Previous recommendations for surgeons to fully cover their hair and ears to prevent infections have probably been observed more in the breach than the observance. Now medical associations have issued a collective statement that says, essentially, there is insufficient evidence to continue to contest the issue, which was a non-starter for many surgeons.

“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,” read a joint statement by APIC, the American College of Surgeons, the Association of periOperative Registered Nurses, The Joint Commission, and other groups. “The requirement for ear coverage is not supported by sufficient evidence.”

The concern is that uncovered hair and ear particles may contaminate the sterile field during a procedure and lead to a surgical site infection. In reassessing the rationale for this “narrowly defined” recommendation, the groups concluded that “evidence-based recommendations on surgical attire developed for perioperative policies and procedures are best created collaboratively, with a multidisciplinary team representing surgery, anesthesia, nursing, and infection prevention.”

The joint statement did cite one recent study that found that “disposable bouffant caps” provide the least effective barrier to transmission of particles into the surgical field. The study’s authors concluded that, when compared with disposable and cloth skull caps, “disposable bouffants had greater particulate contamination and microbial shed.”¹

REFERENCE

1. Markel TA, Gormley T, Greeley D, et al. Hats Off: A Study of Different Operating Room Headgear Assessed by Environmental Quality Indicators. J Am Coll Surg 2017;225(5):573-581.