely cover their hair. As a result, some health care organizations have chosen to remove skull caps from the facility to improve compliance. Undeniably, there are issues with skull caps not fully covering hair, just as there are issues with the comfort of bouffant caps and allowing hair to fall outside of the cap. However, there are skull caps currently available on the market, that when worn correctly, can cover and contain the wearer’s hair, as recommended.

The foremost concern for all perioperative professionals should be for patient safety and for providing the cleanest surgical environment possible for all patients undergoing operative and other invasive procedures. Covering and containing hair is a reasonable and prudent measure that provides no harm, but may benefit the patient through a reduced risk of exposure to potentially pathogenic organisms that live on the hair, skin, ears, and facial hair of perioperative team members.