The skullcap feud (Part 2)

Several months ago I posted on the feud between the surgical community and the Association of periOperative Registered Nurses (AORN). This turned out to be a wildly popular post that generated a great deal of discussion on our blog and other websites. You'll recall that AORN outlawed the surgeon's skullcap in its latest guideline on surgical attire. This caused an uproar among surgeons who noted that there was no substantial evidence on which to make this rule.

In a new paper in Neurosurgery, a surgical group at University of Buffalo took matters into their own hands and decided to generate some evidence after their own hospital banned the skullcap and mandated that all OR personnel don bouffant caps. They compared surgical site infection rates for Class I (clean) procedures 13-months before and after the skullcaps were outlawed. During the study period, approximately 16,000 surgical procedures were performed. There was no difference in SSI rates between the two time periods.

So, my hat's off (no pun intended) to the authors. The score now is Surgeons 1, AORN 0. And I suspect that more studies are on the way.


  1. This is very disappointing at best. Quasi? quasi...........
    combining form
    seemingly; apparently but not really.
    synonyms: supposedly, seemingly, apparently, allegedly, ostensibly, on the face of it, on the surface, to all intents and purposes, outwardly, superficially, purportedly, nominally; pseudo-
    "quasi-scientific theories"
    AORN has a purpose. It is to provide guidelines and standards to enable healthcare professionals give trusting patients the BEST care possible under existing circumstances. We in the industry simply call this Best Practice. AORN collects information gathered from numerous double and triple blind studies every year. If the evidence indicates a necessary change in practice, the guidelines are changed.
    No, it's not perfect. Non sterile Operating Room lights hover over a sterile field, so do a surgeons eyebrows. But these examples cannot realistically be helped. We can, however, at least TRY to give the best care available to us at a given moment. Our practice should NOT be based on satisfying anyone's ego. I can just imagine th outrage and disgust you would display if, at your favorite restaurant, you were told by the owner that they had been doing a little quasi-experiment over the last year. THEY had told all of their employees, especially those handling food, to never wash their hands while at work ( Hey, just a way to speed things up ). The owners assure you that no one has gotten sick.......YET! Be honest, would you go back? Hell No!
    And tell us, did your patients know what you were up to. Maybe you told them. Maybe you let them know up front that you really wanted to wear your lucky hat from your college alma mater. Wow, of all the things to be focused on during surgery. Why is there, in today's surgical world, such a want to do LESS THAN instead of more than. Don't worry about doing a proper prep, don't apply the Avagard correctly, don't wear approved surgical attire. Instead, wear as much dirty jewelry as you want, drink coffee during the operation, utilize the 5second rule.......nobody's lookin right. Well, I've been a surgical nurse for almost 30 years and I'm still watching. And I will be until my last day in the OR. Our patients deserve it.

  2. The difference between your example with restaurant and surgical caps is one has numerous studies proving the benefits of handwashing in controlling infection spread, the other has none. Just assumptions and good intentions based on "we believe", "we strive". Assumptions that only AORN, nobody else, want the best care for their patients. Beliefs, not evidence, that bouffant provides better protection than cap.


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