Why Having a Strict Surgical Attire Policy Doesn’t Matter
The debate around surgical attire in the OR continues to swirl round and round. While some consensus has occurred between groups like AORN and ACS, I can’t help but feel like the groups have just ‘agreed to disagree’. Surgeons I have worked with across the country see no reason to change what has worked for them and nurses argue that the hot dog guy at Costco does a better job at covering his hair than most surgeons in the OR. I think we all agree that no one wants a hair in their hot dog or surgical wound, so why so much arguing?
Having been a nurse outside of the OR for the first part of my clinical career, I find the culture inside the OR fascinating- especially how there are generally accepted double standards related to attire and what I’ll call surgical environment hygiene. For example, some surgeons will come completely unglued when asked to cover their hair and beards for some cases, yet will insist on full spacesuits for other cases. Why the difference?
Part of the problem is that we as healthcare professionals cannot agree to an evidenced-based standard and to date there are only a handful of a few conflicting studies that have looked at the relationship of implementing a strict policy on surgical attire and surgical site infections. I would argue that the studies I have found to date made a serious error in their presumptions- that the strict policy was actually followed. In my recent experience, merely having a strict surgical attire policy was not enough- we need to focus on the compliance to the strict policy. In one hospital I recently encountered, once the focus shifted to compliance, the results were compelling and just as you would expect- as compliance went up, the SSI rate went down… significantly.
Could this be true? Does it matter if you cover up and prevent hair, skin and bacteria from contaminating your environment? Of course it matters and the results of their work should surprise no one and illustrates the fact that common sense dictates a better result if you actually follow the basic rules created to prevent issues like a hair in your hot dog.
To date, their SSI rate has continued to drop as they approached and surpassed compliance to their strict policy through daily audits for more than 90 days and counting. It has been a monumental effort by the team to remain focused and committed to ensuring a safer environment for their patients.
This work has not gone unnoticed. Their quality manager was asked to present their work nationally at IHI- stay tuned as they continue to study and verify the results for possible publication. Seriously though, if Costco thinks its important to not contaminate your hot dog, we should just end the debate and cover up to protect our patients.
Opinions are my own
1 年Just came across this - by any chance did the hospital mentioned above publish their compliance focus efforts? If yes would you mind sharing where this information can be found?
General Surgeon at Palmetto and Memorial Miramar Hospitals
6 年I agree with strict cover policy and strict aseptic technique. I don't agree that the greens in a pile in the hospital transported and kept as they are have a better result than the clean scrubs from my home.(show me data) It seems important not to mix institutions or clean with contaminated cases in immediate the same rooms. Changing clothing and overall environment from contaminated cases to clean cases is a policy that I see? broken in most OR. . I followed the SSI in my institution and some times we have a hard time identifying the source or the error in a scientific fashion and come with an effective policy to lower the SSI rate. We are willing to take on any effective measure administration and medical staff want the success on this issue. Efforts on the simple believes of personal conclusions are not the answer. I see lots of papers written with no? real statistical evaluation that add to the relaxation of measures by discrediting what we really know. Strict surgical attire needs a definition and proven scientific results. Then we will see the run for a change.
CEO/CTO of Infinitus Medical Technologies - A #Veteran Owned Medical Device Company
6 年And now this!! https://www.aorn.org/about-aorn/aorn-newsroom/periop-today-newsletter/2018/2018-articles/4-attire-changes?utm_source=Email&utm_medium=Newsletter&utm_content=10_24_18&utm_campaign=Periop_Today
Account Executive at Ethicon, Inc.
6 年Most facilities are VERY strict on “vendors” but not so much on surgeons and staff. So, I agree! Let’s strictly enforce the policies in place, for our patients sake!!!
Chief Nurse Executive
6 年Strict adherence DOES make a difference! And compliance is crucial!