COP Ref No: COP 437 Expiry date: October 2018 Version Number: V4 CLINICAL OPEARATING PROCEURE Procedure Title: Theatre Apparel; Procedure for all staff in the Operating Theatres Summary statement /scope of the procedure: This procedure sets out the core standards for theatre attire. It is written in accordance with The UHCW Standard Infection Prevention and Control Precautions and Health and Safety Legislation to protect the safety of patients and staff. 1. Indication The purpose of theatre attire is to provide a barrier that protects the patient from micro-organisms, which are shed into the environment from the skin and hair of theatre personnel, and to protect the outside environment from theatre contaminants. (AFPP 2011). 2. Equipment Theatre wear should consist of; Lint free, cotton clothing. isposable theatre Hat /hood. Facial Protection e.g. masks/ fluid shield masks and visors. Enclosed footwear that can be decontaminated. Waterproof gowns 3. Theatre Clothing Action 1. An adequate supply of clean theatre wear must be provided for all theatre personnel. 2. Clothing must be stored above floor level 3. Theatre wear must be changed; aily When the garments are wet or soiled. When re-entering the theatres after visiting areas outside of the theatre ate approved: October 15 ate of next review: October 2017 Rationale To ensure that all personnel dress correctly and reduce the risk of cross infection To reduce the risk of environmental contamination To reduce the risk of cross infection. To protect the healthcare worker from strike through & bacterial passage through wet material. 1 of 6
department 4. Showering facilities must be available to use after the removal of soiled clothing. To promote a high standard of personal hygiene 5.a) Scrub Personnel Waterproof gowns must be worn. To protect the healthcare worker from splashes of body fluids. Thus providing a barrier against blood borne viruses. b) Circulating Personnel- must wear a plastic disposable apron when strike through is possible. isposable aprons must be removed on leaving the operating theatre and after each case. 6. Used theatre garments should be immediately placed in the laundry bags provided and returned to Central laundry for processing. In accordance with UHCW NHS Trust wide Procedure for the Home Laundering of Staff Uniforms (2014) Theatre garments must not be taken home for laundering. 7. When tops and trousers are worn the individual should ensure that the top is secured in a manner that does not risk contaminating the sterile field eg. Whilst repositioning the theatre light 8. Garments that are worn underneath scrub tops (such as t shirts) must be clean and not visible To prevent cross infection To ensure a high standard of infection control is maintained. To reduce contamination of the changing area. To prevent contamination of the home environment. To ensure that the garments are laundered at the correct temperatures and the process is auditable To prevent the dissemination and dispersal of bacteria from the wearer s skin over the sterile field and reduce the risk of contaminating the sterile field through contact with loose clothing. To prevent the introduction of outside contaminants 4.Scrub Clothing Theatre scrub attire must have long cuffed sleeves. To prevent the shedding of bacteria from bare arms. 5. Headwear 9. isposable Headwear must be donned prior to dressing into other theatre attire. To prevent the dispersal of bacteria from the hair onto other theatre clothing. 10. All head and facial hair must be covered by a single-use disposable cap/hood. To minimise the risk of dispersal of bacteria over the operative site. A single-use disposable hood is recommended for those with a beard 11. Headwear must be disposed of in accordance with Trust wide Standard Universal Precautions (UHCW 2012). To prevent environmental contamination. ate approved: October 15 ate of next review: October 2017 2 of 6
12. Hats are colour coded according to the role of the person wearing it Colour Grade/Role Pink Floor Control Yellow Team Leader Blue Registered Staff / Medical Staff Green Support Workers / Radiographers White Visitors / Students 12.1 Head Garments All head garments must be clean, washed and changed daily. All head garments must be secured without loose ends Head coverings must be completely covered by the theatre hat. ifferent types and sizes are available. To easily recognise the roles and responsibilities of the staff in theatres To comply with UHCW NHS Trust Corporate Appearance and Uniform Policy (2014) To minimise the risk of cross infection Linen headwear is not recommended at any time as they are not laundered appropriately using an approved facility (AFPP 2011) 6. Footwear 12. Fully enclosed supportive anti-slip footwear must be available for all theatre personnel. Toffeln Qwirki s 800 Crocs style clogs must not be worn 13. Footwear must be cleaned and decontaminated when contaminated. Footwear should be placed in the appropriate area for cleaning by ISS. Visibly contaminated shoes must not be worn 14. Separate washable visitors shoes must be readily available and regularly decontaminated Once worn, these are to be placed in the skip outside the men s changing room, ready for cleaning (UHCW only). To comply with current Health and Safety recommendations. They may not provide protection against penetration by sharp objects through the sole (oh 2010) To reduce cross-infection risks and promote high standards of infection control. To reduce the risk of cross-infection and promote high standards of hygiene. 7. Face Protection 15. All Theatre scrub staff must wear an appropriate mask and eye protection. for the task to be undertaken To protect scrub staff from blood or body fluid splashes and aerosol contamination to the face. 16. All masks/visors should be close fitting to the mouth and nose. For FFP3 masks the wearer must have undertaken relevant fit testing for the chosen mask To prevent exposure to blood splashes to the face, eyes and mucous membranes. To comply with the Health and Safety Act (1974) and the Standard Infection Prevention and Control Precautions (UHCW 2012). ate approved: October 15 ate of next review: October 2017 3 of 6
The wearing of facemasks by non-scrubbed theatre personnel is a decision that may be made due to the nature of the surgical procedure/individual patient in question, or can be made at the discretion of the Operating Surgeon. Masks and gloves must be removed before leaving the theatre suite and disposed of in clinical waste bins. Hands must be washed in accordance with the Hand econtamination Policy (2015). 8. Jewellery 17. Rings; Only a single smooth plain band may be worn 18. Piercings: Staff who have pierced ears may wear only one pair of plain studs. For all staff; no other visible body piercing is to be worn in the Operating epartment 19. Wristwatches/bracelets or other wrist jewellery must not be worn by those in direct patient contact in the clinical area 20.No other jewellery should be worn. To comply with UHCW NHS Trust Corporate Appearance and Uniform Policy (2014), Health and Safety Act (1974) and Trust wide Hand decontamination Policy (2015). To comply with Trust wide Corporate Appearance & Uniform Policy (UHCW 2014) and Health and Safety Act (1974) To adhere to the Corporate Appearance & Uniform Policy (UHCW 2014) To enable effective hand decontamination (the area beneath the wristwatch act as a reservoir for infection UHCW NHS Trust Corporate Appearance and Uniform Policy (2014), Trust wide Hand decontamination Policy (2015). UHCW NHS Trust Corporate Appearance and Uniform Policy (2014), 9. Make-up 20. Facial make-up, if worn, should be subtle and kept to a minimum Theatre personnel must not wear nail varnish or false (Acrylic) nails. False eyelashes are not appropriate for those in the scrub area. To demonstrate a professional appearance To comply with Trust wide Hand econtamination Policy (UHCW 2015). ue to the risk of wound contamination 10. Visitors to the Operating department All Visitors who are entering the operating theatre in a professional capacity must change into theatre clothing and footwear. They must adhere to the full UHCW Theatre Apparel guidelines. It is not necessary for visitors to PACU or parents who are accompanying their children, to change into theatre clothing or change footwear unless their clothes/shoes are visibly soiled. 11. Procedure for staff breaks All Staff are to change into own clothes or uniform as theatre attire is not to be worn in the dining room, cafes or shops. This is to comply with UHCW NHS Trust Corporate Appearance and Uniform Policy (2014) ate approved: October 15 ate of next review: October 2017 4 of 6
11. Procedure for staff visiting other departments in theatre clothing: Staff (other than porters & recovery staff undertaking patient movement) who leave the operating department are to change into their own clothes/uniform and don outdoor footwear unless it is in the course of urgent clinical duties eg. to urgently review a patient during a theatre session or in an emergency situation (UHCW, 2009). If this is the case the member of staff is required to change their theatre clothing & ensure footwear is cleaned before reentering theatre. Soiled scrubs must be always changed before leaving the theatre department. STAFF MUST NOT LEAVE THE HOSPITAL SITE IN THEATRE ATTIRE. Author Name: Theatre Policy Group (2004) Author Job Title/Grade: To Be Completed Author email address: To Be Completed Appraiser Name: Appraiser Job Title/Grade: Appraiser email address: Carolyn Letchford Practice Facilitator carolyn.letchford@uhcw.nhs.uk If the Reviewer and Author is the same person please tick box If the Reviewer and Author is not the same person please provide the Reviewer details below Reviewer Name: Reviewer Job Title/Grade: Reviewer email address: Theatre Speciality Leads/ Liz Fitzhugh Liz Fitzhugh Theatre Manager Elizabeth.fitzhugh@uhcw.nhs.uk Approved by: Theatre QIPS ate Approved: 1/10/15 Speciality Folder 1: Speciality Folder 2: Other speciality folders: Theatres References: Association For Perioperative Practice (AFPP) Standards and Recommendations for Safe Perioperative Practice (2011) Association For Perioperative Practice (AFPP) Theatre Attire (2011) Category of evidence (see Table 1.) British Orthopaedic Association (1998) Recommendation on Sterile Procedures in the Operating Theatre epartment of Health (2010) EFA 2010/012 Toffeln Qwirki's 800 Crocs Style Clogs sold as personal protective equipment (PPE) (A4 Electronic Only) ate approved: October 15 ate of next review: October 2017 5 of 6
HMSO (1974) Health & Safety at Work Act Hospital Infection Society Working Party (2001) Behaviours and Rituals in the Operating Theatre NATN (1998) Principles of Safe Practice in the Operating Theatre. A Resource Book. University Hospitals Coventry and Warwickshire NHS Trust (2012) Standard Infection Control and Prevention Guidelines University Hospitals Coventry and Warwickshire NHS Trust (2015) Trustwide Hand econtamination Policy University Hospitals Coventry and Warwickshire NHS Trust (2014) Corporate Appearance & Uniform Policy University Hospitals Coventry and Warwickshire NHS Trust (2014) Trust wide Procedure for the Home Laundering of Staff Uniforms Table 1. Grade of Evidence A B C based on systematic review or meta-analysis of randomised controlled trials or at least one randomised controlled trial based on at least one well-designed controlled study without randomisation or at least one well designed quasi-experimental study, such as a cohort study based on well designed non-experimental descriptive studies, such as comparative studies, correlation studies, case control studies and case series directly based on expert committee reports, opinions and/or clinical experience of respected authorities ate approved: October 15 ate of next review: October 2017 6 of 6