The Association of periOperative Registered Nurses (AORN) has updated its Guideline for Surgical Attire. AORN updated the guideline after several new published studies regarding attire were released and significant enough to consider practice changes, noted Lisa Spruce, DNP, RN, CNS-CP, CNOR, ACNS, ACNP, FAAN, AORN director of evidence-based practice and lead author of the update, in a May 22, 2019, prepared statement.
Spruce encourages the use of evidence to drive adherence and understanding and to “provide a rationale for practice change and to guide perioperative team members on making policy decisions.” The evidence-based guideline directly impacts Central Service/Sterile Processing (CS/SP) professionals because the preparation and packaging, sterilization and sterile storage areas are classified as semi-restricted. In addition, CS/SP staff may enter the surgical department and must comply with these recommendations.
Proper donning, doffing and laundering emphasized
Many of the basic requirements for surgical attire remain unchanged, but they nonetheless warrant discussion due to their importance. Where surgical attire is donned (put on), doffed (removed) and laundered is essential for safety and infection prevention. Clean surgical attire should be laundered by a healthcare-accredited laundry facility or at the healthcare organization — in accordance with state regulatory requirements — and donned at the facility to protect patients from exposure to microorganisms that could contribute to surgical site infections (SSIs). Scrub attire should be removed before leaving the facility. Surgical attire should not be laundered at home because it cannot be monitored for quality, consistency or safety. Home laundering also does not provide for the necessary parameters to reduce microbial levels in soiled scrub attire.
The AORN guideline recommends establishing and implementing a process for managing personal clothing that may be worn under scrub attire. Some of the features to consider include: the type of fabric, the amount of fabric that can be seen outside of the scrub attire, and type of laundering and frequency. There is no recommendation in the updated Guideline for Surgical Attire for wearing long sleeves while preparing instrumentation (wearing personal attire under scrub attire was reviewed, with no recommendation being made).
For head attire, the guideline recommends that the scalp and hair be covered. Head attire must be removed at the end of the shift or when contaminated. When working in the preparation and packaging area, beards must be covered; AORN highlighted a 2014 Journal of Hospital Infection study (“Bacterial ecology of hospital workers’ facial hair: A cross-sectional study”) by Wakeam et al that compared bacterial shedding among bearded and clean-shaven men, and women. The researchers discovered significantly more bacterial shedding by bearded men than by clean-shaven men or by women, even when a mask was worn.
There are also recommendations in the guideline for employee identification badges because it is possible that badges can become contaminated with pathogens. If employee identification badges become contaminated with blood, body fluids or other potentially infectious materials, they should be cleaned with a low-level disinfectant.
Outside items and electronics
Bringing items from outside the healthcare facility into the CS/SP preparation and packaging area is a concern because such items may be difficult to clean and may harbor pathogens, dust and bacteria, which can contaminate the area. Some personal items of concern include briefcases or backpacks brought in by vendors for demonstration, or by repair personnel. It is recommended that a process be established to prevent contamination of the CS/SP areas by designating a location to place such items or establishing a process to clean and contain them.
Hand-held electronic devices, such as cell phones and tablets, are a new area of concern. Research has shown that these items can also be highly contaminated with microorganisms, including some that are potentially pathogenic. Before entering the surgical suite, it is recommended that these devices be cleaned according to their manufacturers’ instructions for use; proper hand hygiene must also be performed.
At the time of this article’s publishing, AORN had not yet published the updated Guideline for Surgical Attire, however, official release is expected soon. For more information, visit: www.aorn.org/about-aorn/aorn-newsroom/periop-today-newsletter/2019/2019-articles/surgical-attire-challenges.
