Recommended practices for surgical attire

AORN Journal, Feb, 2005

The following recommended practices were developed by the AORN Recommended Practices Committee and have been approved by the AORN Board of Directors. They were presented as proposed recommended practices for comments by members and others. They are effective January 1, 2005.

These recommended practices are intended as achievable recommendations representing what is believed to be an optimal level of practice. Policies and procedures will reflect variations in practice settings or clinical situations, which will determine the degree to which the recommended practices can be implemented.

AORN recognizes the numerous types of settings in which perioperative nurses practice. These recommended practices are intended as guidelines adaptable to various practice settings. These practice settings include traditional ORs, ambulatory surgery units, physicians' offices, cardiac catheterization suites, endoscopy suites, radiology departments, and all other areas where operative and other invasive procedures may be performed.

Purpose: These recommended practices provide guidelines for attire worn within the semirestricted and restricted areas of the surgical environment. The human body is a major source of microbial contamination in this environment; therefore, scrub clothing is worn to promote a high-level of cleanliness and hygiene within the surgical environment. These recommended practices are not intended to address sterile attire worn at the surgical field.

RECOMMENDED PRACTICE I

All individuals who enter the semirestricted and restricted areas of the surgical suite should wear freshly laundered surgical attire intended for use only within the surgical suite.

1. Facility approved, clean, and freshly laundered surgical attire should be donned in a designated dressing area of the facility upon entry or re-entry to the facility. (1-3) If scrubs are worn into the institution from outside, they should be changed before entering semirestricted or restricted areas to minimize the potential for contamination (eg, animal hair, cross contamination from other uncontrolled environments). (4)

2. Surgical attire helps contain bacterial shedding and promotes environmental control. (1,5) Surgical attire made of reusable woven fabric or single-use, nonwoven fabric that is low-linting should be worn. Low-linting surgical attire that minimizes bacterial shedding and provides comfort, safety, and a professional appearance should be selected. As personnel move, friction between their bodies and clothing frees bacteria. Research indicates that chafing increases dispersal of body scurf into the environmental. (5) If a two-piece pantsuit is worn, the top of the scrub suit should be secured at the waist, tucked into the pants, or fit close to the body. There is little evidence to support a preference for scrub pants over scrub dresses.

3. Surgical attire should be changed daily or whenever it becomes visibly soiled, contaminated, or wet. (2,4,6) Worn surgical attire should be placed in an appropriately designated container for washing or disposal and should not be hung or placed in a locker for wearing at another time. This promotes high-level cleanliness and hygiene within the practice setting. It has been reported that bacterial colony counts are higher when scrub clothing is removed, stored in a locker, and used again. (7-9)

4. Reusable woven or single-use, nonwoven attire should be appropriately placed in designated containers after use. (1,4,5)

5. Visibly soiled, contaminated, or wet surgical attire should be removed as soon as possible and replaced with fresh, clean surgical attire. Changing contaminated, soiled, or wet attire reduces the potential for cross-infection and protects personnel from prolonged exposure to potentially harmful bacteria. (4,5)

6. Surgical attire contaminated with visible blood or body fluids must remain at the facility and be laundered by the hospital or a hospital-contracted commercial laundry. (4,5,6,10) Controlled laundering of attire contaminated by blood or body fluids reduces the risk of transferring pathogenic microorganisms from the facility to the home or the general public.

7. Home laundering of surgical attire is not recommended. (4,6,10-15) Without clear evidence about the safety for patients, health care workers, and their family members, AORN does not support the practice of home laundering of surgical attire. Reusable surgical attire, including cover jackets and cloth hats, should be laundered by a designated facility-approved and monitored commercial laundry after daily use.

Commercial laundries are required to follow strict guidelines (4,8,16-19) that incorporate

* proper and controlled water temperatures;

* use of detergents;

* use of oxidizing agents (eg, chlorine bleach) in specified and monitored concentrations;

* repeated changes of water; and

* dryer or iron and press drying temperatures that typically are not found in home laundry equipment.

Home laundering of surgical attire that is not visibly soiled is controversial, and there is no concrete evidence to either support or refute the practice. Surgical attire becomes soiled or contaminated with microorganisms during wear. Taking worn, soiled, or contaminated surgical attire into the home can result in the spread of contamination to the home environment.