Surgical Attire: Are We Doing this Right? AORN Guidelines & OASIS Policy and Procedure

Surgical Attire: Are We Doing this Right? AORN Guidelines & OASIS Policy and Procedure

Objectives Review OASIS policy for proper surgical attire Review AORN guidelines for surgical attire Review proper use of PPE for isolation patients

OASIS Surgical Attire Policy Clean surgical attire will be worn in semi-restricted and restricted areas Individuals who enter semi-restricted and restricted areas will wear scrub attire that has been laundered at the health care-accredited laundry facility or wear single-use scrub attire provided by the facility and intended for use within perioperative areas Scrub attire that has been penetrated by blood, body fluids, or other potential infectious materials must be removed immediately as soon as possible and replaced with clean attire Perioperative personnel will change into street clothes whenever they go outside of the building Identification badges will be worn by all personnel authorized to enter perioperative areas Jewelry that cannot be contained or confined within the scrub attire will not be worn in the semi-restricted or restricted areas Shoes worn within the perioperative environment must meet Occupational Safety and Health Administration standards for protective footwear Be constructed to prevent exposure to blood, bodily fluids and other potential infectious materials Have closed toes and backs, low heels and non-skid soles Surgical masks in combination with eye protection devices (eg, goggles, glasses, with solid side shields, chin-length face shields) must be worn whenever splashes, spray, splatter or droplets of blood, body fluids or other potentially infectious materials may be generated and eye, nose or mouth contamination can be reasonably anticipated Personnel entering the semi-restricted and restricted areas will cover the head, hair, ears and facial hair. Cologne, perfume and lotions usage is kept to a light scent due to the possibility of an allergic reaction causing patient and/or staff respiratory agitation

Head Coverings Head covering should cover head, hair, ears, facial hair, and nape of neck when personnel enter the semi restricted and restricted areas. Do NOT take your head covering off unless you leave the facility for the day or travel outside. You may remove your outer bonnet if your hair is COMPLETELY covered by cloth head cover.

Challenge: The Skull Cap Rationale: Reduction of patient s exposure to potentially pathogenic organisms from clinician s hair and bare skin; a skull cap does not cover all recommended areas.

Reasons with Recommendations and Policy Bare skin (ie, baldness) contains skin squames and microorganisms. Skin organisms may be dispersed in air Hair can carry microorganisms and bacterial contaminants Cover the head, hair, ears, facial hair, and nape of neck when entering the semi restricted and restricted areas. Non disposable head coverings should be covered with disposable head cover Rationale: Reduction of patient s exposure to potentially pathogenic organisms from clinician s hair and bare skin; a skull cap does not cover all recommended areas.

Surgical Attire Put on clean attire daily in a designated dressing area. Avoid having attire touch the floor and other surfaces as much as possible Wear close fitting long sleeved jackets with snaps closed Tuck in your shirt or make sure if fits tightly If you wear personal clothing such as a t-shirt make sure it is completely covered by the scrub attire Change into street clothes if you go outside, and don clean attire when you come back in.

Challenges I am hot and I m not the Patient why do I need to cover my arms with a scrub jacket if I m not scrubbed in?!? I am cold and I am not the patient...why can t I wear fleece jacket or long sleeve undershirts? I always wear my wedding ring. I need my watch to keep time.

Reasons and Policy Reasons Skin contains squames Skin is the source of multiple organisms Skin organisms may dispersed in air Tightly woven attire can reduce dispersal Wearing jewelry was found to increase bacterial counts on skin surfaces when the jewelry is in place Policy Wear scrub attire that covers arms when: You are in the restricted area prepping the patient Opening sterile supplies preparing and packaging sterile items in the clean assembly area of sterile processing Personal clothing that is not covered by the scrub attire will be laundered in the health care-accredited laundry facility after daily use and when contaminated Jewelry that can not be contained or confined within the scrub attire should not be worn

Solutions have the jacket laundered at the facility wear undershirts that are V-neck or wear camisoles Fleece can be worn if it is tightly woven without holes. Don t forget: Clothing that comes from home should not be in contact with the surgical environment.

Surgical Masks Policy Wear a mask when open sterile supplies and equipment are present Don a fresh, clean surgical mask before performing or assisting with each new procedure Cover the mouth and nose with the mask and tie it securely Do not wear mask hanging down from the neck Discard and replace the mask whenever it becomes wet or soiled or has been taken down from the face Remove the mask by handling only the mask ties and perform hand hygiene after removing the mask Clean reusable protective devices worn with surgical masks (eg, goggles, personal glasses supplemented with solid side shields) according to the manufacturer s instructions for use before and after performing or assisting with each new procedure

Shoes Policy Wear shoes that are clean and dedicated for use within the perioperative area Wear shoe covers when gross contamination can reasonably be anticipated Remove single-use shoe covers worn as personal protective equipment immediately after use, discard and perform hand hygiene Reason/Rationale Wearing shoes dedicated for use in the OR may help reduce contamination of the perioperative environment Shoes must meet OSHA safety requirments.

Identification Badges Policy Secure identification badges in a visible location on the scrub attire top or long-sleeved jacket Do not wear lanyards around the neck Clean identification badges with a low-level disinfectant regularly and when the badge becomes soiled Reason/Rationale Visible identification helps support security measures and assists in identifying personnel. Lanyards may become contaminated with bacteria and microorganisms.

Personal Items Policy Briefcases, backpacks, and items intended to be taken into the semi-restricted or restricted areas must be made with material that can be cleaned with lowlevel disinfectant or are not to be taken into the semi-restricted or restricted areas and are not placed on the floor Clean cell phones, tablets and other personal communication or hand-held electronic equipment according to the manufacturer s instructions for use with a low-level disinfectant before and after taking them into the semi-restricted or restricted areas Reason/Rationale Unclean items brought into OR can be highly contaminated with microorganisms and may harbor dust, pathogens, and bacteria

Contact Patients in the OR

References Guideline for sterile technique. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2014:67-96. Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2015:97-120. Guideline for prevention of transmissible infections. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2015:419-451. [IVA] OASIS Policy: Surgical Attire OR-1026 Revised 06/2017