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Enforce Your OR's Dress Code
Charlene DiNobile, Lisa Reed
Publish Date: June 10, 2008   |  Tags:   Ideas That Work

Next chance you get, take the "Surgical Attire Audit Tool" on the next page into your ORs and note what your staff is wearing. Chances are, you'll see unconfined hair and jewelry, Croc-like footwear with holes or open backs and dangling surgical masks — as well as other infractions of your surgical attire policy.

A New Column Focused on Monitoring Your OR Team's Practices

When it comes to meeting all of the changing guidelines and regulations governing your OR, it's not enough to simply develop policies and procedures that look good on paper. Written policies are useless unless they're enforced. Every surgical facility needs someone to monitor practices, and in many cases, that person will be you. In the interest of getting back to basics, this new column is going to show you how to follow these three simple guidelines:

  • Develop audit tools. One glance around the room isn't going to tell you if everyone's following policy. Create a systematic method of observing practices and documenting your findings.
  • Get to the root of the problem. You may find just a few outliers failing to comply, or you may find systemic problems that require changes to existing policies and better educational efforts.
  • Nip it in the bud. The goal of regular monitoring is to stop problems before they escalate. Once you've identified the source of the problem, take the appropriate steps to bring accountability and enhance compliance.

— Lisa Reed, CST, RN, MS, CNOR, and Charlene DiNobile, RN, MEd, CNOR, CNAA, CST

These infractions may seem minor, but the last thing you need is a surgical team that appears careless and unconcerned about infection control. What's more, team members who fail to wear the appropriate attire pose a real risk to patients. It's easy to forget that Staphylococcus aureus, in particular, thrives in hair and in the nares. Just as we don gloves, scrubs and masks to protect ourselves from patient blood and body fluids, we must also take steps to protect patients from our own shedding.

The best way to ensure your staff is following policies is to conduct regular checks. The "Surgical Attire Audit Tool," which you can modify to your liking, can get you started. Here's how it works:

  • Make a plan. Inform your staff that you'll be inspecting their surgical attire and explain why, but conduct random, unannounced audits. Determine a compliance benchmark that you'd like your facility to attain. The audit should be done until you've achieved your benchmark. For auditing surgical attire, we recommend 100-percent compliance. Once you've attained your benchmark, perform an annual surgical attire audit.
  • Appoint an auditor. You may be the best person to take on this responsibility, but if you decide to delegate the task, choose someone who'll be able to observe the team and collect data in a professional, unbiased manner. The auditor could be an educator, manager, staff member or an outside consultant.
  • Communicate your findings. Once the audit tool has been filled out, review the data, share the results with any team members found to be noncompliant, and solicit feedback on why they didn't adhere to policy. If you find a consistent deviation from policy, counsel those who are failing to comply and conduct a follow-up audit. Share an overview of the results with the entire staff, including what the benchmarks were, without mentioning any individuals.

An easy fix
The OR is not a fashion show — what your surgical team is wearing should be the least of your concerns. But in reality, OR staff present a significant risk to patients if they fail to comply with the rules governing attire. Luckily, mandating and monitoring practices in this area is relatively simple once you've equipped yourself with the proper tools.

Surgical Attire Audit Tool


Yes / No / N/A


All Surgical Team Members


Surgical scrubs are clean and in good repair.


All hair, including facial hair, is confined.


All jewelry is confined.


Mask covers both the nose and mouth and is secured.


Solid, fluid-resistant footwear with no holes is worn. Toes and heels must be enclosed.


Shoe covers worn when splashes or spills are anticipated.


Other protective equipment if applicable (laser eyewear, lead aprons, etc.)

Non-sterile Team Members


Long-sleeved jackets are worn and buttoned or snapped closed.


Fingernails are short, clean and healthy. No artificial nails are worn.


Eye protection is worn if splashing or spraying is likely.


Gloves are worn if handling contaminated items.

Sterile Team Members


Eye protection is worn.


Sterile surgical gown is completely closed.


Sterile surgical gloves are worn and completely cover the knitted cuff of the gown.