Tuesday, March 16, 2010

The well-dressed surgeon

AORN, the Association of periOperative Registered Nurses, has developed new draft guidelines on surgical attire available for public comment. The document can be viewed here.

Some highlights:
  • Fresh scrubs are to be donned on entry or re-entry to the OR
  • Hands should be washed prior to donning scrubs
  • Surgical scrubs should not be laundered at home (believe it or not, some hospitals do not currently provide laundered scrubs to OR personnel as a cost-savings measure)
  • All undergarments must be covered by the scrubs (e.g., no crew neck t-shirt or turtleneck with v-neck scrubs)
  • Shoes with holes on the tops or sides (i.e., traditional Crocs) are not permitted

2 comments:

  1. One recommendation I'm not completely sure of is this one: "III.b.3 ...When extensive contamination of the (healthcare worker's) body occurs, a shower or bath should be taken before donning fresh attire." They then reference an OSHA document.

    I was always under the impression that surgeons should not shower immediately before surgery as this increases shedding of skin colonizers. Of course they should wash, but should they be asked to wait before operating? See:
    1. Speers R, Bernard H, O’Grady F, Shooter RA. Increased dispersal of
    skin bacteria into the air after shower-baths. Lancet 1965;1:478-83.
    2. Hall GS, Mackintosh CA, Hoffman PN. The dispersal of bacteria and skin scales from the body after showering and after application of a skin lotion. J Hyg (Camb) 1986;97:289-98.
    3. Ulrich JA. Dynamics of bacterial skin populations. In: Maibach HI, Hildick-Smith G, editors. Skin bacteria and their role in infection. New York: McGraw-Hill; 1965. p. 219-34.

    Thanks to Elaine Larson for the references from her Decennial (2000) talk. see: www.cdc.gov/ncidod/EID/vol7no2/pdfs/v7n2.pdf

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  2. In the case of a surgeon covered in blood in the middle of a case, it probably wouldn't be practical to have him/her wait several hours after showering to return to the OR. So I guess they are trying to make the best of a bad situation. Have to admit, I'm not sure I'm interpreting this standard correctly, so maybe they need to re-write this one for better clarity.

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