Reduce Risk of SSIs from Surgical Attire, Stethoscopes & Personal Items

Critical Updates to Guideline on Surgical Attire

What You Need to Know to Reduce Risk of SSIs

Infection prevention is top of mind for every periop RN. So, it’s no surprise many seek guidance on use of personal items and surgical attire in the OR setting.

To address these issues, AORN is publishing important updates in February 2024 available in AORN eGuidelines Plus (for subscribers).

Below are the important updates and clarifications every periop RN needs to know. Whether you’re an experienced periop RN or new to the OR setting, be sure to familiarize yourself with these updates. Also, be sure to share this with your team members.

Updates to the Guideline for Surgical Attire are also available as a webinar (1 CH).

Summary Updates

• Form an interdisciplinary team to determine circumstances that may require periop staff to change surgical attire when returning to the OR or procedural area after being in other areas of building or outside building for short periods of time.
• Develop and implement staff education to increase compliance with cleaning and disinfection of stethoscopes, cell phones, and personal communication devices.
• Perform frequent hand hygiene when handling communication devices throughout the workday.
• Form an interdisciplinary team to determine if lanyards will be used in perioperative setting. If so, then develop and implement a process and schedule for routine disinfection.

In-depth Look at Updates & Clarifications

Personal Clothing & Laundering

• Recommendation – No recommendation can be made for changing attire when returning to the OR or procedural area after being in other areas of the building.
  • An interdisciplinary team should determine the circumstances that require changing of surgical attire when periop staff leave the department.
  • No evidence exists regarding when personnel should change surgical attire if they go to other areas of the facility, such as the decontamination area of the sterile processing department, or facility cafeteria – or outside the facility, e.g., outdoor patio, supermarket, etc.
• Recommendation – an interdisciplinary team should develop and implement the process for managing personal clothing that can be worn under surgical attire.
  • The team should determine:
    • Types of fabric that may be worn,
    • Amount of fabric that may extend beyond the surgical attire, and
    • Laundry method and frequency.
  • This team should include perioperative nurses, surgeons, anesthesia professionals, infection preventionists, and other people as determined by the organization.
• Recommendation – scrub apparel should be laundered per the following:
  • • At a healthcare-accredited laundry facility,
    • According to the state’s regulatory requirements, or, in their absence,
    • According to the Centers for Disease Control and Prevention.
  • This laundering recommendation only refers to scrub apparel:
    • Scrub apparel is defined as a scrub top, scrub pants, or scrub dress with or without a long-sleeve scrub jacket (aka warm-up jacket) worn in the semi-restricted and/or restricted areas of the OR, or procedural areas.
    • Surgical attire is defined as scrub apparel and a head covering (disposable or reusable).
      • Head coverings: it is up to the facility to determine what types of head coverings can be worn, and if reusable head coverings are allowed.
      • If reusable header coverings are used, the facility should establish and implement a process for laundering frequency and laundering method.

Stethoscopes

• Cleaning and disinfection of stethoscopes should be encouraged by:
  • Creating a standardized process,
  • Placing supplies such as disinfectant and/or hand rub dispensers in convenient locations,
  • Providing education to staff members on the risk of cross-contamination and cleaning processes, and,
  • Posting visual reminders with cleaning instructions.
• Education with real-time feedback for cleaning and disinfection may be implemented, e.g., verification testing with adenosine triphosphate, culturing before and after disinfection.
  • Real-time feedback has been shown to increase buy-in and compliance with cleaning and disinfection of stethoscopes.

Badges, Access Cards & Personal Items

• Access Cards are now included with badges in the recommendations to clean and disinfect these items when they are soiled with blood or other body fluids, or other potentially infectious materials and to implement a routine disinfection schedule.
• Recommendation: An interdisciplinary team should decide if lanyards can be used in the perioperative environment.
  • If allowed, establish a process for routine disinfection (e.g., daily, weekly)
• Recommendation: Cell phones, tablets, and other personal or handheld electronic devices have been shown to possibly be highly contaminated with microorganisms, some of which are pathogenic.
  • Clean and disinfect these items before bringing them into the OR now also indicates that hand hygiene should be performed frequently when handling these items throughout the day.
• Recommendation: Cleaning and disinfection of badges, access cards, and personal electronic devices should be encouraged via the same methods as for stethoscopes; education with real-time feedback for cleaning and disinfection also may be implemented.
• Recommendation: an interdisciplinary team can assess technologies for cleaning badges, access cards, lanyards, and personal electronic devices.
  • Technology may include ultraviolet (UV) wavelength, specifically UVC, and a portable electric steam sterilizer with a dryer.
    • Four new high-quality studies showed a significant decrease in the number of organisms on phones when UVC devices were consistently used, but none of them were conducted in the OR.
    • More studies are needed on their use in the perioperative environment and to determine the most effective delivery system and nanometer frequency.
    • Only one study is available on electric steam sterilizer with dryer. Use of this technology reduced 30 pathogenic bacteria from a lanyard, quickly, and produced a dry lanyard for immediate use.

Watch & Learn

Webinar – Surgical Attire: Guideline Update 2025

The guideline update features expansion of criteria for scrub apparel selection, new evidence of microorganism growth on cell phones, stethoscopes, and lanyards, and actions to promote adherence to cleaning and disinfection of identification badges, stethoscopes, and personal items.

» View the new webinar (1.0 CH)

View Guideline Details

This updated guideline is available in AORN eGuidelines Plus (available to subscribers). 

» Members log in for Guideline Essentials for Key Takeaways, implementation tools, and more.

eGuidelines Plus is an online library of clinical resources for your facility. It provides your team and multiple service lines at your facility with digital access to evidence-based guidelines, customizable implementation tools, and time-saving clinical resources.