6 Best Practices for Wearing and Handling Surgical Attire



This is the fourth article in a series of five articles focused on the most pressing issues in patient safety and infection control, published during International Infection Control Week. The series is sponsored by X-STATIC
®. Access the first article on hand hygiene here. Access the second article on safe injection practices here. Access the third article on OR collaboration here. Access the fourth article on soft surface fabrics here.

Proper treatment of surgical attire is essential to prevent infection from spreading in the hospital setting. Here Linda Spruce, RN, DNP, ACNS, ACNP, ANP, CNOR, director of evidence-based perioperative practice for AORN, discusses six best practices for handling surgical attire.

1. Clothes should be made of tightly-woven fabric.
Fabric for surgical attire should always be made from a tightly-woven fabric with a low-linting capability, Dr. Spruce says. "That's usually going to be a cotton polyester blend or 100 percent polyester," she says.

She says it's important that the fabric is low-linting to make sure it doesn't shed into the OR environment. She says surgical attire should also have long sleeves to cover providers' arms completely.

2. Cover hair and wear no jewelry. Providers should be reminded to cover their hair and wear no jewelry in the OR. "Sometimes providers aren't covering all their hair completely — and this means all the hair, including the nape of the neck and the beard," she says.

3. Use a dedicated pair of OR shoes. Dr. Spruce says OR shoes should meet OSHA requirements to protect the healthcare worker from hazards in the OR, meaning they completely cover the foot and the heel and are made from a material that prevents puncture.

She adds that shoes should not be taken outside the OR setting. Wearing a dedicated pair of OR shoes primarily contributes to a safe and clean environment for patients, as well as protecting the worker's personal environment. "That will contribute to the overall safe and clean environment of the healthcare worker's home," she says. If the OR shoes stay in the OR, the worker does not bring hazards in from outside or transport material from the operating room to their living space.

4. Do not take clothing outside the hospital.
Studies have proven that microorganisms, such as bacteria, viruses and fungi, can live on materials for months. "Because of that, we recommend that staff don't take the attire outside the restricted area of the hospital to their homes," she says. "We want the healthcare workers to take the scrubs off and have them laundered at the healthcare facility."

The healthcare industry regulates the temperature of washing and drying, which the worker may not be able to comply with in their home. Dr. Spruce adds that staff should never go outside in surgical attire, even if it's just to walk from building to building. "Then you contaminate them with dust and debris, and you're going to have to change your scrubs again if you come back in," she says.

5. Do not bring additional, non-sterile items into restricted areas. Dr. Spruce says she sometimes encounters healthcare providers who bring backpacks and briefcases into semi-restricted areas of the hospital. She recommends prohibiting personnel from bringing items from home into restricted areas, as they could carry bacteria that would lead to infection.

6. Give OR personnel permission to speak up. No patient safety initiative can be carried out effectively without encouraging teamwork in the operating room, Dr. Spruce says.

"Every single person that works in the operating room or the perioperative area has to have the courage to step up on the issue of proper attire," she says. "Everyone should be empowered, because we're all accountable for protecting the patient."

This means educating physicians and other OR providers about the hospital's policy on pointing out potential safety issues. The hospital should publicize a campaign that tells nurses and techs to stop physicians when they feel an action is unsafe, and vice versa.

Learn more about AORN.

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