The InstaPoll question we posted last month on our website about surgical skin preps was more pop quiz than opinion poll: Should you wear a long-sleeved jacket when prepping patients' skin?

As Mike Pankey, RN, MBA, administrator of the ASC of Spartanburg (S.C.), was quick to point out, "This is not an opinion poll. There is a correct answer. You wear a jacket!"

Indeed, you should wear a long-sleeved warm-up jacket when applying skin preps. And be sure that it's snapped all the way up, too. That's been a part of AORN's "Recommended Practices for Surgical Attire" since 1984, so you'd think it'd be an ingrained part of OR practice.

But nearly half (45%) of the 576 surgical facility leaders who answered our InstaPoll favor bare-armed prepping over a long-sleeved jacket. They feel the loose-fitting material can potentially drag across the patient's skin and contaminate the surgical site.

The 2 AORN perioperative nursing specialists who authored "Can You Pass This Prepping Quiz?" would caution them that skin squames from their bare arms may drop onto the area that is being prepped and may increase the patient's risk for a surgical site infection.

Who's right? Who's wrong? Who knows? And who cares? We didn't ask the question to gauge our readers' prepping preference. We wanted to find out if they knew recommended from wrong. Many, it turns out, don't. Or maybe they do, but they don't think that cloth sleeves are safer than bare skin when it comes to prepping.

It's hard to condemn so many for going against the grain in the sleeves vs. skin debate, especially when patient harm appears to be a non-issue. We can also see why you don't force your nurses to wear a warm-up jacket when prepping. The jackets may be too hot and uncomfortable. Plus, it's one less thing to launder.

This sharp split in opinion points out that not all OR practices are black and white. A recommended practice carries with it AORN's seal of approval. Each document consists of recommendations based on the highest level of evidence available. But what if you were taught differently — both in nursing school and on the job. What if you've been bare-arm prepping for 20 years without incident? Like prepping, maybe it's okay to color outside the lines just a little in surgical practice, to trust your mentors, your education and your experience. Even AORN allows for a little leeway. "Although the recommended practices are considered to represent the optimal level of practice, variations in practice settings and clinical situations may limit the degree to which each recommendation can be implemented."

As a follow-up to the prepping InstaPoll, we asked How often do you follow AORN recommended practices? At deadline, 40% of our 365 respondents say they follow AORN recommendations all of the time and 52% who don't believe everything they read adhere to them most of the time. You can lead an OR nurse to water, but you can't make her drink.