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Readers in a Flap Over Surgeons in Skullcaps
Re: "Don't Flip Your Lid Over Surgeons in Skullcaps" (September, page 4). I personally hate the bouffant hats, but am willing to listen to evidence-based medicine — but let's see it. Can you identify any literature that demonstrates that the average male surgeon, with no facial hair, short sideburns and reasonably cut hair, has a higher infection rate because he's wearing a skullcap? Someone's opinion about what might be true should not be the basis for new standards. That is not the scientific way. Surgeons must operate for up to 8 to 12 hours in some cases. Temperature and comfort are significant factors that let them do so. At our ASC, where 5 male plastic surgeons who wear skullcaps perform more than 3,800 operations a year, our infection rate is less than 0.5%.
Some of our surgeons and many of our anesthesiologists love their skullcaps, but I banned the headwear after the Centers for Medicare & Medicaid Services and The Joint Commission cited us over it during our 2016 survey. Yes, there are still some who don't like our policy, but they abide by it. After you've been in health care for a while, you find that things are constantly changing. We're going to focus on providing the safest patient care possible and not sweat the small stuff.
It's not nursing staff that dictate what kind of headwear is allowed in the OR, it is AORN, The Joint Commission or whichever governing body's guidelines you adopted into policy. Policy is the law in any healthcare organization. Because facility administrators are generally not in the OR, it falls to the nurse to enforce the policies. About 95% of doctors, nurses and staff comply with the skullcap rule without any problems, as we generally have more relevant issues to deal with. There is plenty of evidence for and against skullcaps, but it does not matter, if your policy doesn't allow them. We all have to follow the rules.
This discussion seems "silly" indeed. Imagine a grown man, a surgeon, needing a special hat to show he's in charge.
Your editorial was offensive and patronizing to the nursing profession. The title alone suggests that the AORN standards are wrong and that the reader shouldn't be concerned about the practice of wearing skullcaps. Articles like yours perpetuate the divide between nurses and physicians. I appreciate that you at least included AORN's position on this issue, but it's clear that you support Dr. Hollander's belief that the AORN standard requiring hair to be covered is "silly."
Nurses are often responsible for infection prevention efforts in hospitals, but it can be like fighting an uphill battle when physicians resist our feedback and ridicule our suggestions. Healthcare improvement and improved safety are maximized when the healthcare team works together with mutual respect. Who is responsible for patients? The entire healthcare team — not just surgeons, as Dr. Hollander claims. ?
The AORN and American College of Surgeon guidelines are just that, guidelines. Look to CMS and The Joint Commission for the rules that we will all be held responsible to follow. Those governmental bodies will promulgate the rules based on research and investigation, not because some believe it is a badge of identification or because you can support your favorite team or cause. Rather, surgical attire is, as it should be, decided on the issues affecting our patients and their well being. Infectious disease is a tremendous antagonist to patient outcomes and drives hospital costs up, while reducing revenue. Seems that some folks have lost sight of the real reason we are all supposed to be in the healthcare business. So it's not the "lowly nurses" from the AORN telling the awesome "DOKTOR" what to wear, it's your government, and largest healthcare payer.
Clarifying 30-Day H&P Concept
- "No Need to Rewrite Unchanged H&Ps" (August, page 15) contains some language that, if not factually incorrect, could easily be misinterpreted. Consider the following when determining whether your facility complies with H&P (History & Physical) requirements.
- The 30-day window for validity, while perhaps arbitrary, does not permit extension beyond that timeframe.
- During the 30 days after an H&P is performed, your facility's policy may let a practitioner update the original document. This might be accomplished with a notation asserting that a reassessment has been conducted, and that all previous findings and information are unchanged.
- In all circumstances, adherence to and compliance with stricter state laws and regulations takes precedence, and must be incorporated into your facility's policies and procedures.
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