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Science Prevails-Operating Room Attire

Guest post from Marshal D. Peris, MD, FAAOS (left)
President of the Westchester County Medical Society, Northern Westchester Hospital
Director of Spine Surgery, Mount Sinai Health System at CareMount Medical
Mount Kisco, NY
Deborah L. Benzil, MD, FACS, FAANS (right)
Chair, AANS/CNS Communications and Public Relations Committee
Vice Chair, Neurosurgery
Cleveland Clinic Foundation
Cleveland, OH

Excellent patient outcomes and limiting complications using medical expertise, experience and scientifically based rules is our goal. This rigorous approach seemed tossed to the wind as across our health care system mergers and acquisitions led to the promulgation of many regulations with little or no science as their foundation. There was an enormous impact on operating rooms (OR) everywhere. Thus, the recent position statement by the American College of Surgeons (ACS) in conjunction with many other national societies was a breath of fresh air! Finally, reason seems to have prevailed. It is only a shame that so much time and money was spent on efforts refuting a policy that should never have been implemented. Wouldn’t it have been better if the guidelines were written after the scientific studies were done? Wouldn’t it be better if our OR staff and nurses spent their time improving patient care and outcomes instead of policing this flawed policy?

The take-home message from the ACS is:

Over the past two years, as recommendations were implemented, it became increasingly apparent that in practice, covering the ears is not practical for surgeons and anesthesiologists and in many cases counterproductive to their ability to perform optimally in the OR.  Furthermore, in reassessing the strength of the evidence for this narrowly defined recommendation, the group concluded the following:

  • Evidence-based recommendations on surgical attire developed for perioperative policies and procedures are best created collaboratively, with a multi-disciplinary team representing surgery, anesthesia, nursing, and infection prevention.
  • The requirement for ear coverage is not supported by sufficient evidence.
  • At present, available scientific evidence does not demonstrate any association between the type of hat or extent of hair coverage and SSI rates. One recent study* on head coverings (disposable bouffant or skullcap, cloth cap), identified that the commonly available disposable bouffant hat is the least effective barrier to transmission of particles.
  • Other issues regarding areas of surgical attire need further evaluation.

Thanks to the following organizations for their involvement and rational approach:

Now that this group has conquered the demons related to OR attire, it is time for the same studied approach to the room temperature requirements. Certainly, common sense in this arena will prevail.

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