4 Evidence-Based Answers to Common Surgical Attire Questions

Can you wear a skirt in the OR? What if your scrubs give you a rash—or you have to wash them at home? These are just a few of the real-life questions nurses bring to the AORN Nurse Consult Line.

Lately, surgical attire has become a hot topic again among perioperative professionals, says AORN’s Senior Director of Evidence-Based Perioperative Practice Lisa Spruce, DNP, RN, CNOR, CNS-CP, EBP-C, APRN, FAAN.

Why the renewed attention? Two reasons: The evidence around best practices is evolving—and there’s a noticeable gap in awareness and agreement, which can lead to confusion and inconsistency across teams.

Evidence-Based Attire Practices Matter

Surgical attire may seem like a routine part of perioperative care—but it plays a critical role in infection prevention and patient safety, says Dr. Spruce.

“These are essential components of maintaining a clean and hygienic perioperative environment that help protect both patients and healthcare personnel by minimizing the risk of contamination,” she explains. “By limiting the release of microorganisms from the skin and hair of perioperative team members, these measures contribute to reducing the patient’s risk of developing a surgical site infection.”

Being familiar with the evidence behind attire practices—from laundering to head and arm coverings—not only helps reinforce current standards, it also empowers nurses to educate others and guide conversations that might otherwise rely on opinion or outdated habits. Dr. Spruce adds that this knowledge also supports compliance with institutional and regulatory policies.

Top Attire Questions Answered

To keep up with the latest evidence on what to wear in perioperative care, she suggests getting familiar with the guideline for Surgical Attire, as well as important attire-specific recommendations in the guideline addressing Transmission-Based Precautions.

She demonstrates how a quick search through these guidelines provides answers to the following top four questions that nurses ask:

Question: Why do bald people have to wear head coverings?

Answer: The epidermis (outer skin layer) renews itself approximately every 28 to 40 days, meaning skin cells are constantly being shed and replaced. The wearing of a head covering is intended to contain hair, skin, and microorganisms that can be shed by perioperative team members, which can prevent contamination of the sterile field. Reducing the risk of contamination of the sterile field is an important consideration for reducing the patient’s risk for SSI.

From recommendation 5.1 in Surgical Attire guideline.

Question: Do scrub jackets need to be worn during the preop patient skin antisepsis?

Answer: Arms may be covered during performance of preoperative patient skin antisepsis. Although the benefits of wearing long sleeves during performance of preoperative patient skin antisepsis are likely to exceed the harms, further research is needed to confirm the risk-benefit assessment and the effect on surgical site infection rates.

From recommendation 3.1 in Surgical Attire guideline.

Question: Can you wear a skirt in the OR?

Answer: There is no recommendation on skirts because there is a gap in the research related to this topic. But AORN recommends that the interdisciplinary team determine policies and procedures related to scrub skirts, including which areas they may be worn in and whether leggings are required. The policy should also address whether the facility provides and launders the skirts. And leaders should keep in mind cultural and religious practices related to alternative surgical attire and make reasonable accommodations to support an inclusive environment.

From general information in Surgical Attire guideline.

Question: What is the order of putting on and taking off PPE in sterile processing?

Answer: With gloved hands, grasp the front of the gown below the neckline.

1. Pull the gown away from the body so that the attachments break.
2. While removing the gown, roll the gown inside out into a bundle, touching only the outside of the gown with gloved hands.
3. Peel off the gloves as the gown is being removed, touching only the inside of the gloves and gown with bare hands.
4. Discard the gown and gloves into a waste container or soiled linen bin and perform hand hygiene.

From recommendation 2.5.6 in Transmission-Based Precautions guideline

Access AORN Guidelines at aornguidelines.org.