Specialty surgical attire; sharps safety program; surgical attire OR visitors; OR medication administration - Clinical Issues - operating room

AORN Journal, March, 2002 by Carol Petersen

Question: An orthopedic surgeon has just begun practicing at our facility. He requires the staff members assigned to his room to wear hoods and tape their sleeves and pant legs. Our policy requires surgical team members to wear bouffant-style disposable hats and two-piece scrub suits. Staff members believe this surgeon's request is excessive and unnecessary. What is AORN's recommendation regarding this practice? Is there any research to support or dispute this practice?

Answer: AORN recommends the same surgical attire for everyone entering the restricted and semirestricted areas of the surgical environment for all surgical procedures. Although wearing hoods may be preferred by some surgeons for specific procedures, AORN's recommendation is that a cap or hood be worn that fully covers all hair on the head and face. The determining factor is covering the hair not the type of procedure. Wearing proper surgical attire reduces shedding and promotes environmental control. AORN recommends that a cap or hood be worn that fully covers all hair on the head and face when in restricted and semirestricted areas of the surgical suite. Surgical attire should be secured at the waist, tucked in, or fit close to the body. Nonscrubbed personnel should wear long-sleeved jackets that are secured closed to decrease shedding. (1) Jackets should be snapped completely closed to prevent contamination when opening sterile supplies.

The Centers for Disease Control and Prevention (CDC) also does not differentiate surgical attire for specific procedures. The CDC recommends that surgical caps or hoods be worn to reduce contamination of the surgical field by organisms shed from the hair and scalp. (2)

Although taping sleeves and pant legs may provide a sense of increased confidence in reducing the potential risk of infection, AORN is not aware of any published research, recommendation, or guideline that recommends the sleeves and pant legs be taped. It would not hurt, but AORN knows of no evidence that it will help prevent surgical site infections. Although the surgeon's added vigilance and concern for preventing surgical infections may seem excessive, surgical team members who are careless and unconcerned about infection control and aseptic technique are cause for much greater concern. AORN's recommendations do not differentiate surgical attire based on specific procedures.

Question: We have been experiencing an increase in sharps injuries, and as a result, we are reviewing our sharps safety program. We are following the Occupational Safety and Health Administration's (OSHA's) bloodborne pathogen regulations for prevention of sharps Injuries. The OSHA regulations suggest work practice controls such as "hands-free technique" for passing sharp instruments. We have never used this technique and do not know how or where to begin. Does AORN have any recommendations for hands-free techniques?

Answer: AORN recommends that surgical team members use a hands-free technique for passing sharp instruments and needles whenever possible and practical. (3) Risk of injury during transfer of needles or sharp items is a serious safety hazard for perioperative personnel. The safest method of preventing injury from sharps on the sterile field is using the hands-free technique instead of hand-to-hand passing of needles or sharp items between the surgeon and scrub person. The hands-free technique ensures that the surgeon and scrub person do not touch the same instrument at the same time.

The OSHA requirements for sharps injury prevention assert that preventing exposures requires a comprehensive program that includes engineering and work practice controls. Work practice controls are required by OSHA to reduce exposure to hazards as much as possible. Proper work practice controls include a no-hands procedure for handling contaminated sharps and eliminating hand-to-hand instrument passing in the OR. (4) This does not mean that every instrument has to be passed using the hands-free technique, but instruments that are a potential sharps hazard should be passed using the hands-free technique. This includes, items such as scalpels, hypodermic and suture needles, and osteotomes.

The hands-free technique can be accomplished by creating a neutral zone in which one person places a sharp instrument to be picked up by another. A neutral or safety zone does away with two individuals touching the same instrument simultaneously, thus preventing unnecessary exposure of personnel to hazardous bloodborne pathogens. The neutral zone can be created with items such as magnetic pads or transfer basins. The scrub person should verbally alert the surgeon that the sharp item, such as a scalpel or needle holder, is in the neutral zone. The surgeon picks up the instrument, and after the instrument is used, he or she verbally alerts the scrub person that the sharp item has been replaced in the neutral zone. (5) Movements should be announced clearly and controlled. Sharps and instruments should be put back on the Mayo stand and should not be allowed to remain near the incision site when not in use.