New rules on surgical attire will increase patient safety

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Scott Foster, M.D.
Executive, Oregon Region Surgery Program

April 16, 2014

As you know, there are longstanding and generally accepted standards for appropriate attire in the operating room. To prevent infection, we minimize introducing hair, skin and other contaminants to the surgical environment. And we take steps not to carry contamination out of the OR through our clothing or other objects.

For years physicians and Providence staff have tracked and followed these important safety standards developed by national societies and regulatory agencies. In fact, we have been a leader in setting community standards for safe practice.

In 2011, a new set of recommended practices were introduced nationally that went beyond our standards. These called for surgical teams to:

  • Ensure that all hair is covered. This means requiring caps or hats to completely cover the hair, issuing covers for facial hair and ensuring warming jackets are used to cover the arms for non-scrubbed personnel.
  • Minimize outside items in the OR. All clothing brought from home (including T-shirts, sweaters, personal cloth caps, scrubs, jewelry and lab coats) must be removed or covered under hospital-provided scrubs and surgical hats. Any bags or briefcases brought into the OR need to be wiped with alcohol or placed in a plastic bag issued by the hospital.

Since their introduction, these recommendations slowly have been integrated into regulatory compliance reviews, including those from The Joint Commission. In addition, local community standards have evolved, with similar precautions being taken by large health care systems in Oregon.

As a result, Providence has changed its policy accordingly and is implementing the new rules at all Oregon hospitals over the next few weeks. Your local OR managers and directors will keep you informed of specific details and can direct you where to find appropriate hats, cover bags and jackets should you need them. For most physicians and staff, this represents no significant change. However, scrutiny over hair covering and outside items is increasing, so your understanding of these rules is appreciated.

At the same time these changes are going into effect, we also will be launching a surgical-site infection reporting system. This will enable much more targeted, specialty-specific interventions and help ensure that we truly raise the bar on our patient safety standards.