4 Attire Changes on the Horizon

Surgical attire is critical to get right … to protect patients and staff.

“With the release of several new published studies regarding attire, we felt this new evidence was significant enough to consider practice changes,” says Lisa Spruce, DNP, RN, CNS-CP, CNOR, ACNS, ACNP, FAAN, AORN director of evidence-based practice and lead author of AORN’s forthcoming update to the guideline on surgical attire. The current guideline on attire was published in 2015.

The updated guideline goes up for public comment in January 2019 and Spruce encourages all members to mark their calendar and be ready to share their feedback.

In the meantime, she shares four important updates she hopes perioperative teams will start thinking about.

1. When to safely wear long sleeves—based on a new study authored by Markel et al 2018 that found wearing long sleeves when prepping a patient reduced airborne contamination and a lack of evidence on the benefits of wearing long sleeves in the OR during other activities, AORN is anticipating a change to recommend that arms only be covered when performing patient skin antisepsis.


2. How to wear personal clothing under scrubs—with a lack of evidence on the harms of wearing personal clothing under scrub attire, AORN is considering a change to leave it up to an individual facility’s interdisciplinary team to direct perioperative team members on what types of clothing may be worn under scrubs and how it will be laundered.


3. Considering risk with different head and facial hair covering—based on input from three new studies, including a study by Markel et al 2017 that evaluated different OR headgear assessed by environmental quality indicators, AORN is anticipating the addition of a recommendation to enable individual facilities to determine which type of head coverings health care professionals may use to cover their head and facial hair during perioperative care, and that personnel consider the patient’s risk of surgical site infection (SSI) when selecting a head covering.


4. Addressing ear covering—while there is a lack of evidence to demonstrate whether or not covering the ears reduces SSI, there was a study by Katsuse et al 2018 that found that pierced earlobes could pose a transmission risk when health care personnel touch their ears. Touching the ear and then the patient care environment could lead to cross contamination and a risk for health care-associated infections. AORN is anticipating a recommendation that interdisciplinary teams establish practices for ear covering and safe earring wear in the perioperative setting.

Spruce says changes are also being considered in several other recommendations affecting scrub attire, such as types of fabrics, changing attire, wearing dresses or leggings, and storing scrubs in lockers. These proposed changes are primarily a shift to deferring to individual facility interdisciplinary teams to decide on attire guidance for themselves given a lack of evidence.

“It may be hard to let go of some of these traditional practices but understanding evidence-based practice and how evidence-based guidelines are created is important in understanding why AORN is changing some of our recommendations and eliminating others,” Spruce explains.

She stresses it’s important perioperative teams consisting of all disciplines discuss the evidence and make decisions and policy at their own facility based on types of surgeries they do and patient population in examining patient risk of developing a SSI.

To help teams understand this evidence and apply it to practice, AORN will also be releasing a number of resources to help interdisciplinary teams make these important attire decisions. These resources will include audit tools, case studies, checklists, gap analysis tools, implementation road maps, power point education presentations, webinars, key takeaways, and sample policy and procedures will be released in conjunction with the updated guidance on surgical attire through AORN’s Facility Reference Center and the members-only Guideline Essentials.