AORN addresses concerns about surgical attire

To help our readers, Same-Day Surgery newsletter will print the top 10 issues that receive the most questions at the Center for Nursing Practice, Research, and Health Policy at the Association of Operating Room Nurses (AORN) in Denver. The first issue focuses on attire:

The AORN Recommended Practices for Surgical Attire was revised in August 1994. Several of the individual recommended practices have been updated, based on the results of studies found in the literature. The recommended practices, with significant changes, are reviewed here.

Recommended Practice I states: "All persons who enter the semirestricted and restricted areas of the surgical suite should wear surgical attire intended for use within the surgical suite."1 Hospital laundering of scrubs is still recommended. The use of cover apparel should be determined by the practice setting. The value of cover apparel is unknown, as its use has not been proven to affect the rate of surgical wound infection. The decision on cover gowns depends on the culture in each perioperative suite, the manager’s assessment of priorities, and individual state regulatory rulings.

Recommended Practice III states: "All persons entering the restricted areas of the surgical suites should wear a mask when there are open sterile items and equipment present."2 Differ-ences of opinion exist in the literature regarding the wearing of masks by non-scrubbed personnel and the risk of infection. Individual practice settings should develop their policies based upon recommendations from the Occupational Safety and Health Administration and state-mandated recommendations for the wearing of masks.

Recommended Practice V states: "Fingernails must be kept short, clean, and healthy."3 The traditional recommendation against nail polish has had little supporting research, and recent studies found no increase in microbial growth related to the wearing of freshly applied nail polish.

No artificial nails

Available data suggest that nail polish that is obviously chipped or worn longer than four days has a tendency to harbor greater numbers of bacteria. Artificial nails should not be worn within the semirestricted and restricted areas of the practice setting, as they may harbor organisms and prevent effective hand washing. Studies have found that fungal growth occurs frequently under artificial nails as a result of moisture becoming trapped between the natural and artificial nails. (Editor’s note: In an upcoming issue of Same-Day Surgery, we will reprint more of AORN’s advice on nails.)

Recommended Practice VII states: "Policies and procedures for surgical attire should be developed, reviewed annually, revised as necessary, and available within the practice setting. These policies and procedures should include, but not be limited to, definition of areas where surgical attire must be worn, appropriate attire within those defined areas, and the choice for the use of cover apparel outside the surgical suite."4

The 1996 AORN Recommended Practices for Surgical Attire includes a glossary of terms and a list of reference articles.


1. Association of Operating Room Nurses. AORN Standards and Recommended Practices. Denver; 1996.

2. Ibid, 142.

3. Ibid, 143.

4. Ibid, 144.